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Category: Trauma; Ankle; Other Introduction/Purpose: Ankle fractures correspond to a substantial portion of traumatic injuries assisted in a primary health care unit. These fractures are usually promptly recognized by physical exams and conventional radiographs. Nevertheless, the number and pattern of the lesions and the identification of possible associated injuries still fail when using only these methods. CT scans have developed into an excellent instrument to analyze joint fractures in recent years. This study aims to compare ankle fracture assessment using CR in isolation with CT and CR in combination. This comparison will be performed considering diagnosis, lesions features, and treatment. We hypothesize that CT, in conjunction with CR, can significantly modify the diagnosis, therapeutics, and operative planning of ankle fractures when confronted with isolated CR. Methods: A total of 53 patients (mean age: 42 years, 15 - 75) diagnosed with an ankle fracture between 2011 and 2016, were assessed with CT and CR. Evaluations of the fractures using CR in isolation and CR combined with CT were compared using seven different readers. Fractures were assessed in terms of type, displacement, size, associated injuries, treatment, patient position, the implant of choice, and surgical planning considering the presence or absence of malleolar fractures and potential associated injuries. The concordance was measured for the own examiner's evaluations and between the examiners' assessments (intra-observer and inter-observer) by the Kappa coefficient. The results were determined by relative frequency distribution analysis (in percentage terms) and compared using a two-proportions test. Results: The Kappa index was higher than 0.75 for all interobserver and intra-observer reliabilities. Medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, size, posteromedial or posterolateral segment) (ps0.75). Conclusion: Conventional radiographs may fail to demonstrate subtle and more complex lesions of the ankle joint, such as posterior and medial malleolus fractures, undermining its capability to determine the appropriate treatment plan. This study showed evidence that a CT scan, a widespread available exam, and the standard for the study of other articular fractures, increased the diagnostic capability in ankle fractures when used with radiographs. In addition, the combination of methods may improve the quality of the information received by the orthopedic surgeon, providing more details for a proper surgical or non- surgical treatment, positively affecting patient care.

Category: Ankle; Sports; Other Introduction/Purpose: The isokinetic test has been used diffusely as a way to evaluate the functional results after the rehabilitation of musculoskeletal injuries. In the ankle, in particular, most studies are related to lateral ligament injuries and Achilles tendon's injuries. However, different protocols are used and a lack of normative values is observed in the literature. The aim of this work is to perform a global isokinetic evaluation on healthy ankles in order to propose reference values for future patients. Methods: We evaluated 100 participants (200 ankles) using the Biodex 3 System for the eversion, inversion, dorsiflexion and plantar flexion movements of the ankle. The sample consisted of individuals aged 20-60 years, with an active life and practice of recreational physical activity (non-athlete) and without previous injuries. Five repetitions for strength (N / m) and work (J) at a speed of 30o / sec and 10 repetitions for power (W) at a speed of 120o / sec were performed in our protocol. Agonist / antagonist ratio and the Muscle Deficiency Index, which globally assesses the balance between the sides for each movement, were also evaluated, as well as the demographic variables. Different statistical analyzes were performed for each parameter. Results: The mean age was 38.5 years and BMI 25.8 (CI 2.7 and 0.8 respectively) in 69 men and 31 women. In 78% of participants, the dominant ankle was the right one. The non-dominant side was consistently stronger (higher peak torque) in all movements (p= 90% between sides in all four moviments (91,99% for eversion, 98,57% for inversion, 96,96% for dorsiflexion and 94,72% for plantarflexion). Conclusion: The non-dominant side was stronger in this evaluation of the two hundred healthy ankles. However, this difference was within the expected range for the limb symmetry index and for the MDI, showing that limb dominance is not relevant for the isokinetic assessment of the ankle. In the studied sample, the demographic variables (except gender) did not show any correlation with the evaluated parameters, especially with the maximum torque. Normative values of torque forces and agonist/antagonist balances were proposed. The results have implications for rehabilitation protocols and criteria for returning to sports.

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are one of the most operated injuries in orthopedic practice. The decision upon the best management is based on the displacement of the bone fragments and the presence of associated lesions (osseous and/or soft tissues). The therapeutic decision is classically established upon plain radiographs, which might be temerarious due to the usual difficulty in analyzing those exams. In recent years, some authors have advocated that computed tomography could be used as an assistant instrument on the decision-making. Our study aims to demonstrate the superiority of the association between both methods on diagnosis, therapeutic decision, and surgical plan for these injuries. Methods: Patients diagnosed with an ankle fracture, between 2011 and 2016, and assessed with CT and X-ray were included in our investigation. Seven examiners with different degrees of experience analyzed the exams, determined the injuries, chose how they would treat, and the defined surgical strategy when applicable. This was done, at first, only with radiographs and after with the combination of CT and radiographs. The data were statistically compared. Results: Fifty-three patients were included. The medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, bone fragment greater than 25%, posteromedial or posterolateral segment), syndesmosis injury, and the absence of deltoid ligament lesion were more noticeable from the combination of CT and radiography. Concerning surgical treatment, the prone position, the posterolateral surgical approach (rather than anterolateral) on lateral malleolus osteosynthesis, the decision to surgically treat the posterior malleolus fracture (through posterolateral approach with posterolateral plate), the option to include the syndesmosis approach in the treatment, and not to include deltoid ligament repair were more noticeable from the combination of CT and radiography, among all groups of expertise, with high inter-observer reliability. Conclusion: The usual radiographs may fail to demonstrate subtle lesions, as posterior malleolus fractures and syndesmotic injuries. The tomographic evaluation increases the precision of diagnosis and improves the quality of information that the surgeon receives, providing data that can positively affect patient care.

Category: Ankle; Sports Introduction/Purpose: The isokinetic test has been used diffusely as a way to evaluate the functional results after the rehabilitation of musculoskeletal injuries. In the ankle, in particular, most studies are related to lateral ligament injuries and Achilles tendon's injuries. However, different protocols are used and a lack of normative values is observed in the literature. The aim of this work is to perform a global isokinetic evaluation on healthy ankles in order to propose reference values for future patients. Methods: We evaluated 100 participants (200 ankles) using the Biodex 3 System for the eversion, inversion, dorsiflexion and plantar flexion movements of the ankle. The sample consisted of individuals aged 20-60 years, with an active life and practice of recreational physical activity (non-athlete) and without previous injuries. Five repetitions for strength (N / m) and work (J) at a speed of 30° / sec and 10 repetitions for power (W) at a speed of 120° / sec were performed in our protocol. Agonist / antagonist ratio and the Muscle Deficiency Index, which globally assesses the balance between the sides for each movement, were also evaluated, as well as the demographic variables. Different statistical analyzes were performed for each parameter. Results: The mean age was 38.5 years and BMI 25.8 (CI 2.7 and 0.8 respectively). The non-dominant side was consistently stronger (higher peak torque) in all movements (p