Telos Stress Device User Manual
Contents
1. m l WE e Sit the patient with his knee flexed at u TE E EI 90 and the sole flat see fig Fi Re e Place the pressure device a little Q proximal of the tuberositas ossis z navicularis The lateral Chopart s joint lies more distal than the medial Chopart s joint e Pressure load for routine examination 25 daN Positioning of the patient Positioning of the patient for the left leg for the right leg Information for diagnostics Comparative X rays are indispensable An opening of more than 5 mm is pathologic according to the actual state of medical scientific knowledge e Adifference of more than 2 mm between comparative X rays is pathologic Operating instructions GA III E 13 Knee in a p view Device setup Device setup for the left leg Please note for the right leg e Insert two counter supports into the 15 outer guide bushes 15 daN e Mount the extension piece to the daN 5 Q em pressure device En e Place the pressure device exactly in the middle between the counter IE 1 mM SOPOR l bo al H EI e Sit the patient with the knee flexed in I u 2 15 minimum Q e The flexion of the knee must not exceed 30 e The front cushion pad of the pressure device should lie on the lateral articu lar space e Pressure loa2. Fix the heel with the swivel clamp by _ turning the fastening screw clockwise e Place the front cushion of the pres sure device approx 5 cm above the inner maleolus BE Opu Pressure load for routine examination 15 daN IMPORTANT The tube has to be tilted 30 caudio cranial Positioning of the patient Positioning of the patient for the left leg for the right leg gt D 30 adaptor w Information for diagnostics e The horizontal opening between talus und calcaneus is measured lt a more than 5 are pathologic according to the actual state of medical scientific knowledge e The translation inwards from the calcaneus towards the talus is measured c more than 5 mm are pathologic according to the actual state of medical scientific know ledge e The vertical talo calcaneare angle determined by outer tangents at the talus and calcaneus is measured lt more than 10 are pathologic according to the actual state of medical scientific knowledge 20 Operating instructions GA III E Shank in a p view Device setup Device setup for the left leg Please note for the right leg e Mount a counter support into the 15 C outer guide bush 15 daN e First mount the anti rotation lock and daN then the footholder on the opposite extension arm as depicted s
3. Positioning of the patient for the left leg Talocalcaneal joint in lateral view Please note Mount the footholder to the extension arm by fitting the axial socket pin into the inner guide bush so it cannot turn Mount a counter support in the outer guide bush of the opposite arm Put the patient in a lateral position with the knee flexed in 30 the leg is seen from medial The heel must be placed firmly against the center bar of the foot holder Place the front cushion of the pres sure device approx 5 cm above the inner maleolus see X ray Pressure load for routine examination 15 daN The X ray should be taken after 1 minute of pressure application Device setup for the right leg Positioning of the patient for the right leg The subluxation of the talus in ventral direction is measured e The distance between the rearmost part of the tibia joint sur face to the nearest point of the talus surface is measured e More than 10 mm positive findings according to the actual state of medical scientific knowledge e With clinical findings in combination with a measurement of 5 10 mm a comparative X ray is recommended Information for diagnostics aig te Gt ieee a Talocalcaneal joint in a p view Device setup Device setup for the left leg Please note for the right leg e Mount the 15 slant
4. medical scientific knowledge e An opening of more than 10 mm a comparative X ray is strongly recommended t T Operating instructions GA III E 15 Knee in lateral view Device setup Device setup for the left leg Please note for the right leg e Mount a counter support in the outer 15 guide bush 45 daN e Mount the extension bar as depicted daN es O and insert another counter support in a O the guide bush of the extension bar e Position the patient in a lateral recumbent position see fig with the e E knee flexed 10 20 eee LE E e The tibia should lie parallel to the a X ray table place a cushion under the heel e The front cushion pad of the pressure 3 device should lie approx 6 cm distal the hollow of the knee e Pressure load for routine examination mg m 15 daN mg m Positioning of the patient Positioning of the patient for the left leg for the right leg Information for diagnostics Comparative X rays are recommended e The contours of the dorsal edge of the medial and lateral tibial plateau should lie as close as possible together as well as the contours of the dorsal edge of the femoral condyles sufficient outer rotation e Anterior drawer values from 10 mm on are pathologic for a lesion of the anterior cruciate ligament according to the actual state of medical scien
