Purpose Despite being a signiicant public health problem, ankle sprains' prognostic factors are largely unknown. This review aimed to systematically analyze the literature on acute ankle sprains to compare the prognosis of a combined anterior taloibular (ATFL) and calcaneoibular (CFL) ligaments rupture with an isolated ATFL rupture in terms of progression to chronic ankle instability and other clinical outcomes. Methods The databases for Pubmed, CENTRAL and Web of Science were searched. Clinical studies reporting the prognostic efect of combined ATFL-CFL rupture versus an isolated ATFL rupture in conservatively treated ankle sprains, with a minimum follow-up of 12 months, were eligible for inclusion. Only studies with a reliable diagnostic method for anterolateral ankle ligaments evaluation, namely ultrasonography, magnetic resonance imaging, arthrography or stress tenography, were included. The relative risk (RR), along with the 95% conidence interval (CI), was used to quantitatively analyze the main outcomes. Results Nine papers were selected for inclusion, of which ive were suitable for quantitative analysis. None of them found a statistically signiicant correlation between ligament injury severity and progression to chronic instability. Concerning other clinical outcomes, three studies found a statistically signiicant correlation between a combined ligament injury and a worse clinical prognosis. From the quantitative analysis, the relative risk (RR) of chronic ankle instability in a single versus a combined ligament rupture showed no signiicant diference. Conclusion A signiicant statistical correlation between a combined ATFL-CFL rupture and chronic ankle instability, compared to an isolated ATFL rupture, was not found. There is, however, fair evidence showing a worse clinical outcome score in the combined ruptures, as well as a decreased return to full sports activities. The use of reliable and accessible diagnostic methods to determine the number of ruptured ligaments might have a role in managing severe ankle sprains. Level of evidence Level III.

Horner's syndrome is a condition that results from sympathetic nervous system dysfunction. Labor epidural analgesia is known to be a rare cause of Horner's Syndrome. However, in the obstetric population, the incidence of Horner's Syndrome is higher than in the rest of the population as it is a consequence of high cephalad spread of local anesthetic (LA) probably enhanced by the anatmophysiologic changes of pregnancy. We present a case of unilateral Horner's syndrome as a complication of epidural analgesia with accompanying upper limb paresthesia and motor weakness, a rarely encountered symptom.

Neuraxial blockade is a useful technique in the paediatric population, particularly in cases where the risks of other anaesthetic techniques outweigh their benefits. Ultrasound-guided approaches are becoming more popular than established classical techniques. In paediatrics, the development of new approaches to neuraxial techniques have been slow and their contribution yet to be demonstrated in prospective studies. We describe a successful case related to surgery on an infant with Crouzon syndrome, in which we used a new combined ultrasound-guided block.

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