ABSTRACT
Objective To explore the surgical efficacy of trans-syndesmotic ankle fracture dislocation (the "Logsplitter" injury) plus the Tillaux-Chaput fracture / the Wagstaffe-Lefort fracture and the Volkmann fracture without tibiofibular joint screwing.Methods Between January 2015 and December 2018,16 adult patients with the "Logsplitter" injury plus avulsion fractures were treated by open reduction and internal fixation at Department of Orthopaedics,The Sixth Affiliated Hospital,Xinjiang Medical University.They were 11 males and 5 females with an average age of 36.4 years (range,from 27 to 56 years).There were 2 open fractures (one type Ⅱ and one type ⅢA by the Anderson-Gustilo classification) and 14 closed ones;all fractures were type 44-C by the AO/OTA classification;according to the Lauge-Hansen classification,there were 9 cases of pronation-abduction rotation,3 cases of pronation-external rotation and 4 cases of supination-external rotation.The fibular fractures were treated through a single lateral approach followed by plate fixation.The Volkmann fractures were fixed with screws and the Tillaux-Chaput fractures / the Wagstaffe-Lefort fractures with screws or Kirschner wires.The ankle functions were assessed postoperatively using the ankle-hindfoot rating system of the American Orthopaedic Foot and Ankle Society (AOFAS),and the dysfunction index and bother index of Short Musculoskeletal Function Assessment (SMFA).Results All the patients were followed up for 8 to 27 months (average,21.3 months).X-ray films showed complete fracture healing in all cases after 12 to 18 weeks postoperatively (mean,14.8 weeks).At the last follow up,13 patients walked normally and 2 with mild discomfort.Their AOFAS scores averaged 96.3 (range,from 86 to 100),giving 12 excellent,3 good and one poor cases;their SMFA dysfunction index was 15.9 (range,from 8 to 17)and SMFA bother index 6.5 (range,from 3 to 9)at the last follow-up.Conclusions In the treatment of trans-syndesmotic ankle fracture dislocation — the "Logsplitter" injury,open reduction and internal fixation of the Tillaux-Chaput fracture / the Wagstaffe-Lefort fracture and the Volkmann fracture to reconstruct the lower tibiofibular horizontal stable "ring",without tibiofibular joint screwing,can obtain satisfactory clinical results.
ABSTRACT
Objective To investigate the clinical efficacy of a period of joint fusion and plate internal fixation for four parts calcaneal fractures.Methods The clinical data of 53 patients with four parts calcaneal fractures from January 2009 to January 2013 were analyzed retrospectively.Twenty-two patients were performed a period of joint fusion (joint fusion group),31 patients were performed plate internal fixation (plate internal fixation group).The Bohler angle and Gissane corner before and after operation,operation time and bleeding,the Maryland foot function score between two groups were compared.Results Compared with before operation,the Bohler angle and Gissane corner in plate internal fixation group and joint fusion group were improved significantly after operation (34.6° ± 4.2° vs.5.7° ± 2.4°,125.4° ± 8.2° vs.87.2° ± 6.8°,32.8° ± 3.9° vs.5.4° ± 2.7°,127.6° ± 7.8° vs.86.9° ± 6.7°),and there were significant differences (P ＜0.05),but the Bohler angle and Gissane corner before and after operation between two groups had no significant difference (P ＞ 0.05).The operation time and bleeding were (52.1 ± 5.1) min,(50.0 ± 10.2) ml in plate internal fixation group and (70.3 ± 5.2) min,(105.0 ± 20.5) ml in joint fusion group,and there were significant differences between two groups (P ＜ 0.05).The fineness rate of Maryland foot function at 6 months follow-up between two groups had no significant difference (P ＞ 0.05).Conclusions The plate internal fixation and joint fusion is therapeutic equivalence in treatment of four parts calcaneal fractures.Due to the small surgical trauma and less bleeding of plate internal fixation,it may be preferred in the treatment of four parts calcaneal fractures.