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Practicing physical activities or sports that involve frequent jumping and landing can strain the muscles and joints of the lower limbs, especially in those who do not have adequate physical preparation. The objective of this study was to (a) determine the correlation between ankle range of motion (ROM) and landing stability following jumps; (b) assess the association between the jump height in a counter-movement jump (CMJ) test and ankle ROM; and (c) examine the connection between stabilometry during specific jumps movements present in many sports and in ankle stabilization. Sixty-two healthy amateur volleyball players participated in the study (age: thirty-seven females and twenty-five males; age (years): 16.5 ± 4.25; height (cm): 166 ± 11.4; weight (Kg): 61.6 ± 13.7). Participants were recruited for the study in collaboration with student sports associations. The evaluations encompassed the measurement of ankle joint mobility for both lower limbs using an inertial sensor, a static baropodometric and stabilometric analysis using a pressure platform, and the CMJ test using the Microgate system. After the assessments, participants performed a "specific jump landing task". Significant correlations were found between foot range of motion (ROM) and counter-movement jump (CMJ) performance. Specifically, the ROM of the right foot had a strong correlation with the CMJ (r = 0.81, p < 0.001), while the left foot ROM showed a moderate correlation (r = 0.46, p < 0.001). The specific jump task revealed substantial changes in stabilometry parameters, particularly during forward hops compared to lateral jumps. Dorsiflexion ROM significantly impacts jumping ability. Evaluating landing patterns and stabilometry during targeted activities can help optimize training, improve dynamic balance, and reduce ankle injury risk.

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Syndesmotic ankle injuries, often referred to as "high ankle sprains," pose intricate challenges in orthopedic practice, particularly among athletes engaged in high-impact sports. Conventional treatments have encompassed conservative approaches and the use of syndesmotic screws, each beset by inherent limitations. The Arthrex TightRope system has emerged as a pioneering alternative, heralded for its capacity to facilitate physiologic micromotion, eliminate the necessity for hardware removal, and expedite early rehabilitation. This case report delineates the management of a 29-year-old male professional soccer player who suffered a trimalleolar ankle fracture compounded by a severe syndesmotic injury subsequent to a road traffic accident. The patient underwent a comprehensive treatment involving open reduction and internal fixation (ORIF) of all three malleoli, complemented by syndesmotic stabilization employing the Arthrex TightRope system. Post-operative care encompassed a regimen of gradual weight-bearing and methodical rehabilitation. At the one-year follow-up, the patient demonstrated excellent ankle joint function devoid of pain or complications related to hardware, underscoring the efficacy of managing syndesmotic and malleolar fractures successfully. This case underscores the potential advantages of integrating traditional ORIF techniques with contemporary syndesmotic fixation strategies like the TightRope system for complex ankle fractures, advocating for further research to refine their optimal utilization in clinical settings.

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The purpose of this study was to assess whether the type and duration of screw fixation affects ankle joint functional scores and patient activity levels. We evaluated 55 patients who had undergone surgical treatment for ankle fracture with concomitant distal tibiofibular syndesmosis injury. The follow-up period ranged from 2 years to 4 years and 2 months (mean 36 months). Depending on the time of screw removal, patients were divided into 2 groups (the 8-15-week group-19 patients, and the 16-22-week group-36 patients). There were 17 patients with tricortical and 38 patients with quadricortical syndesmosis fixation. The following parameters were assessed: range of motion, rates of complications, level of pain in visual analogue scale (VAS), and function. In the quadricortical fixation group the range of plantar flexion p = .04 and adduction p = .043 were significantly lower in the operated than in the nonoperated limb. In the patients who had their syndesmotic screws removed after 16-22 weeks, the range of plantar flexion in the operated limb was significantly lower than that in the nonoperated limb. We observed no differences between the evaluated groups in terms of ankle joint mobility, VAS pain levels, functional outcomes, or complication rates. All the analyzed subgroups showed poorer ranges of some types of motion in the ankle and worse functional scale and VAS pain scores after treatment in comparison with those before the injury. We suggest removing the syndesmotic screws after 8-15 weeks, due to the possibility of earlier rehabilitation, faster return to work and physical activity and less burden on the health care system. Tricortical or quadricortical syndesmosis fixation is at the surgeon's discretion.