5. stress X Ray place the pressure device proximal of the proc styloideus ulnae e Pressure load for routine examination Device setup 15 daN Device setup for the left arm radial for the right arm radial 15 e The X Ray should be taken after 1 minute of pressure application Positioning of the patient Information for diagnostics Examination of the ligamental carpal stability e To prove the scapho lunal dislocation an X Ray with ulnar stress is sufficient e A scapho lunal distance of more than 3 mm is pathologic accor ding to the actual state of medical scientific knowledge e The radial stress X Ray serves as a proof of the less common dislocation between os lunatum und os triquetrum Hand holder 22 Operating instructions GA III E 30 adaptor to examine Accessory to examine Hand holder to examine the subtalar joint the syndesmosis the wrist joint Shoulder positioning device to Thumb holder to examine MBA to examine examine the glenohumeral joint the thumb basal joint the metatarsalia Universal cassette stand for Foot holding device for Positioning board for use in radiology dept performing Defil X rays use in radiology dept and O R Operating instructions GA III E 23 METAX Kupplungs und Distributed by telos Arzt und Krankenhausbedarf GmbH Dichtungstechnik GmbH Unter den Linden 26 Phone 49 60 36 97 0
6. with the adjacent symbol Environmental condition for transport storage and use 10 40 C 85 humidity Classification acc Annex IX MDD 93 42 EC Im Power Supply 4 5 V DC through 3 Mignon batteries a 1 5 V type AA Maximum force to be applied 25 daN Standard value is 15 daN Accuracy at standard value 1 daN Maintenance It is recommended to check the telos Stress Device by the manufacturer and if neccessary to calibrate it once a year in order to maintain the accuracy of the force measuring unit Dimensions Width x Depth x Height Min space requirement for device 500 x 650 x 220 mm Dimensions of Transport and storage case 510 x 410 x 170 mm Weight Device w o accessory in case 10 1 kg Accessories 3 8 kg Device complete in case 13 9 kg Recommended separation distances between porta ble and mobile RF communications equipment and the telos Stress Device type GA III E The telos Stress Device type GA III E is intended for use in the electromagnetic environment mentioned below The customer or the user of the telos Stress Device type GA III E can help prevent electromagne tic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the telos Stress Device type GA III E as recommended below according to the rated output power of the communications equip ment Separation distance according to frequency of transmitter
7. 50 Unter den Linden 34 D 35410 Hungen Fax 49 60 36 92 97 D 35410 Hungen Germany www telos stress device com Germany Rev 3 1
8. Operating instructions telos Stress Device GA III E acc to Prof Dr G Scheuba Designation of id gt gt oN EXXXX 3 EIx In this manual and or on the device the following symbols are used Attention refer to the accompanying documents Hints for the setup maintenance and intended operation of the telos Stress Device type GA III E Must be observed to avoid bodily injuries malfunctions or damages to your equipment Application part of type B The device complies with the requirements of type B for protection against electrical shock Serial number of the device The serial number is placed right hand next to the symbol Order number of the device The order number is placed right hand next to the symbol Device complies with EC Directive 93 42 EC MDD Disposal Recycling Manufacturer of the device The name of the manufacturer is placed right hand next to the symbol Date of manufacture The date of manufacture is placed under the symbol Table of contents Designation of symbols Table of contents Safety Instructions Replacing the batteries Technical Data GA III E Electromagnetical Compatibility EMC telos Stress Device Instructions for use Transport and storage case Examination of the ligamentum talofibulare anterius Examination of the ligamentum calcaneofibulare Examination of the ligamentum deltoideum Examination of the ligamentum calcaneocuboideum dorsale Examination of the ligamentu
9. Rated output of transmitter 150 kHz to 80 800 MHz to 2 5 For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be estimated using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter on watts W according to the transmitter manufacturer Note 1 An additional factor of 10 3 is used in cal culating the recommended separation distance for transmitters in the ISM frequency bands between 80 MHz and 2 5 GHz in the frequency range to decre ase the likelihood that mobile portable communica tions equipment could cause interference if it is inad vertently brought into patient area Note 2 These guidelines may not apply in all situ ations Electromagnetic propagation is affected by absorption and reflection from buildings objects and people The type of ligamental rupture depends on the direc tion speed and force which occur on the ligament or its attachments to the cartilage or bone The X ray can only show the injury when the ligament rupture is located at the bone and contains an avul sion Normally ligamental rupture can be demonst rated by a stress X ray In this case imaging shows an extreme position of the joint which diagnoses an opening or subluxation For each joint there are rou tine methods which allow for an examination standar dization for diagnosis A proper fun
