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Objective:To explore the clinical features and treatment strategies of the transsyndesmotic ankle fracture dislocation.Methods:Data of 26 patients of transsyndesmotic ankle fracture dislocation who were treated in our hospital from December 2013 to November 2020 were retrospectively analyzed. There were 16 men and 10 women with an average age of 49.54±12.81 years (range, 26-68 years). Open injuries in 17 cases, of which the Gustilo-Anderson II type in 6 cases, IIIA type in 11 cases, closed injuries in 9 cases. According to the AO/OTA fracture classification, 44B type in 4 cases, 44C type in 22 cases. According to the Lauge-Hansen classification, there were 16 cases of pronation-abduction, 10 cases of pronation-external rotation, including 4 cases of Maisonneuve fractures, and of the 4 cases of Maisonneuve fractures, there were 3 cases of double Maisonneuve fracture. The talar dislocation was anterior, neutral, and posterior within the distal tibiofibular joint in 10 cases, 7 cases, and 9 cases. Fibular fractures in 26 cases, medial malleolar fractures in 24 cases, deltoid ligament rupture in 2 cases, posterior malleolar fractures in 13 cases, and anterior malleolar fractures in 8 cases. All closed injuries were closed reduction and plaster fixation and all open injuries were emergently debridement and reduced under the tibial plafond in the emergency department. Surgical treatment was taken until the soft tissue conditions to be allowed. The reduction quality was assessed by postoperative radiography according to the criteria proposed by Burwell-Charnley. The function of the ankle joint was assessed by the ankle-hindfoot rating system of the American Orthopaedic Foot and Ankle Society (AOFAS), and the posttraumatic arthritis and objectively quantified was assessed using the Kellgren-Lawrence grading scale.Results:There were 4 cases were unreduced due to the tibial posterior tendon to flip through the ankle joint and dislocate anterior to the tibia through the interosseous membrane. Stabilization of fibular fractures were achieved with plate in 25 cases. There were 24 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 23 cases and with K-wire fixation in 1 case. There were 12 cases of posterior malleolar fractures treated with open reduction and internal fixation including cannulated screws in 9 cases and antiglide plates in 3 cases. There were 7 cases of anterior malleolar fractures treated with open reduction and internal fixation including suture anchors in 1 case and cannulated screws in 6 cases. Stabilization of syndesmosis was achieved with syndesmotic screws in 14 cases and with TightRope in 2 cases. All patients were followed up for 20.23±9.70 months (range, 12-60 months). According to the Burwell-Charnley criteria of reduction quality, anatomic reduction was obtained in 22 cases, and satisfactory reduction was gained in 4 cases. All fractures healed in 16.31±3.64 weeks (range, 10-24 weeks). Functional examination of the ankle joint (angle measurement method): dorsiflexion average angle 10.38°±6.66°, plantarflexion average angle 34.04°±7.20°. At latest follow up, the AOFAS score was 83.30±13.94 (range, 24-100). Ten (38%) of 26 patients had radiographic evidence of posttraumatic ankle arthritis. According to the Kellgren-Lawrence grading scale criteria, there were grade I in 5 cases, II in 2 cases, III in 2 cases, and IV in 1 case. 2 cases of wound dishence were recovered through changing dressing and 2 cases of skin necrosis were recovered by skin graft and flap transposition respectively. There were no significant complications such as infection, nonunion, or implant failure.Conclusion:The transsyndesmotic ankle fracture dislocation, represents an exceptional pattern of high-energy fractures with significant syndesmotic disruption, and potential soft tissue compromise. Careful attention to radiographic findings can identify unique fracture characteristics relative to operative decision-making. Tibialis posterior tendon dislocation, a rare complication in the transsyndesmotic ankle fracture dislocation injuries, can impede anatomical reduction of the ankle mortise. The open reduction and internal fixation may be an optimal approach to treat transsyndesmotic ankle fracture dislocation injuries. However, the rate of posttraumatic arthritis is relatively high.