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OBJECTIVES: We aimed to investigate the effects of ankle taping on lower extremity biomechanics related to injury development and how these effects change after sports-specific use. DESIGN: Randomized, repeated measures design with three conditions: Barefoot, tape applied fresh, and tape after sports-specific use (between-subject factor: sex). METHODS: Twenty-five healthy participants (ten female) performed sports-specific movements, including running, drop jumping, and 180° change of direction, under the three conditions. Kinetic and kinematic data were collected using 3D motion capturing and force platforms. RESULTS: Tape applied fresh and tape after sports-specific use significantly reduced peak ankle inversion. Biomechanical risk factors for anterior cruciate ligament or running overuse injuries were either unchanged or decreased with tape applied fresh, except for the peak loading rate of the resultant ground reaction force, which increased between 4% and 18% between movement types. After 15 minutes of sports-specific use of the tape, the alterations induced by tape applied fresh remained for some biomechanical risk factors while they became closer to barefoot again for others, indicating a differential response to prolonged use of taping for different biomechanical variables. CONCLUSIONS: Ankle taping protects the ankle joint by reducing biomechanical risk factors associated with ankle sprains, and most biomechanical risk factors for anterior cruciate ligament or running overuse injuries are not increased. Further research is needed to explore the duration of protective effects, variations across sports, and its impact on patients with chronic ankle instability, contributing to a more comprehensive understanding of ankle taping's influence on lower extremity biomechanics.

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OBJECTIVE: To provide a systematic review and meta-analysis of the proportion of ankle sprains in running practices. DESIGN: Systematic review and meta-analysis. MAIN OUTCOME MEASURES: We calculated the weighted summary proportion and conducted meta-analyses for runners, considering levels (elite/recreational) and disciplines (distance, track, cross-country, trail, and orienteering). RESULTS: 32 studies were included in the systematic review and 19 were included in the meta-analysis with a level of quality ranging from poor to good. Proportion of ankle sprains in runners was 13.69% (95%CI = 7.40-21.54; I2 = 98.58%) in global, 12.20% (95%CI = 5.24-21.53; I2 = 89.31%) in elite, 19.40% (95%CI = 10.05-30.90; I2 = 99.09%) in recreational, 8.51% (95%CI = 4.22-14.12; I2 = 96.15%) in distance, 67.42% (95%CI = 0.50-82.85; I2 = 99.36%) in track, 27.07% (95%CI = 12.48-44.81; I2 = 97.97%) in cross-country, and 25.70% (95%CI = 19.87-32.14; I2 = 0.00) in orienteering. CONCLUSIONS: Running practice results in significant proportion rate of ankle sprains. Recreational runners exhibit higher proportion than elite. Running disciplines, especially track, cross-country, and orienteering, influence reported ankle sprain rates, surpassing those of distance runners.

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The deltoid ligament plays a key role in ankle stability. Ankle fractures involving the medial ligamentous complex are evaluated on the basis of medial-sided tenderness and the Ottawa ankle rules. Evolution in our understanding of this ligament over the last three decades has shown that, within this medial ligamentous complex, it is the deep deltoid ligament that confers mechanical stability. The latest evolution in this understanding, and the learning point of this report, is that only a distinct component of the deep deltoid ligament - specifically the discreet posterior third - the rear attachment of the deep deltoid ligament (RAD) - confers mechanical value. The RAD is responsible for providing the medial ligamentous component of ankle stability - specifically talar shift, tilt, and importantly rotational stability. This knowledge is of key importance in the assessment and management of ankle fractures with associated deltoid ligament injuries. In this technical report, we highlight the biomechanical contribution of the RAD, which will help surgeons and physiotherapists to accurately manage ankle injuries.