10. ce as care ful as any other precision apparatus and should not be sprayed on with solvents To apply pressure the grip 1 8 is turned clockwise until the desired readout is reached The pressure device has a built in quick adjustment function which could be operated by pressing the quick release button 1 5 This function allows to overcome long distances quickly Do notuse the quick adjustment function if there is a pressure readout on the display Please turn the grip counter clockwise until the dis play shuts off no pressure and then use the quick adjustment function If the spatial proportion is appropriate it is recommen ded to turn the device 180 and leave the patient in his position when changing the sides to be examined 1 Pressure device 4 Counter support 1 1 Front cushion 4 1 Rounded cushion 1 2 Extension 4 2 Socket pin 1 3 Display 1 4 Display cover 1 5 Quick release button 1 6 Safety latch 1 7 Guiding shaft 1 8 Turning grip 1 9 Threaded spindle 2 Frame 5 Extension bar 2 1 Guide bush 5 1 Socket pin 2 2 Extension arm 5 2 Guide bush 2 3 Elastic footings 2 4 Guide rail 3 Foot holding device 6 Back drawer 3 1 Fastening screw 6 1 Fastening screw 3 2 Swivel clamp 6 2 Socket pin 3 3 Fastening cushion 6 3 Rounded cushion fixed 3 4 Socket pin for lateral X ray 6 4 3 5 Socket pin for a p X ray 3 6 Reducer The working principle of the telos Stress Device is When mounti
11. ctional diagnostic examination is subject to consideration of all biomechanically relevant joint stabilizing factors which are 1 the specific anatomy of the joint 2 the muscles 3 the capsular ligamental structures For proper assessment of the ligament point 1 and 2 are taken into account by positioning the patient such that his muscles are relaxed and the stress on the ligament cannot be reduced by the nature of the joint anatomy The design of the Telos equipment allows for correct anatomical positioning and proper equipment align ment to obtain the anatomical demonstration desired Any muscular compensation is visible on the elect ronic display and may also be detected by manually examining the muscles for tension Before considering taking a stress X ray native X rays are taken in two different planes to rule out a fracture of the bone if clinically suspected In such cases a stress X ray should not be taken The most common ligamental injuries are those of the anterior ankle joint ligaments fibular side mostly caused by supination trauma Injuries of the medial ligaments by pronation trauma occur rather rarely and are mostly accompanied by a fracture of the fibula The anterior ankle joint consists of the distal ends of the two bones of the lower leg tibia and fibula and one tarsal bone the talus The anterior ankle joint is a hinge articulation equip ped with collateral ligaments These ligaments are charac
12. d for routine examination En ce 15 daN spel Dee Positioning of the patient Positioning of the patient for the left leg for the right leg Information for diagnostics The width of the medial articular space is measured e An opening of more than 15 mm is pathologic according to the actual state of medical scientific knowledge e An opening of more than 10 mm a comparative X ray is strongly recommended 14 Operating instructions GA III E Knee in a p view Device setup Device setup for the left leg Please note for the right leg e Insert two counter supports into the O 15 outer guide bushes 15 daN e Mount the extension piece to the daN r 3 A pressure device SmE e Place the pressure device exactly in the middle between the counter Hr ABPO l i fo al H T e Sitthe patient with the knee flexed in I u FE 15 minimum e The flexion of the knee must not exceed 30 e The front cushion pad of the pressure device should lie on the medial articu lar space e Pressure load for routine examination En ce 15 daN sais eae Positioning of the patient Positioning of the patient for the left leg for the right leg Information for diagnostics The width of the lateral articular space is measured O e An opening of more than 15 mm is pathologic according to the actual state of
13. e circumvented In case an X ray is not taken with the recommended pressure load the load actually used should be recor ded on the picture to inform the attending physician in order to avoid a false diagnosis Comparative X rays of the counterside should always be taken under the same load Ligamentum talofibulare anterius Ligamentum calcaneofibulare Lateral collateral ligament When mounting the equipment please follow the schematic drawings which show the telos Stress Device from a top view It is important to mount each accessory as depicted Examination of the collateral ligaments of the knee in sedentary position results in the desired flexion of 15 to 20 An enlargement of the flexion up to 30 could be achieved easily In case the knee shall be examined in extension supine position of the patient in combination with supporting the heel by a cushion is recommended The design of the telos Stress Device also allows for examining the cruciate ligaments of the knee while rotating the tibia in or outwards Please note that the attending physician could be exposed to indirect X ray radiation because he has to maintain the inner or outer rotation of the tibia manually during this exa mination Posterior cruciate ligament Anterior cruciate ligament ligament Medial collateral The telos Stress Device consists of a frame 2 with movable extension arms 2 2 which can be adjusted to the length
