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Background. Isolated Lisfranc ligament and some other combined ligament injuries to the Lisfranc Joint Complex are frequently found in clinical practice, and surgical treatment is commonly indicated. In order to achieve favorable outcomes following the repair of Lisfranc injuries, a successful anatomical reduction is required. Various fixation methods currently exist such as screw fixation, dorsal bridge plate fixation, K-wire stabilization, primary fusion, neoligamentplasty and TightRope stabilization. Each technique has its own advantages and disadvantages. any rigid and long immobilization of a ligament is detrimental to healing and compromises its mechanical properties. Ideally, the best form to treat an articular joint involvement is to use a long-lasting implant, with flexibility that could potentially provide the proper stability allowing enough motion to achieve a more physiologic ligament healing. We describe a novel technique to reconstruct the Lisfranc injuries with pure ligament disruption using a synthetic neoligamentplasty with FiberTape - InternalBrace™ (Arthrex, Naples, FL) passed through anatomic bone tunnels that mimic the original isometric position of the ligaments. Methods. We described the technique and evaluated 7 consecutive patients with midfoot ligament injury and a combination of tarsometatarsal instability and/or intercuneiform instability. Results. We found no postoperative complications, stiffness, or loss of correction. Conclusions. The innovative surgical technique present in this article is effective and eliminates the need for subsequent implant removal for lisfranc joint injuries. It could also provide a more physiologic arch deformation to interact with the environment in a more effective way, protecting the surrounding joints from excessive loads. [ABSTRACT FROM AUTHOR]

The electrodiagnostic examination provides the basis for a diagnostic workup in diseases involving nerve roots, peripheral nerves, neuromuscular junctions and muscles in humans and animals. It is a functional test that enables identification, localization and characterization of the disease within the peripheral nervous system. The study was carried out retrospectively on a group of 61 dogs of different breeds referred for an electrodiagnostic examination because of local or generalized peripheral nervous system impairment. The electrodiagnostic examination consisted of electromyography, electroneurography, F-wave and repetitive nerve stimulation testing. The results of electrodiagnostic studies and their impact on the diagnosis of neuromuscular diseases of different etiology is presented in the study. The lesion was localized to peripheral nerves in 38%, nerve roots in 34%, skeletal muscles in 18% and the neuromuscular junction in 10% of cases. Electrodiagnostics enabled an objective assessment of the extent, distribution and nature of the disease in the study group. However, only when it is used in conjunction with a complete physical and neurological examination and appropriate laboratory or imaging studies, it may be helpful in determining the etiological diagnosis in patients with peripheral nervous system disease. [ABSTRACT FROM AUTHOR]

Summary: Objectives: This study aims to evaluate sympathetic sudomotor activity in Parkinson''s disease (PD) by means of the sympathetic skin response (SSR) and explore its possible changes due to mental stress. Methods: Sudomotor function was evaluated using SSR in 29 patients with PD (Hoehn and Yahr stage I–IV) without any clinical evidence of autonomic dysfunction. Twenty-seven healthy matched controls were also evaluated. SSR was elicited by electrical stimulation of the right median nerve and simultaneously recorded on the palms of both hands. Arithmetic mental stress was evoked by means of the WAIS-R arithmetic subscale. Latency and amplitude of SSR were evaluated before and after arithmetic mental stress. Results: The SSR was obtained in all patients and controls. There were no significant differences in its mean latency and amplitude between patients and controls. SSR parameters were significantly correlated with disease duration, UPDRS score, and disease stage. There were also significant correlations with rigidity and bradykinesia, but not with tremor. Mental stress had no effect on SSR parameters in any group. Conclusions: SSR parameters in PD without autonomic dysfunction were comparable to matched controls. Although PD patients are sensitive to mental stress, the arithmetic task had no effect on SSR parameters. Consequently, SSR as a method of evaluation of sympathetic sudomotor function is not sufficient for exploration of subclinical autonomic dysfunction in PD, but should be combined with other tests of autonomous nervous system. [Copyright &y& Elsevier]

Objective: The injury data from the first two seasons of the Women's United Soccer Association (WUSA) were analysed to determine the injury incidence, anatomic location of injuries, and relation of player position. Methods: Injury data on 202 players from eight teams during the first two seasons of the WUSA were prospectively collected and analysed. Results: A total of 173 injuries occurred in 110 players with an overall injury incidence rate of 1.93 injuries per 1000 player hours. The incidence of injury during practice and games was 1.17 and 12.63 per 1000 player hours, respectively. Of the injuries 82% were acute and 16% were chronic. Most of the injuries (60%) were located in the lower extremities. Strains (30.7%), sprains (19.1 %), contusions (16.2%), and fractures (11.6%) were the most common diagnoses and the knee (31.8%) and head (10.9%) were the most common sites of injury. Anterior cruciate ligament (ACL) injuries accounted for 4.6% of all injuries and the incidence of ACL tears was 0.09 per 1000 player hours (practice 0.04, game 0.90). Midfielders suffered the most injuries (p<0.007). Conclusion: We conclude that the injury incidence in the WUSA is lower than the 6.2 injuries per 1000 player hours found in the corresponding male professional league (Major League Soccer); however, knee injuries predominate even in these elite female athletes. [ABSTRACT FROM AUTHOR]

A letter to the editor about glossopharyngeal neuralgia with cardiac syncope is presented.

Fractures of the first rib are uncommon in athletes and present a different clinical entity From traumatic first rib fracture associated with high energy thoracic trauma. These fractures are stress induced and precipitated by chronic muscular forces acting on the first rib. Typically they heal with conservative treatment. This report describes a fracture of the first rib in a tennis player that developed into a symptomatic pseudarthrosis as a result of persistent overhead activities. Symptoms mimicked ipsilateral shoulder injury. Pseudarthrosis of the first rib should be included in the differential diagnosis of chronic persistent shoulder pain in the overhead athlete. [ABSTRACT FROM AUTHOR]

BACKGROUND: The modified Brostrom ligament reconstruction using anchor sutures has been performed in adults with clinical success; however, the safety parameters for the use of suture anchors in adolescent lateral ankle ligament reconstruction have not been established. PURPOSE: To perform a radiographic analysis comparing the depth of penetration of suture anchors in adult ankle ligament reconstruction with the average distance of the physis from the tip of the fibula in adolescents. STUDY DESIGN: Cross-sectional study, Level of evidence, 4. METHODS: Forty postoperative ankle radiographs of adult patients who had a modified Brostrom procedure were compared with 40 normal adolescent ankle radiographs. In the adult group, the distance of the suture anchor penetration from the distal tip of the fibula was measured; in the adolescent group, the distance of the physis from the distal tip of the fibula was measured. RESULTS: The mean depth of the suture anchors was 17 mm (range, 14-21 mm) from the tip of the fibula in the adult group, and the mean distance of the growth plate was 23 mm (range, 18-29 mm) in the adolescent group. Eight radiographs from the adolescent group (20%) had a physis measurement of <22 mm on the anteroposterior or mortise view. CONCLUSIONS: Using careful preoperative planning and intraoperative technique, it is possible to safely perform lateral ankle ligament repair in the skeletally immature patient using suture anchors. [ABSTRACT FROM AUTHOR]