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BACKGROUND: In suspected Ankle Instability, the parameters that can be defined in the X-ray have their limitation owing to their variability in positioning and rotation of the tibiofibular joint. This inaccuracy further increases due to variability in morphometric parameters of distal tibiofibular syndesmosis among different populations based on race and sex. This research aims to study morphometry of normal distal tibiofibular syndesmosis based on computed tomography imaging in the Indian population. METHODS: An Prospective observational study was performed from December 2020 to October 2022 on normal ankle CT scans of 100 Indian population using axial, sagittal, and coronal CT images. Anterior and posterior tibiofibular distance, Morphology of the incisura fibularis based on depth, Tibiofibular clear space (TFCS) and tibiofibular overlap (TFO), Transverse and longitudinal length of the fibula, and Relationship between the center of the talus and the center of a line joining the outer aspect of malleoli in the coronal plane were measured and analyzed by two different observers. RESULTS: Out of the 100 participants, 77 (77 %) were male, and 23 (23 %) were female. The overall mean age of participants was 34.69 ± 9.7 years. The incisura fibularis was concave in 54 %, and shallow in 46 %. Anterior tibiofibular distance, Posterior tibiofibular distance, and Tibiofibular overlap were significantly different in comparison to the male with female populations (p-value < 0.05). CONCLUSION: This study gives the indices that describe normal variations in the anatomical relationship between the fibula and fibular incisure in the Indian population, which will be helpful for improving the diagnostic accuracy of distal tibiofibular syndesmoses and providing optimal treatment in order to improve functional outcomes and reduce the risk of complications. LEVEL OF EVIDENCE: III.

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PURPOSE: Ankle sprains remain the most common soft tissue injury presenting to Emergency Departments. Recently, there has been increased awareness and reporting of deltoid ligament injuries in association with injuries to the lateral ligament complex as well as with fibula fractures. This article reviews the currently available literature on the anatomy of the deltoid ligament, clinical and radiological diagnosis of injuries to the deltoid ligament and treatment recommendations. METHODS: A literature review was conducted for keywords associated with deltoid ligament injuries. MEDLINE, PubMed and Embase databases were utilised for this search. Articles were included if involving an adult population, were English-language, were related to deltoid ligament injuries (with or without associated injuries) and reported on patho-anatomy, clinical or radiological diagnosis or treatment methods. RESULTS: A total of 93 articles were assessed for relevance from the database search, and 47 were included after the removal of irrelevant articles and duplicates. Several studies reported on the clinical findings of deltoid ligament injury, as well as the radiographic analysis. Arthroscopy was considered the gold standard of diagnosis, with authors reporting on the potential benefit of performing arthroscopic repair or reconstruction at the same time. There were no studies that provided a system for the classification of deltoid ligament injury or larger studies of treatment pathways. Long-term studies of the incidence of instability in deltoid ligament injuries were not available. CONCLUSION: There is limited evidence available regarding deltoid ligament injuries, particularly in terms of treatment options, either in isolation or with concomitant injuries. Long-term follow-up studies are needed to obtain more accurate data on the number of complications. LEVEL OF EVIDENCE: Level IV.

