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Purpose@#In Lisfranc joint injury, the traditional treatment has been open reduction and internal fixation with a transarticular screw. Despite this, additional complications, such as damage to the articular surface and breakage of the screw, have been reported. Therefore, this study compared the clinical and radiological outcomes of dorsal bridge plating with those of transarticular screws and combination treatment in Lisfranc joint injury. @*Materials and Methods@#Among the 43 patients who underwent surgical treatment due to Lisfranc joint injury from June 2015 to March 2021, 40 cases followed for more than six months after surgery were analyzed, excluding three patients: one lost to follow-up, one had to amputate, and one expired. The radiological parameters were measured using the Wilppula classification in the last follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. @*Results@#The AOFAS midfoot score, according to the surgical method, was significantly higher in the dorsal bridge plating (p=0.003). The radiological outcomes showed significantly better anatomical reduction when dorsal bridge plating was used (p=0.040). According to the Wilppula classification, the AOFAS midfoot score improved as the quality of anatomical reduction improved (p=0.018). Finally, the AOFAS midfoot score decreased as the number of column fixations increased (p=0.002). There were two complications: screw breakage in dorsal bridge plating and superficial skin necrosis in the combination treatment. Skin defects caused by necrosis improved after negative pressure wound therapy and split-thickness skin graft. @*Conclusion@#In treating Lisfranc joint injuries, open reduction and internal fixation by dorsal bridge plating can be an appropriate treatment option. Nevertheless, studies, such as long-term follow-up research, on complications, such as osteoarthritis, will be needed.
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Background@#Preoperative verification of fracture morphology is essential for determining the definitive fixation strategy in the management of a pilon fracture. This study aimed to determine the correlation between fibular injury patterns and fracture morphologies and introduce clinical implications. @*Methods@#Computed tomography scans of 96 pilon fractures were retrospectively analyzed and divided into three types: intact fibula, simple fracture, and multifragment fracture. The principal fracture line and comminution zones were illustrated on a plafond template and diagrammatized on a 6 × 6 grid using PowerPoint software as fracture mapping. Correlations between fibular injury patterns and fracture morphologies, including comminution zones and principal fracture lines, were analyzed. @*Results@#The thickest comminution zone was most often located in the anterolateral quadrant. According to fibular injury patterns, the comminution zone of the multifragment group was placed two grids more lateral than that of other groups. Lateral exits of the principal fracture line in the multifragment group were much more concentrated within the fibular incisura. @*Conclusions@#In pilon fractures, a more complex fibular fracture pattern was related to the valgus position. Moreover, the articular fracture pattern of pilon fractures differed according to coronal angulation and fibular fracture pattern. These differences should influence the operative approach and placement of the plate.
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Purpose@#This study evaluated the clinical and radiological outcomes of TFNA (Trochanteric Fixation NailAdvanced; Depuy Synthes) for the treatment of proximal femur fractures. @*Materials and Methods@#This was a retrospective study of 64 patients diagnosed with a proximal femur fracture from January 2019 to November 2019. The patient’s demographic data, preoperatively and postoperatively Koval grade, modified Harris hip score, EQ-5D (Euro-Qol-5 Dimension), sliding and advancement of the blade, radiologic outcome, and complications were investigated. @*Results@#Fifty patients were available for evaluation at one year postoperatively. The patients reported the following: the Koval grade decreased after surgery; the modified Harris hip score decreased from 78.56±8.88 to 72.74±6.59 (p=0.149); the mean EQ-5D decreased from 0.75±0.09 to 0.72±0.06 (p=0.000). Satisfactory reduction was achieved on a postoperative radiographic examination in 47 patients in six months. Complications occurred in seven cases. @*Conclusion@#TFNA is considered an appropriate implant for treating intertrochanteric fractures of the femur with a minimum follow-up of one year.
