Purpose Patients with primarily ligamentous injuries of the distal tibiofibular joint comprise up to 12% of all ankle sprains. Patients frequently present late after a syndesmosis injury and delayed treatment potentially leads to pain, prolonged disability and arthritis in the long term. This study aimed to assess clinical outcomes in patients who required syndesmosis fixation in the presence of arthroscopically proven instability, the hypothesis being that a delay to treatment would be associated with worse function. Method A retrospective cohort study was performed of patients with dynamic instability requiring fixation between the years of 2010–2016. The procedures were performed by two foot and ankle fellowship trained orthopaedic surgeons, over three hospital sites. Patients were classified into three groups based on the time since injury to surgery, acute syndesmotic injury (< 6 weeks), sub‐acute (6 weeks–6 months) and chronic syndesmotic injury (> 6 months). Functional scores were retrospectively collected using the Foot and Ankle Outcome Score (FAOS). Results Compared to patients with acute injuries, those with chronic injuries had significantly lower FAOS subscales (p < 0.001), with the greatest difference in quality of life (− 20.7, 95% CI − 31.6 to − 9.8, p = 0.012). There was a mean follow‐up of 4.3 years. Although the average FAOS subscales in those with sub‐acute injuries were lower than in those with acute injuries, the difference was not statistically significant. Conclusion The results of this study suggest that delayed surgical stabilisation (> 6 months) is associated with significantly worse clinical function, and thus timely identification and early referral of those patients with potentially unstable syndesmotic injuries is recommended. Level of evidence Level III.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

No abstract

Physiology in King's College, London.THE sound heard on auscultating a continuously contracting skeletal muscle is generally ascribed to certain vibrations of the active tissue of such periodicity as to give rise to a tone of some 36--40 waves per sec. The theory that the normal nmuscle sound might be said to have a relationship to a musical tone has been always urged as an important link in the evidence tending to prove that normal nerve impulse is intermittent, and that continuous voluntary contraction is composed of summated single contractions like the artificial tetanus produced by interrupted stinmulations.Further, the fact that the heart-beat is but a single contraction is commonly urged against the view that the systolic sound is due to muscular tone, because it is commonly accepted that the sound produced by contractinig skeletal muscles depends upon the regular variations of tension of the tetanic contraction.It appears from a carefuil examination of the literature of the suibject that this explanation of the musctular sound is commonly accredited with a degree of certainty that the facts of the case do not warrant. The persistence of these views is the more remarkable, since they have been actively combated by the most trustworthy authorities, and all attempts to arrive with accuracy, by acoustic means, at the exact tone have failed, though many attempts have been made in this direction by the most competent persons. Wollaston' compared the sound heard when the meatus was closed by the finger and the muscles of the fore-arm made to contract, to the rumbling of carriages over pavement, to which no doubt the sensations conmmunicated by contracting muscle are extremely like, if the two be not identical; and he gave the limits of rate as varying between 14 and 36 per sec. according to the degree of force with which the muscle contracted.Erman2 compared the sound heard when the ear was stopped and the muscles of mastication were forcibly contracted, to the purring of a cat, and also thought the pitch depended on the force of contraction.

Introduction. 2 "Die Bildung der Kohlensiure innerhalb des ruhenden und erregten Muskels." Arbeiten aus der physiol. Anstalt zu Leipzig. liter Jahrgang, 1876.