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INTRODUCTION: Athletes in the National Basketball Association (NBA) are subjected to high levels of mechanical stress increasing their risk of injury. The purpose of this study was to see how certain lower extremity injuries affect in-game performance in relation to each NBA athlete's demographics. The hypothesis was that NBA players' post-injury performance would differ depending on their demographics and the type of injury sustained. METHODS: Descriptive epidemiology study of NBA injury list designations from the 2010/2011 season to the 2018/2019 season. About 255 lower leg injuries that met the inclusion criteria were selected from the injury lists spanning from the 2010/2011 season to the 2018/2019 season. These included ligamentous knee injuries, knee sprains, knee strains, knee hyperextensions, patellar injuries, ankle injuries, and Achilles injuries. The change in performance was determined by comparing mean game scores before and after injury with single-tailed, heteroscedastic t-testing and 95% confidence intervals for mean values. RESULTS: An overall statistically significant decrease in mean game score from 9.82 to 8.75 was seen in all included players (p = 0.01). Only athletes taller than the mean height (199.85 cm; p = 0.01) and heavier than the mean weight (101.63 kg; p = 0.02) showed a significant decline in performance. Ankle and knee injuries both resulted in a significant loss in game score (p = 0.04), with ankle injuries resulting in a greater average decline (-1.76 post-injury) than knee injuries (-1.34 post-injury). CONCLUSIONS: These findings suggest that treatment regimens should reflect the type of injury and demographics of the specific NBA player injured. Further research is warranted to determine if treatment may be more efficacious when streamlined based on player size and injury type.

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BACKGROUND: Perceived instability is a primary symptom among individuals with chronic ankle instability. However, the relationship between joint kinematics during landing remains unclear. Therefore, we investigated the relationships between landing kinematics and perceived instability in individuals with chronic ankle instability. METHODS: In 32 individuals with chronic ankle instability, we recorded ankle, knee, and hip joint angles during a single-leg drop landing. Joint angle waveforms during 200 ms before and after initial contact were summarized into single values using two methods: peak joint angles and principal component scores via principal component analysis. Using Spearman's rank correlation coefficient (ρ), we examined the relationships of peak joint angles and principal component scores with the Cumberland Ankle Instability Tool score, with a lower score indicating a greater perceived instability (α = 0.05). FINDINGS: The second principal component scores of ankle angle in the horizontal and sagittal planes significantly correlated with the Cumberland Ankle Instability Tool score (Horizontal: ρ = 0.507, P = 0.003; Sagittal: ρ = -0.359, P = 0.044). These scores indicated the differences in the magnitude of angles before and after landing. Significant correlations indicated a greater perceived instability correlated with smaller internal rotation and plantarflexion before landing and smaller external rotation and dorsiflexion after landing. In contrast, no peak joint angles correlated with the Cumberland Ankle Instability Tool score (P > 0.05). INTERPRETATION: In individuals with chronic ankle instability, ankle movements during landing associated with perceived instability may be a protective strategy before landing and potentially cause ankle instability after landing.

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First-time lateral ankle sprains often lead to chronic ankle instability (CAI), with 47% facing recurrent injuries, emphasizing the need for preventive measures. Side-cutting movements in sports pose a risk for CAI individuals due to potential biomechanical control alterations. While the hop-stabilization warm-up program has proven effective in preventing ankle sprains, its specific acute impact on CAI individuals lacks substantial evidence. This study employed a crossover design with eight CAI participants (23 ± 3.4 years, BMI 23 ± 1.5 kg/m2) and eight healthy participants (25 ± 3.6 years, BMI 23 ± 1.7 kg/m2) to investigate the acute effects of the hop-stabilization warm-up program on dynamic balance, ground reaction force (GRF), and muscle activity during 45- and 90-degree side-cutting movements. Each participant underwent hop-stabilization and control warm-up programs on two experimental days. Assessments, including the Y-balance test, GRF, and muscle activity pre- and post-warm-up, revealed significant improvements in dynamic balance, GRF, and muscle activity during 45-degree side-cutting movements in CAI participants. These findings suggest the potential benefits of incorporating the hop-stabilization warm-up program into the warm-up protocol for individuals with CAI.