14. ed pin of the foot holder into the inner guide bush z 15 e Mount the counter support into the daN opposite guide bush e Sit the patient with his knee approx 20 flexed supported with a cushion under the hollow of the knee Bw Ewe e The heel should be placed firmly H z against the center bar of the foot holder e Fix the heel by using the swivel clamp and turning the fastening screw N clockwise e Place the front cushion of the pres sure device approx 5 cm above the inner maleolus see X ray Positioning of the patient e Pressure load for routine examination Positioning of the patient for the left leg 15 daN for the right leg Information for diagnostics The opening angle between tibia and talus is measured e Avalue above 10 is pathologic according to the actual state of medical scientific knowledge e A value between 5 10 makes a comparative X ray neces sary e In addition a difference of the distances between the tip of the fibula and talus comparative X ray can be evaluated as another sign for a rupture Operating instructions GA III E 11 Talocalcaneal joint in a p view Device setup Device setup for the left leg Please note for the right leg e Mount the 15 slanted pin of the foot holder into the inner guide bush e Mount the counter support into the opposite guide bush e S
15. ee fig al P e Instead of the front cushion install the adaptor with the pressure roll on the _ an pressure device Zu I e The height of the pressure roll can be fixed with the fastening screw e Sit the patient with his knee approx 20 flexed e Fix the heel with the swivel clamp by turning the fastening screw clockwise e Place the pressure roll approx 5 cm above the lateral maleolus and ante rior of the tibia Pressure load for routine examination 15 daN Positioning of the patient Positioning of the patient for the left leg for the right leg Fastening screw Pressure roll Foot holding device Pj Anti rotation Toa lock By s ae oc Adaptor u 2 caw Operating instructions GA III E 21 Wrist joint in a p view Device setup Device setup for the left arm ulnar Please note for the right arm ulnar 15 e Position the patient sitting at the 15 X Ray table with shoulder elbow and hand forming a horizontally even line s fig e The hand and the lower arm should lie flat on the device e To prevent rotation fix the hand with the upper bar against the back of the hand e For a radial stress X Ray place the pressure device proximal of the proc O Al styloideus radii e For an ulnar
16. er support in the outer 15 N guide bush 15 daN I I e Mount the accessory Back Drawer daN O em U as depicted ee O e Position the patient in a lateral recumbent position see fig with the knee flexed 90 i al e The tibia should lie parallel to the X ray table Support under the ankle rl u e The accessory Back Drawer should O I fix the thigh closely above the femoral condyles e The front cushion pad of the pressure device should lie approx 2 cm below the tibial head e Pressure load for routine examination Positioning of the patient aan Positioning of the patient for the left leg for the right leg Information for diagnostics Comparative X rays are indispensable e Check dorsal displacement of the tibial head drawer pheno menon by superimposing the X rays Back Drawer Operating instructions GA III E 19 Subtalar joint Device setup Device setup for the left leg Please note for the right leg e Mount the 30 adaptor into the inner guide bush e Mount the 15 slanted pin of the foot holder into the adaptor e Mount the counter support into the opposite guide bush e Sit the patient with his knee approx 35 20 flexed e The heel should be placed firmly against the center bar of the foot holder
17. ion bar N Operating instructions GA III E 17 Knee in lateral view Device setup Device setup for the left leg Please note for the right leg e Mount a counter support in the inner guide bush 15 15 e Mount the extension bar as depicted daN and insert another counter support in daN 2 aa the guide bush of the extension bar e Mount the pressure device outside of the extension arms IE 7 l e Position the patient in a lateral i recumbent position see fig with the knee flexed 90 e The tibia should lie parallel to the X ray table Support under the ankle i e The front cushion pad of the pressure device should lie exactly on the patella e Pressure load for routine examination Positioning of the patient 15 daN Positioning of the patient for the left leg for the right leg zn Information for diagnostics Comparative X rays are indispensable e Check ventral displacement of the tibial head by superimpo sing the X rays e A difference of 3 mm is pathologic according to the actual state of medical scientific knowledge e A drawer of 2 mm could represent a rupture if clinically sus pected Extension bar r 18 Operating instructions GA III E Knee in lateral view Device setup for the left leg Device setup Please note for the right leg e Mount a count
