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Ankle fractures and dislocations are common injuries. The aim of this pictorial review is to illustrate their radiological assessment, the normal anatomy, the radiographic techniques and the classification of fractures and dislocations in and around the ankle. The mechanism of injury will also be described, which not only can help in classifying the injury, but may also aid in deciding their management. This is not a comprehensive surgical review; however, the importance of determining whether fractures are stable or unstable and the various treatment options are discussed. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this study was to evaluate the relation between pelvic fracture patterns and the angiographic findings, and to assess the effectiveness of the embolisation.Methods: This retrospective study, included patients with pelvic fractures and angiographic evaluation. Demographics, Injury Severity Score (ISS), associated injuries, embolisation time, blood units needed, method of treatment and complications were recorded and analysed. Fractures were classified according to the Burgess system.Results: Between 1998 and 2008, 34 patients with pelvic fractures underwent angiographic investigation. Twenty six were males. The mean age was 41 years. Twenty-seven were motor vehicle accidents and seven were falls. There were 11 anterior posterior (APC) fractures, 12 lateral compression (LC), eight vertical shear (VS) patterns and three with combined mechanical injuries. The median ISS was 33.1 (range 5-66). From the 34 who underwent angiography, 29 had positive vascular extravasations. From them, 21 had embolisation alone, two had vascular repair and embolisation, five required vascular repair alone and one patient died while being prepared for embolisation. Five cases were re-embolised. The findings suggested that AP fractures have a higher tendency to bleeding compared with LC fractures. Both had a higher chance of blood loss compared to VS and complex fracture patterns. We reported 57 additional injuries and 65 fractures. The complications were: one non lethal pulmonary embolism, one renal failure, one liver failure, one systemic infection, two deep infections and two psychological disorientations. Seven patients died in hospital.Conclusion: Control of pelvic fracture bleeding is based on the multidisciplinary approach mainly related to hospital facilities and medical personnel's awareness. The morphology of the fracture did not have a predictive value of the vascular lesion and the respective bleeding. [ABSTRACT FROM AUTHOR]

Unlabelled: Cobb described a method of reconstruction in Johnson and Strom Type II tibialis posterior dysfunction (TPD) using a split tibialis anterior musculotendinous graft. We assessed patient function and satisfaction after a modified Cobb reconstruction in a group of patients with a narrow spectrum of dysfunction, examined a modification of the Johnson and Strom classification to emphasize severity of deformity, and assessed the ability of the technique to prevent subsequent fixed deformity. We prospectively followed 32 patients managed by this technique and a translational os calcis osteotomy with early flexible deformity after failed conservative treatment. There were 28 women and four men with unilateral disease. The average followup was 5.1 years. Staging was confirmed clinically and with imaging. The modified surgery involved a bone tunnel in the navicular rather than the medial cuneiform with plaster for 8 weeks followed by orthotics and physiotherapy. All of the osteotomies healed and 29 of the 32 patients could perform a single heel rise test at 12 months. The mean postoperative American Orthopaedic Foot and Ankle Society hindfoot score was 89. One patient had a superficial wound infection and one a temporary dysesthesia of the medial plantar nerve; both resolved. The observations suggest the technique is a comparable method of treating early Johnson and Strom Type II TPD.Level Of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background. We report a patient with ossification of the Achilles tendon, presenting plain radiographs, ultrasound, power doppler, computed tomography and magnetic resonance findings. The majority of the tendon was ossified, and there was adjacent soft tissue oedema. The appearance of peritendinous oedema associated with ossification has not, to our knowledge, been reported in the literature, and could account for hindfoot pain in cases of tendon ossification. Method. A review of 44 articles on aetiology, histology and imaging was performed. Results. Trauma, either accidental or from surgery, rather than tendinopathy is the likely aetiological factor. Conclusion. The Achilles tendon usually responds to an insult with the development of mature bone, not dystrophic calcification, with no evidence of inflammatory or degenerative changes. [ABSTRACT FROM AUTHOR]

Aim: To compare the radiation dose of cervical spine clearance and body CT in a cohort of unconscious, major trauma patients for three different protocols, comparing spiral to multislice CT. To quantify the radiation exposure effect of the protocols on the lifetime cancer risk. Method: The hospital trauma database was used to find the unconscious (GCS<9), severely injured (Injury Severity Score >15) from 1 January 2001 to 31 December 2003, excluding isolated head injuries. The protocols used for imaging the brain and cervical spine were, including the radiographs performed as a mode: The exposure factors and field of view used were put into the Monte Carlo software, to estimate the CT and radiographic X-ray doses to the body as a whole and the dose to the thyroid associated with each region imaged. The associated nominal additional lifetime cancer risk was assessed. Results: Excluding inter hospital transfers, where data was incomplete, 87 patients survived to be admitted and fulfilled the criteria. In 30 cases, the CT films were missing, the exposure factors were not recorded or no imaging was performed. In a further 21 cases, the X-ray packets were missing. Three patients had brain and cervico-dorsal CT imaging only, leaving 33 cases for evaluation. The effective radiation dose for a spiral CT of the brain using the Toshiba Xpress GX CT scanner was 3.8 mSv. The total effective doses for imaging the brain and cervical spine using the three protocols with the same CT scanner were (S.D. as % of mean): (1) 4.4 mSv (5%), (2) 7.1 mSv (10%) and (3) 8.2 mSv (15%). The corresponding mean thyroid doses were: (1) 8.5 mGy (25%), (2) 48.9 mGy (20%) and (3) 66.5 mSv (20%). The resultant nominal lifetime cancer risks were: (1) 1:4500, (2) 1:2800 and (3) 1:2400. For the Siemens Sensation 16 multislice CT scanner, the total effective doses (S.D. as % of mean) were: (1) 2.3 mSv (10%), (2) 4.3 mSv (25%) and (3) 5.4 mSv (35%). The mean doses to the thyroid were: (1) 5.9 mGy (30%), (2) 36.1 mGy (50%) and (3) 52.4 mGy (40%). The lifetime cancer risks were: (1) 1:8700, (2) 1:4600 and (3) 1:3700. Using the Toshiba spiral CT scanner, the total dose and additional lifetime nominal cancer risk associated with CT of the chest, abdomen and pelvis (CAP) as 16 mSv and 1:1250, respectively. Using the Siemens multislice CT scanner, these were 11.8 mSv and 1:1700. The cancer risk for protocol 1 when combined with a CT scan of the chest, abdomen and pelvis was 1:1000 for the spiral CT scanner and 1:1500 for the multislice CT (MCT) scanner. The cancer risk for protocol 2 with CAP CT using the MCT was 1:1200. The cancer risk for protocol 3 when combined with a CT scan of the chest, abdomen and pelvis was 1:1100 for the multislice CT scanner. Prior to the introduction of the BTS guidelines for cervical clearance, 12% of cases had CT of the body, which increased to 16% post-guidelines. Conclusions: CT of the trunk (chest, abdomen and pelvis) is associated with the greatest risk of inducing a fatal cancer in the severely injured patient with a GCS less than 9. In our institution the multislice CT protocols expose the patient to less radiation than single slice CT, which is contrary to much of the published work to date. CT scanning the thyroid (or whole cervical spine) still has a marked effect on the cancer risk in cervical clearance. Many centres will relax cervical spinal precautions in unconscious trauma patients if the cervical spine CT with reconstructions is normal. CT of the whole cervical spine may be justified in the unconscious, severely injured patient. In conscious trauma patients, the additional lifetime risk may not justify CT of the whole cervical spine as a routine practice. [ABSTRACT FROM AUTHOR]