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BACKGROUND: Ankle sprains are one of the most frequent injuries of the musculoskeletal system. The injury pattern determines the treatment and are crucial for the outcome. Nonoperative treatment is commonly recommended for isolated injuries of the lateral ligaments but no standard strategy exists in combined ankle ligament injuries. The goal of this national survey was to achieve an overview about the current diagnostic strategies and common treatment concepts in Germany. MATERIAL AND METHODS: All members of the German Society for Orthopaedics and Trauma Surgery (DGOU) were invited to participate in an anonymous survey about the diagnostic and therapeutic approach in cases of ankle sprains. The online survey consisted of 20 questions. Besides questions about the speciality and scope of activities the participants were ask to depict their diagnostic and therapeutic strategy. RESULTS: A total of 806 participants completed the survey. Most of them were orthopedic trauma surgeons and worked in a hospital. During the first presentation the anterior drawer test (89.5%) and the inversion/eversion test (81.6%) were most commonly used, 88.1% always make an X­ray examination and 26.5% an ultrasonography examination. Isolated injuries of the anterior fibulotalar ligament (LFTA) were treated nonoperatively by 99.7% of the participants, 78.8% recommend full weight bearing in an orthesis, 78.8% treat the complete rupture of the lateral ligaments without operation whereas 30.1% stated that they would treat a combined lateral ligaments rupture with an injury of the syndesmosis nonoperatively. DISCUSSION: Due to the heterogeneity of injury patterns after ankle sprain no consistent recommendations for diagnostics and treatment exist. The Ottawa ankle rules and ultrasonography were not often utilized despite of the good evidence. The isolated rupture of the LFTA is diagnosed and treated according to the national guidelines by most of the participants. In cases of combined injuries of the lateral and medial ankle ligaments the majority choose a nonoperative treatment strategy which is justified by the guidelines with a low level of evidence. Combined injuries of the syndesmosis and the lateral ankle ligaments were treated operatively, which also correlates with the recommendations in the literature. The standard care of ankle sprain in Germany is in accordance with the recommendations from the current literature.

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Lateral ankle sprain (LAS) is a common injury in sports and daily activities. The present study aimed to determine the prognostic value of clinical and anthropometric parameters in predicting LAS recovery after physiotherapy. Twenty-seven patients with acute LAS were included in this cohort study. First, prognostic factors and anthropometric variables were assessed, along with the time elapsed since the injury, pain score on a visual analogue scale (VAS), navicular drop, ankle range of motion (ROM), and ambulation status. Second, patients received physiotherapy, and their recovery status was assessed using the foot and ankle outcome score (FAOS) questionnaire immediately (first evaluation) and one month after physiotherapy (second evaluation). Univariate regression analysis and stepwise regression were used to evaluate the association between prognostic factors and outcome predictability. The results of this paper have shown that ambulation status was significantly correlated with all FAOS subscales in both the first and second evaluations, except for the FAOS-symptoms (FAOS-Sx) and FAOS-quality of life (FAOS-QOL) subscales in the first evaluation. The eversion ROM was significantly correlated with the FAOS-Sx and FAOS-Sports and Recreational activities (FAOS-Sport/Rec) subscales in the first evaluation. Additionally, age, height, and VAS were significantly correlated with FAOS-activity of daily living (FAOS-ADL) in the first evaluation, so this means that ambulation status is a valuable predictor of treatment success immediately and one month after physiotherapy intervention and compared to other FAOS subscales, the FAOS-QOL subscale is a more reliable predictor of the effectiveness of physiotherapy.

