Posterior Impingement of the Ankle

Patients with posterior impingement of the ankle oftentimes complain of pain in the posterior, or back of, the ankle. There may be an associated snap or catching sensation along with it, which may be caused by the tendon which lies next to this area, called the FHL (Flexor Hallucis Longus). Along with physical examination and plain x-rays, an MRI may be useful in making the diagnosis. The nonoperative treatment typically consists of NSAIDS, injections, and rest. If these fail, an endoscopic surgical technique may be used to remove the excess bone (Os trigonum or trigonal process) with release of the FHL (Flexor Hallucis Longus) tendon. This endoscopic technique is a minimally invasive technique that has the potential advantages of less bleeding, faster recovery, less scarring, and less pain.

Types of treatment of hip labral (labrum) tears

There are 4 main treatment options for the treatment of labral tears. The best way to treat specific patterns of damage has not been fully clarified in publications on hip arthroscopy, but here I present some guidelines:
1. Debridement: This has been historically the main treatment for labral injury. This treatment is performed via hip arthroscopy and essentially consists of removing the damaged tissue with a shaver and/or with an electrocautery device. I perform this technique rarely, as preservation of this tissue when possible is beneficial.
2. Repair: This treatment also is performed via hip arthroscopy and consists of placing suture anchors in the bone and reattaching the labral tissue after it has been prepared. There is increasing evidence that this technique of repair is superior to debridement when possible.
3. Reconstruction: Also performed via hip arthroscopy, this technique may be performed when the labral tissue is too damaged or too small to be repaired. The technique consists of replacing the labrum with new tissue, and may be performed with autograft or allograft tissue.
4. Joint replacement: When the labral damage is associated with significant hip arthritis, the best treatment option is a hip replacement.

Ankle fracture

Which ankle fractures are treated surgically? When do you treat them? The simple answer is that unstable ankle fractures are treated surgically. If both the medial and lateral sides of the ankle are fractured (called a bimalleolar ankle fracture) or if three sides are fractured (including the posterior malleolus, that is a trimalleolar ankle fracture), then surgical open reduction and internal fixation is recommendable. Fractures of the lateral malleolus alone, when displaced and in combination with a severe injury to the medial, or deltoid ligament, may also be unstable and benefit from surgical fixation. The timing for surgery is dependent on the skin and soft tissues, and is typically done around a week after the injury, to allow the swelling to minimize and thereby decrease risk for wound problems. The ankle fracture may also be treated within a few hours of the injury, before much swelling has developed.