I Ekenman — Page 2 | PubMed Health

PubMedDate not supplied

Dislocation of the tibialis posterior tendon: diagnosis and treatment.

Traumatic dislocation of the tibialis tendon occurred from minor ankle sprains in a 37-year-old male and a 53-year-old female. Both complained of local pain at the medial malleolus, and both walked with a limp. The diagnosis was suspected by clinical examination, in one case with 2 months' delay, and verified by ultrasound, computed tomography, and magnetic resonance imaging. The male patient was initially treated for an "uncomplicated ankle sprain." For various reasons surgery was delayed 4 months. During this interval the male patient complained of pain and severe dysfunction, requiring analgesic treatment. A medial Achilles tendon flap was used to support the repositioned tendon. The female patient was operated on within 1 week from injury, by resuturing of the retinaculum over the tendon. Postoperatively, both patients were immobilized with below-knee casts for 6 weeks, allowing full weightbearing, followed by strength and stretching exercises. They were free of symptoms 2 and 3 months, respectively, after surgery. At follow-up 1 year postoperatively, both were asymptomatic and participated in activities like those before their injuries.

Adult↗

PubMedDate not supplied

Stress fractures of the femoral neck in athletes. The consequence of a delay in diagnosis.

Twenty-three patients with stress fractures of the femoral neck were followed up at an average of 6.5 years after the injury. There were 16 recreational athletes and seven elite athletes. Most injuries (N = 15) occurred during running. The diagnosis was confirmed within 3 to 104 weeks (mean, 14 weeks) after the initial onset of symptoms. Sixteen of the patients were treated with internal fixation, the remaining seven were treated conservatively. Seven patients (30%) developed complications requiring major surgery. Five of these patients had Type 3 fractures (displaced) and four had been treated with internal fixation initially. The remaining two patients had Type 1 fractures (endosteal or periosteal callus without an overt fracture line); one was treated operatively and the other conservatively. Three patients developed avascular necrosis and two were treated by hip replacement. The third patient was treated with arthrodesis. Three refractures and one pseudarthrosis were treated by osteotomy. At followup, all elite athletes stated that they had to end their career as a result of the injury. Results were rated by the ability of the athlete to return to sports. There were 9 bad or fair results, 13 good, and 1 excellent result. No difference in activity level or subjective rating was observed between the surgically and conservatively treated group either preinjury or postinjury. The most important factor influencing the complication rate seems to be the type of fracture. The high incidence of displaced fractures (Type 3) could speculatively be caused by undiagnosed tension side stress fractures. If so, the delay in correct diagnosis may be disastrous. However, we could only objectively observe this in one of our cases.

Adolescent↗