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CONTEXT: Repeated ankle sprains can lead to injuries, including those of the anterior talofibular ligament; however, the extent to which these ligament injuries are associated with symptoms of chronic ankle instability remains unclear. OBJECTIVE: To examine the influence of anterior talofibular ligament injury and ankle anterior displacement on symptoms of chronic ankle instability. DESIGN: Case-Control Study. SETTING: A university laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 426 college students completed a questionnaire survey on the history of ankle sprain. Thirty-four (24 males, 10 females; age = 20.6 ± 0.5 years), 49 (38 males, 11 females; age = 20.2 ± 1.2 years), and 39 (24 males, 15 females; age = 20.1 ± 1.1 years) participants were enrolled in the healthy, coper, and chronic ankle instability groups, respectively. DATA COLLECTION AND ANALYSIS: One examiner measured the anterior talofibular ligament delineation using ultrasound and anterior ankle displacement using a capacitance-type sensor device. The Cumberland Ankle Instability Tool was applied to assess pain and perceived instability. RESULTS: The anterior talofibular ligament was normal significantly more frequently in healthy participants and abnormal significantly more frequently in patients with chronic ankle instability (p < 0.001). Anterior ankle displacement was significantly greater in the coper and chronic ankle instability groups than in healthy individuals (p < 0.001), but no significant difference was observed between the coper and chronic ankle instability groups. There was no significant correlation between the anterior ankle displacement and Cumberland Ankle Instability Tool scores (p = 0.709) in participants with previous ankle sprains. CONCLUSION: Observation of an abnormal anterior talofibular ligament on ultrasonography is associated with anterior displacement of the ankle joint. However, it is assumed that the influence of anterior ankle displacement due to damage to the anterior talofibular ligament on the pain and perceived instability in chronic ankle instability is small.

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Introduction: The Reactive Balance Test (RBT) could be a valuable addition to research on chronic ankle instability (CAI) and clinical practice, but before it can be used in clinical practice it needs to be reliable. It has already been proven reliable in healthy recreational athletes, but not yet in patients with CAI who have shown persistent deficits in dynamic balance. The study aimed to determine the test-retest, intra-, and inter-rater reliability of the RBT in patients with CAI, and the test-retest and inter-rater reliability of the newly developed RBT score sheet. Methods: We used a repeated-measures, single-group design to administer the RBT to CAI patients on three occasions, scored by multiple raters. We included 27 participants with CAI. The study used multiple reliability measures, including Pearson r, intra-class correlations (ICC), standard error of measurement (SEM), standard error of prediction (SEP), minimal detectable change (MDC), and Bland-Altman plots, to evaluate the reliability of the RBT's outcome measures (visuomotor response time and accuracy). It also assessed the test-retest and inter-rater reliability of the RBT score sheet using the same measures. Results: The ICC measures for test-retest reliability were similar for accuracy (0.609) and VMRT (0.594). Intra-rater reliability had high correlations and ICCs for accuracy (r = 0.816, ICC = 0.815) and VMRT (r = 0.802, ICC = 0.800). Inter-rater reliability had a higher ICC for VMRT (0.868) than for accuracy (0.690). Conclusion: Test-retest reliability was moderate, intra-rater reliability was good, and inter-rater reliability showed moderate reliability for accuracy and good reliability for VMRT. Additionally, the RBT shows robust SEM and mean difference measures. The score sheet method also demonstrated moderate test-retest reliability, while inter-rater reliability was good to excellent. This suggests that the RBT can be a valuable tool in assessing and monitoring balance in patients with CAI.

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BACKGROUND: Ankle muscle strength should be assessed after a lateral ankle sprain (LAS) because a strength deficit can lead to chronic ankle instability (CAI). No field method is available to obtain quantitative ankle dynamic strength values. This study aimed to assess the reliability of the one-repetition maximal (1-RM) method and to compare ankle muscle strength between healthy volunteers and those with CAI using 1-RM strength assessment approach. METHODS: We recruited 31 healthy volunteers and 32 with CAI. Dorsiflexor, evertor, and invertor 1-RM were performed twice at a one-week interval. The intraclass correlation coefficient (ICC) and minimal detectable change (MDC) were calculated. Strength values were compared between healthy volunteers and CAI. RESULTS: The 1-RM method is reliable for assessing ankle dorsiflexor, evertor, and invertor strength, with an ICC ranging from 0.76 to 0.88, and MDC ranging from 19 to 31%. Volunteers with CAI obtained evertor (3.0 vs. 3.5 N/kg), invertor (2.9 vs. 3.7 N/kg), and dorsiflexor (5.9 vs. 6.5 N/kg) strength values that were lower than healthy volunteers (p < 0.05). CONCLUSION: The 1-RM test can be used in practice to assess evertor, invertor, and dorsiflexor strength during the rehabilitation of LAS. This field method could help practitioners to detect a strength deficit and individualize a strengthening programme if necessary.