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Objective:To describe the surgical technique and explore clinical and radiological outcomes of Seinsheimer V subtrochanteric femoral fractures treated by clamp-assisted reduction with limited incision and InterTan nailing fixation.Methods:Data of 22 patients with Seinsheimer V subtrochanteric femoral fractures who were treated by clamp-assisted reduction and InterTan nailing fixation with limited incision in our hospital from January 2015 to June 2018 were retrospectively analyzed. There were 14 men and 8 women with an average age of 62.95±12.44 years (range, 36-81 years). Among them, 7 cases with a big butter-fly fragment were fixed by one cable. After the reduction, the fractures were fixed with InterTan nailing. The operative time, intraoperative blood loss and postoperative complication were recorded. The reduction quality was assessed by postoperative radiography according to the criteria proposed by Baumgartner. The function of the hip joint was assessed by the Harris score and VAS score.Results:All patients were followed up for 18±5.33 months (range, 12-30 months). According to the Baumgartner criteria of reduction quality, anatomic reduction was obtained in 20 cases, and satisfactory reduction was gained in 2 cases. All fractures healed in 4.36±1.36 months (range, 3-8 months). At latest follow-up, the mean Harris scores was 89.05±7.75 (range, 71-100 points), including 11 cases of excellent, 8 cases good, and 3 cases fair (satisfactory rate=86.4%). The mean VAS score was 0.64±0.85 (range, 0-3 points). Two patients had limb length discrepancy which was less than 10 mm. There were no significant complications such as infection, deep vein thrombosis, nonunion, nail cut out and implant failure.Conclusion:Clamp-assisted reduction and InterTan nailing with limited incision for Seinsheimer V subtrochanteric femoral fractures is simple and easy to manipulate, which can achieve anatomic reduction and has good clinical effects.
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Objective To explore clinical and radiological outcomes of treating displaced fractures of proximal clavicle by open reduction and internal fixation with an inverted anatomic locking plate for distal clavicle.Methods From August 2013 to August 2015,12 patients with displaced fracture of proximal clavicle were treated in our hospital by open reduction and internal fixation with an inverted anatomic locking plate for distal clavicle.They were 11 men and one woman,with an average age of 43.5 years (range,25 to 62 years).There were 9 fresh and 2 old fractures.According to the Edinburgh classification,10 fractures were classified as type 1B1 and 2 as type 1B2.After fixation,the 180° inverted plate on the ipsilateral side was placed on the superior aspect of proximal clavicle.The medial fragment was fixed with 2 to 4 pieces of 2.7 mm multidirectional locking screw and the lateral fragment with 2 to 3 pieces of 3.5 mm locking screw.X-ray and CT were performed to assess union,delayed union,nonunion,and hardware failure.Functional outcomes were assessed by Constant-Murley scores and Disabilities of the Arm,Shoulder and Hand (DASH) scores at final follow-ups.Results There were no significant neurovascular injuries intraoperatively.All patients were followed up for an average of 15.6 months (range,12 to 24 months).All fractures healed after an average of 14.3 weeks (range,8 to 24 weeks).At final follow-ups,the mean Constant-Murley score was 96.0 points (range,84 to 100 points) and the mean DASH score 1.9 points (range,0 to 14.8 points).There were no such significant complications as infection,reduction loss or implant failure.Conclusion Displaced fractures of proximal clavicle may be treated with an inverted anatomic locking plate for distal clavicle on the ipsilateral side because of rigid fixation,fine stability and good chance for early rehabilitation.
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Objective To evaluate the clinical results of uncemented fully porous-coated long femoral stems in treating Vancouver type B2 periprosthetic femoral fracture following hip arthroplasty.Methods A retrospective analysis was made on 12 patients (12 hips) with Vancouver type B2 periprosthetic femoral fracture treated using the uncemented fully porous-coated long femoral stem prosthesis combined with cerclage fixation with steal-wire or titanium cable devices from February 2006 to January 2013.There were 5 males and 7 females,aged average 69.8 years (range,62 to 79 years).The status of primary arthroplasty was uncemented bipolar hemiarthroplasty in 2 patients and total hip arthroplasty in 10 patients (2 cement and 8 cementless femoral stems).At the final follow-up,Harris hip score for clinical evaluation,Beals and Tower's criteria for radiological evaluation,and complications were recorded.Results There were no intra-operative complications such as femoral perforation and femoral fracture.All patients were followed up for mean 38 months (range,24-72 months).At the last followup,mean Harris hip score was 87.2 points (range,50 to 100 points).All fractures healed at average 16 weeks (range,12-28 weeks).All the 12 hips showed prosthesis stability despite there was one femoral stem subsidence of 3 mm.One patient slipped and sustained another periprosthetic fracture (Vancouver type B1) at postoperative 4 months and was treated successfully with locking plate and cables.According to the Beals and Tower's criteria,there were 10 excellent,1 good and 1 poor results.Final follow-up revealed no complications of deep vein thrombosis,dislocation and prosthesis loosening.Conclusion Uncemented fully porous-coated long femoral stems provide good primary stability that promotes fracture healing and offers a reasonable treatment of Vancouver B2 femoral periprosthetic fracture.