18. it the patient with his knee approx 20 flexed Supported with a cushion under the hollow of the knee _ e The heel should be placed firmly m N T A d against the center bar of the foot holder e Fix the heel by using the swivel clamp and turning the fastening screw clockwise 1 e Place the front cushion of the pres sure device approx 5 cm above the outer maleolus see X ray Positioning of the patient e Pressure load for routine examination Positioning of the patient for the left leg 15 daN for the right leg j Information for diagnostics Comparative X rays are indispensable e Avalue above 10 is pathologic according to the actual state of medical scientific knowledge e A value between 5 10 makes a comparative X ray neces sary e This examination technique is rarely used in the routine diagnostics since the typical eversion trauma is generally accompanied by a fibula fracture 12 Operating instructions GA III E Lateral calcaneocuboidal joint in dorsoplantar view Device setup Device setup for the left leg Please note for the right leg e Insert two counter supports into the 25 outer guide bushes 25 daN e Place the extension arms approx R daN 5 O am 2 cm adjacent to the pressure device em e Mount the extension piece to the pressure device
19. m collaterale tibiale Examination of the ligamentum collaterale fibulare Examination of the anterior cruciate ligament Lachman s test Examination of the posterior cruciate ligament Lachman s test Examination of the anterior cruciate ligament 90 Examination of the posterior cruciate ligament 90 Options depending on additional equipment Examination of the ligamentum talocalcaneare interosseum Examination of the syndesmosis Examination of the proximal row of the wrist bones Accessories for GA III E optional available Stress examination of other joints Other positioning aids NO 20 21 22 23 23 23 Please read the operating instructions carefully before operating the telos Stress Device This device is manufactured and tested according to the actual rules of electrical and electromagnetical safety In case you experience failures e g false rea ding or no display caused by interferences of other appliances operate the Stress Device in a greater distance to the interferring appliance To clean and disinfect any tested approved wipe dis infectant commercially available can be used Repair procedures are only allowed for authorized personel who are thoroughly familiar with applicable safety regulations If necessary it is recommended to have the device repaired by the manufacturer in order to maintain the warranty Remove the 4 screws of the front cover Remove the 3 batteries type AA Fo
20. ng the pressure based on a lever action with two fixed points For exa device 1 on the guide rail 2 4 mination of the ankle joint the footholding device 3 and one counter support 4 is used of the frame please secure the pressure device by sliding The use of the reducer 3 6 is recommended for pati the safety latch 1 6 located at the bottom ents with very small feet e g children The foot hol forward in order to avoid tilting of the ding device 3 has two socket pins 3 4 and 3 5 The pressure device off the giude rail 2 4 axial pin 3 4 is used for taking X rays in lateral view the slanted 15 pin 3 5 is used for taking X rays in a p view The fixation unit 3 2 is used to secure the heel into the foot holding device during examinations in a p view only Examination of the collateral ligaments and the cru ciate ligaments is done with the extension 1 2 and two counter supports 4 The extension bar 5 holds a counter support 4 and is needed to examine the cruciate ligaments in 10 20 flexion Lachman s test as well as the anterior cru ciate ligament in 90 Position anterior drawer The accessory Back Drawer 6 is used for the exami nation of the posterior cruciate ligament in a 90 posi tion only This clamp serves to fix the thigh distal of the femoral condyles The antipole is one counter support 4 Operating instructions GA III E 9 Device setup for the left leg
21. of the leg The frame has four elastic footings 2 3 so that the device stands firmly on the X ray table The extension arms 2 2 contain four guide bushes 2 1 into which a counter support 4 the foot holding device 3 and other accessories may be mounted The pressure device 1 has an electronical measuring equipment and is used to apply force on the joint The value of the force is indicated by the digital display 1 3 The values shown indicate the force applied in dekaNewton daN e g read out 15 15 daN 15 kp The electronical measuring equipment is powe red by three commercially available batteries There is very little power consumption when the device swit ches off so the display will work for years If alkaline batteries are used the lifetime will be appro ximately 150 200 hours of use To avoid damages the batteries should be removed if the device is not in use for a longer period of time The light intensity of the display is controlled independently from the actual state of charge of the batteries Rounded cushion moveable If the batteries need to be replaced the display will start to blink and indicates the user to replace the bat teries The display will still show the correct values If the capacity decreases further the display will show 88 and blink The danger of false measurements is ruled out in this case Although the electronics is quite shock resistant it is advisable to handle the telos Stress Devi