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BACKGROUND: This study aimed to: (1) identify assessment methods that can detect greater ankle dorsiflexion range of motion (DROM) limitation in the injured limb; (2) determine whether differences in weightbearing measurements exist even in the absence of DROM limitations in the injured limb according to non-weightbearing measurements; and (3) examine associations between DROM in the weightbearing and non-weightbearing positions and compare those between a patient group with foot and ankle injuries and a healthy group. METHODS: Eighty-two patients with foot and ankle injuries (e.g., fractures, ligament and tendon injuries) and 49 healthy individuals participated in this study. Non-weightbearing DROM was measured under two different conditions: prone position with knee extended and prone position with knee flexed. Weightbearing DROM was measured as the tibia inclination angle (weightbearing angle) and distance between the big toe and wall (weightbearing distance) at maximum dorsiflexion. The effects of side (injured, uninjured) and measurement method on DROM in the patient groups were assessed using two-way repeated-measures ANOVA and t-tests. Pearson correlations between measurements were assessed. In addition, we analyzed whether patients without non-weightbearing DROM limitation (≤ 3 degrees) showed limitations in weightbearing DROM using t-tests with Bonferroni correction. RESULTS: DROM in patient groups differed significantly between legs with all measurement methods (all: P < 0.001), with the largest effect size for weightbearing angle (d = 0.95). Patients without non-weightbearing DROM limitation (n = 37) displayed significantly smaller weightbearing angle and weightbearing distance on the injured side than on the uninjured side (P < 0.001 each), with large effect sizes (d = 0.97-1.06). Correlation coefficients between DROM in non-weightbearing and weightbearing positions were very weak (R = 0.17, P = 0.123) to moderate (R = 0.26-0.49, P < 0.05) for the patient group, and moderate to strong for the healthy group (R = 0.51-0.69, P < 0.05). CONCLUSIONS: DROM limitations due to foot and ankle injuries may be overlooked if measurements are only taken in the non-weightbearing position and should also be measured in the weightbearing position. Furthermore, DROM measurements in non-weightbearing and weightbearing positions may assess different characteristics, particularly in patient group. LEVEL OF EVIDENCE: Level IV, cross-sectional study.

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Introduction: Extrusion of the talus with fracture dislocation is a very rare and devastating ankle injury usually caused by high-energy impact. There is no common consensus on the management for this type of injury. We intend to report on our experiences with its management and outcomes. Case Report: We received a total of five cases of extruded fracture dislocation of the talus between March 2016 and April 2020. All fracture talus was Hawkins Type IV fracture. All five patients were male with an age range between 18 and 54 years and have sustained an injury in road traffic accidents. They were managed with wound debridement, talar preservation open reduction, and internal fixation with an application of an external fixator for wound care. All were followed up for 2 years. Conclusion: Extruded fracture dislocation of the talus is a rare and devastating ankle injury. Its management is time-dependent and involves meticulous planning for a favorable outcome.