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Purpose@#This paper reports the surgical treatment results of open calcaneal fractures performed at the author’s clinics focusing on open calcaneal fractures to help understand the appropriate treatment and realistic outcomes. @*Materials and Methods@#This study was conducted on 22 cases out of 30 patients who visited the hospital from February 2009 to December 2019 and were followed up for more than one year. In open fractures, the fracture was classified using the Gustilo-Anderson classification and was evaluated using the soft tissue status at the time of visit. Intra-articular calcaneal fractures were classified using Sanders classification. The radiological parameters were measured for the Böhler angle, Gissane angle, calcaneal length, height, and width before and after surgery, and at the last follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and investigated complications. In addition, statistical analysis of the incidence and associated factors of posttraumatic arthritis was conducted. @*Results@#In all cases, the surgical treatment was performed by minimally invasive surgery. The AOFAS ankle-hindfoot scale conducted for a clinical evaluation of the final follow-up was averaged 72.5 points. In the classification of open fractures, the Gustilo-Anderson classification type IIIA was the most common, and the Sanders type III was the most common. Of the 22 cases after surgery, 15 cases had complications, 11 cases had posttraumatic arthritis, eight cases had an infection, and 4 cases had both complications. Only the Sanders classification showed a statistically significant correlation with the incidence of posttraumatic osteoarthritis (p-value 0.032). @*Conclusion@#In treating open calcaneal fractures, internal fixation by a minimally invasive approach showed relatively satisfactory results. However, follow-up research will be needed, including the results of a long-term follow-up through a large number of cases and comparative studies with other surgical methods.
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Purpose@#This paper reports the surgical treatment results of open calcaneal fractures performed at the author’s clinics focusing on open calcaneal fractures to help understand the appropriate treatment and realistic outcomes. @*Materials and Methods@#This study was conducted on 22 cases out of 30 patients who visited the hospital from February 2009 to December 2019 and were followed up for more than one year. In open fractures, the fracture was classified using the Gustilo-Anderson classification and was evaluated using the soft tissue status at the time of visit. Intra-articular calcaneal fractures were classified using Sanders classification. The radiological parameters were measured for the Böhler angle, Gissane angle, calcaneal length, height, and width before and after surgery, and at the last follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and investigated complications. In addition, statistical analysis of the incidence and associated factors of posttraumatic arthritis was conducted. @*Results@#In all cases, the surgical treatment was performed by minimally invasive surgery. The AOFAS ankle-hindfoot scale conducted for a clinical evaluation of the final follow-up was averaged 72.5 points. In the classification of open fractures, the Gustilo-Anderson classification type IIIA was the most common, and the Sanders type III was the most common. Of the 22 cases after surgery, 15 cases had complications, 11 cases had posttraumatic arthritis, eight cases had an infection, and 4 cases had both complications. Only the Sanders classification showed a statistically significant correlation with the incidence of posttraumatic osteoarthritis (p-value 0.032). @*Conclusion@#In treating open calcaneal fractures, internal fixation by a minimally invasive approach showed relatively satisfactory results. However, follow-up research will be needed, including the results of a long-term follow-up through a large number of cases and comparative studies with other surgical methods.
ABSTRACT
Purpose@#This study evaluated the clinical and radiological outcomes of TFNA (Trochanteric Fixation NailAdvanced; Depuy Synthes) for the treatment of proximal femur fractures. @*Materials and Methods@#This was a retrospective study of 64 patients diagnosed with a proximal femur fracture from January 2019 to November 2019. The patient’s demographic data, preoperatively and postoperatively Koval grade, modified Harris hip score, EQ-5D (Euro-Qol-5 Dimension), sliding and advancement of the blade, radiologic outcome, and complications were investigated. @*Results@#Fifty patients were available for evaluation at one year postoperatively. The patients reported the following: the Koval grade decreased after surgery; the modified Harris hip score decreased from 78.56±8.88 to 72.74±6.59 (p=0.149); the mean EQ-5D decreased from 0.75±0.09 to 0.72±0.06 (p=0.000). Satisfactory reduction was achieved on a postoperative radiographic examination in 47 patients in six months. Complications occurred in seven cases. @*Conclusion@#TFNA is considered an appropriate implant for treating intertrochanteric fractures of the femur with a minimum follow-up of one year.