22. r this device it is mandatory to perform frequent safety inspections different regulations in other coun tries may apply It is recommended to check the device once a year by the manufacturer and if neccessary to calibrate it in order to maintain the accuracy of the force measuring unit The minimum lifetime of the device is 5 years After that period the device can be returned to the manu facturer for recycling purposes free of charge Please note that especially the batteries and electro nic parts do not belong to regular waste but have to be disposed of according to local legal regulations Devices that are marked with the sym bol on the left may not be disposed of with the regular household trash but must be surrendered to a recycling cen ter for electric and electronic devices Please do not place the telos Stress Device under water Insert the new batteries Please note the correct polarity Replace the front cover and fasten the screws tighten carefully Do not use rechargeable batteries accumulators Manufacturer METAX Kupplungs und Dichtungstechnik GmbH Unter den Linden 34 D 35410 Hungen Phone 49 6036 9733 0 Fax 49 6036 9733 18 Internet www telos stress device com Model telos Stress Device Type GA IIV E Protection type B live wires are single insulated against contact The device complies with the requirements of type B for protection against electrical shock and is marked
23. terized by their fanlike attachments which split up into several parts fixed at different points on the tarsus Therefore one ligament is always tense to stabilize the ankle irrespective of the position in which the lower leg and the foot move The telos Stress Device allows for separate examination of each ligament It is recommended to start with the examination of the ligamentum talofibulare anterius since this ligament is ruptured first with the typical supination trauma plus the examination is less strenuous for the patient The ligamentum talofibulare anterius is examined in a lateral position through a subluxation of the talus into the ventral direction The heel is fixed the pressure is applied on the tibia Due to the proper positioning of the patient the foot is flexed in plantar direction lig talofibulare anterius is in function characterized by the origin of the ventral tibial condyle being shifted to the vertex of the trochlea of the talus Thus the stabi lization through the anatomy of the joint is reduced While applying the pressure the foot turns slightly inwards the tibia outwards only possible if the knee is flexed at least 30 around the pivot of the delta ligament suspension In order to obtain accurate findings the X ray should be taken after one minute in this case because the talus slowly slides into the ventral direction The examination of the ligamentum calcaneofibulare is performed in a p
24. tific knowledge Extension bar N 16 Operating instructions GA III E Knee in lateral view Device setup Device setup for the left leg Please note for the right leg e Mount a counter support in the outer 15 guide bush 15 O daN e Mount the extension bar as depicted daN O is O and insert another counter support in a O the guide bush of the extension bar e Position the patient in a lateral recum bent position see fig with the knee W z flexed 10 20 mma o e The tibia should lie parallel to the X ray rl B table place a cushion under the heel e The front cushion pad of the pressure Z l device should lie on the tuberositas tibiae e Pressure load for routine examination 15 daN Positioning of the patient Positioning of the patient for the left leg for the right leg Taa m n i A Information for diagnostics Comparative X rays are indispensable e The contours of the dorsal edge of the medial and lateral tibial plateau should lie as close as possible together as well as the contours of the dorsal edge of the femoral condyles sufficient outer rotation e Posterior drawer values from 10 mm on are pathologic for a lesion of the posterior cruciate ligament according to the actual state of medical scientific knowledge f necessary superimpose the X rays of both knee joints Extens
25. view by means of the measure ment of the opening angle between tibia and talus Due to the proper positioning of the patient the foot is in a perpendicular position to the tibia lig calcaneofi bulare is in function The flexion of the knee entails a rectangular position of tibia und calcaneus so that the dorsally tapered talus is firmly fixed in the malleolar furca With a simple tilting motion the talus could get jam med in the furca This problem is solved by means of the construction of the foot holding device The heel is placed excentrically to the pivot of the footholding device which besides the tilting motion performs an additional movement in tensile direction thus pulling the talus out of the furca beyond the pivot of the liga mentum deltoideum Ligamentum talofibulare posterius Moreover flexion of the knee prevents a painrelieving hip turning motion of the patient As to the examina tion of the medial ligaments of the anterior ankle joint lig deltoideum the biomechanical problems are the same The pressure load applied in all stress examina tions should not exceed 15 daN This empiric value is internationally accepted Studies performed under fluroscopic control have shown that the joint opens at values between 6 daN and 7 daN if the ligament to be examined is ruptured A higher pressure load than 15 daN is not advisable because the increasing pain induced muscular reaction force of the patient can hardly b
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