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BACKGROUND: Preprofessional ballet dancers are exposed to the risk of injuries, primarily in the lower extremities, with most injuries occurring during jumping and landing activities. Interlimb asymmetry during jumping and landing activities has been associated with the injury risk in adolescent athletes, but this has not been examined in dancers. PURPOSE: To investigate associations between interlimb asymmetry during a double-leg countermovement jump (DL-CMJ) and single-leg jump (SLJ) and the injury risk in adolescent preprofessional ballet dancers. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Adolescent preprofessional ballet dancers (N = 255) performed 3 DL-CMJs and 3 SLJs on force plates during annual screening. Absolute and directional (separate values for left and right limb dominance) asymmetries in a set of kinetic variables during a DL-CMJ and in jump height during an SLJ were calculated. Each variable was characterized as having "high" or "normal" asymmetry according to the percentage of asymmetry (greater than or less than or equal to, respectively, the mean ± 0.5 SD) based on the present sample. Risk ratios (RRs) and 95% CIs were calculated based on the injury incidence in the subsequent academic year. RESULTS: Of the 242 dancers that satisfied the inclusion criteria, 128 injuries were observed in the subsequent academic year. In the whole sample, 3 absolute, 7 left limb-dominant, and 1 right limb-dominant kinetic asymmetry in the eccentric, concentric, and landing phases of the DL-CMJ as well as left limb-dominant jump height asymmetry in the SLJ were associated with a significant (P < .001) increase in the injury risk (RR, 1.28-1.69 [95% CI, 1.02-2.37]). Separating by sex, asymmetries in the eccentric and landing phase of the DL-CMJ were not significant in boys, while in girls, RRs for asymmetries in the eccentric and landing phase of the DL-CMJ increased, and SLJ jump height asymmetry was not significant. CONCLUSION: Higher asymmetries in certain kinetic variables during the DL-CMJ and in jump height during the SLJ were associated with an elevated risk of injuries in elite preprofessional ballet dancers with some sex-specific differences. Associations were mainly identified for high left limb-dominant asymmetry in the takeoff phase, suggesting that the injury risk may be specific to a relative right limb deficit.

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BACKGROUND:Accurate reduction of ankle fractures under direct vision has become a common understanding among foot and ankle surgeons.How to fully expose free or compressed fragments of the posterior ankle remains one of the most challenging problems. OBJECTIVE:To explore the clinical efficiency of the para-Achilles tendon approach in exposing and repositioning the posterior malleolus sandwich fracture. METHODS:A retrospective study was made for 26 patients with posterior malleolus sandwich fracture treated with open reduction and internal fixation via para-Achilles tendon approach from January to December 2020 in The Second People's Hospital of Dalian.21 of 26 cases were managed with the lateral approach of Achilles tendon and 5 cases were managed with the medial approach of Achilles tendon.There were 19 males and 7 females,with the age of 24-69 years,averagely 38.6 years.The operation time and postoperative complications were recorded.The fracture reduction condition was evaluated by Burwell-Charnley imaging standard.Before operation,3 months after operation and last follow-up,visual analog scale score,ankle plantar flexion and dorsiflexion and American Orthopedic Foot&Ankle Society Ankle Hind Score were used to evaluate the treatment effect. RESULTS AND CONCLUSION:(1)All 26 patients were followed up for an average of 14.6 months(range 13-18 months).The operation time was 52-85 minutes(average 64.2 minutes).(2)Part of the skin edge of the lateral malleolus incision was necrotic in one patient and healed completely after a dressing change.Incision healing of the other patients was in one stage.(3)Through Burwell-Charnley imaging standard,anatomical reductions were obtained in 24 of 26,and good reductions were in 2 of 26,with an excellent and good rate of 100%.(4)At the last follow-up,the visual analog scale score(1.19±0.40)was significantly lower than the preoperative score(6.81±0.80)(P<0.01).Ankle plantar flexion(33.5±5.02)° and ankle plantar back stretch(17.23±0.99)° were significantly increased compared with preoperative data(14.58±2.50)° and(5.81±1.02)°(P<0.01).American Orthopedic Foot&Ankle Society Ankle Hind Score was improved to(89.31±3.62)points compared to preoperative(46.00±5.45)points(P<0.01).The results were excellent in 23 patients and good in 3 patients,with an excellent and good rate of 100%.(5)It is concluded that the open reduction and internal fixation via the para-Achilles tendon approach for the treatment of posterior malleolus sandwich fracture were efficient with decreased operation time,satisfying fracture reduction,fewer complications,satisfactory motion range,and functional recovery.