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Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 283 - 283
1 May 2010
Chokkalingam S Ranjitkar S Dasari K Prakash D
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Introduction: Rotational forces in ankle injuries can present as isolated lateral malleolus fracture with talar shift or ankle subluxation. It results in medial joint space [clear space] widening, and more than 4 mm is considered significant. The extent of medial soft tissue injury and exploration as a routine is always a debate.

Aim: To see if medial clear space widening correlate with medial soft tissue injury. Also to evaluate the out come of these fracture fixation.

Materials and Methods: Retrospective study on the management of isolated lateral malleolus fractures with significant medial clear space widening. N=40. Patient group A [25] under went only lateral side fixation and in group B [15] had additional medial side soft tissue exploration as a routine based on medial clear space widening.

Fractures were Classified based on the Weber’s system. Pre-operative medial clear space measurement was done by 2 independent observer using PACS measurement tool. Intraoperative details for the method of fixation and the medial soft tissue were analysed.

Most common method of fixation is Neutralisation plate for the lateral side. In Weber B type 1/3 rd of the cases had both plate on the lateral side and syndesmotic screw fixation. 2/3rd of them had only plate fixation.

In Webers C type, only syndesmotic screw in n=3, Plate and screw n=4, only plate in n=9 cases

Radiological measurement of medial clear space average = 9.08mm, range= 5 –22 mm

Less than 50% of the patients only had medial clinical signs.

26.6% had soft tissue (periosteal injury) and only 6.6% had deltoid ligament injury Out come assessment criterias:

The failure of fixation or any on going medial symptoms in group A. – one case of failure of fixation.

Final clinical assessment with ankle score (Olerud and Molander score.) at 6 months average (between 3–18 months). No significant difference in the score, on follow up.

Conclusion:

Medial clear space does not correlate with any degree of medial soft tissue injury.

Exploration is indicated if widening persist after lateral side fixation.

Routine exploration of the medial side has no long term impact on the clinical outcome.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 205 - 206
1 May 2009
Ansara S Chokkalingam S Geeranavar S
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Introduction: Idiopathic Adhesive capsulitis [IAC] of the shoulder is a self limited condition that can cause significant morbidity. Most patients (90%) respond to conservative management and those who fails (10%) undergo manipulation under anaesthesia (MUA) Patients who are refractory to both treatments, benefits from arthroscopic capsular release.

Aim: To assess the efficacy of arthroscopic capsular release in patients with IAC refractory to physiotherapy and MUA. Also to compare the clinical outcome between arthroscopic capsular release and MUA.

Materials and methods: We studied 59 patients with IAC, divided into 2 groups. Group A [36patients] had MUA and Group B [23 patients] underwent arthroscopic capsular release. The mean age was (54years).

The mean follow up was 21 and 9 months for group A and B respectively.

Results: We assessed our results according to three parameters:

Final outcome using the Constant and Murley score. The improvement in the score averaged 42 and 47 points in group A and B respectively

Early Post operative pain using visual analogue score (VAS) average of 6 and 3 in group A and B respectively

Overall patient satisfaction: 81% in group A and 89% in group B.

Conclusion:

Patients with IAC who fails to respond physiotherapy and MUA do well after arthroscopic capsular release with little operative morbidity.

Complete normal functional outcome of shoulder is not a prerequisite for patient satisfaction.