Biomechanical Study on Different fixation Methods of Cannulated Screws for Posterior Malleolus Fracture / 医用生物力学

Objective To study biomechanical effects of cannulated screws at different fixation angles on posterior malleolus fracture based on finite element method, so as to determine the best fixation method of cannulatedscrew. Methods The finite element model of ankle joint, including tibia, fibula, astragalus, corresponding cartilage and ligaments was reconstructed using CT images, and 1 / 2 posterior malleolus fracture model was established on the basis of verifying its validity. The biomechanical effects of cannulated screw fixation on posterior malleolus fracture fixation model were analyzed. Results Compared with 0°,5°,10°,20° fixation model, the 15° fixation model had the smallest displacement. The screw stress of 15° fixation model was lower than that of 5°, 10°, 20° fixation model, and higher than that of 0° fixation model. But when the screw fixation angle was 0°, the peak contact pressure of ankle joint was much larger than that of normal ankle joint, which was easy to cause traumatic osteoarthritis. Conclusions Cannulated screw is safe and effective for treating posterior malleolus fracture which is less than 1 / 2 fragment size. The displacement and stress of the model are different at different fixation angles of screws. When the fixation angle of screw is 15°, the biomechanical stability is the best, which can be used to guide clinical operation.

Fracturas del maleolo posterior del tobillo, clasificación y visión de tratamiento / Fractures of the Ankle Posterior Malleolus, Classification and Treatment Vision

Introducción: Las fracturas del maleolo posterior son comunes y son resultado de lesiones por rotación del tobillo que se ignoran debido a la reducción espontánea de estos fragmentos después de la reducción abierta del maléolo lateral. La tendencia actual es realizar la corrección anatómica de la articulación y evitar un escalón intraarticular. Objetivo: Revisar el estado actual de los conocimientos y clasificación de las fracturas del maleolo tibial posterior y las tendencias de su tratamiento. Métodos: Se realiza una revisión de la literatura en PubMed de los trabajos publicados en inglés entre los años 2011-2021, con los siguientes términos de búsqueda: fracturas del maleolo tibial posterior, clasificación de las fracturas del maléolo tibial posterior", tratamiento de las fracturas del maleolo tibial posterior". También se revisaron artículos accesibles de forma libre, o a través del servicio ClinicalKey e Hinari. Conclusiones: La reposición anatómica del maleolo tibial posterior en fracturas de tobillo permite alcanzar mejores resultados. Las clasificaciones y el abordaje posterolateral contribuyen a lograrlo(AU)

Introduction: Fractures of the posterior malleolus are common and resulting from rotational injuries of the ankle, which are ignored due to the spontaneous reduction of these fragments after open reduction of the lateral malleolus. The current trend is to perform the anatomical correction of the joint and to avoid an intra-articular step. Objective: To review the current state of knowledge and classification of posterior tibial malleolus fractures and treatment trends. Methods: A review was carried out of the PubMed literature of papers published in English in the period 2011-2021; the search terms adopted were posterior tibial malleolus fractures, posterior tibial malleolus fracture classification, reatment of fractures of the posterior tibial malleolus. Articles freely accessible or through Clinical Key and Hinari service were also reviewed. Conclusions: The anatomical repositioning of the posterior tibial malleolus in ankle fractures allows to achieve better results. The classifications and the posterolateral approach help to achieve this(AU)

STUDY OF FUNCTIONAL OUTCOME IN DISPLACED BIMALLEOLAR FRACTURE TREATED WITH FIBULAR PLATING FOR LATERAL MALLEOLUS AND PINNING OR SCREW FOR MEDIAL MALLEOLUS

Fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year1. A study was conducted to learn the functional outcome of displaced bimalleolar fracture treated with ?bular plating for lateral malleolus and pinning or screw for medial malleolus. For a good long-term functional outcome to be achieved, reliable early evaluation is crucial so that it can be determined whether the problem is a distortion (sprain), ligament rupture, bony ligament avulsion, or fracture of the talocrural joint. The proper treatment is chosen on the basis of the mechanism of the accident and the correct classi?cation of the injury and accompanying soft-tissue damage. The goal of treatment is to enable the patient to put his or her full weight on the joint once again without pain and to prevent permanent damage2. In this study, a total of 25 patients were included. Detailed history and clinical ?ndings are con?rmed and noted. After surgery patients followed on at 1 month, 3 months & 6 months, and thereafter yearly for their radiological and functional outcome

Medial malleolus malunion with secondary tibiotalar and syndesmotic incongruence - two case reports and «box resection¼ for its treatment / Mal unión del maléolo medial con incongruencia tibiotalar y sindesmótica: «resección en caja¼ para su tratamiento

Abstract: Introduction: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Malunion is one of the possible complications, and corrective surgery is often used to avoid long-term disability. However, few studies address medial malleolus malunion and the best revision surgery technique is controversial. We describe a new surgical technique, the «box resection¼. Material and methods: We present two cases of medial malleolus malunion with secondary talus lateral translation and syndesmotic incongruence. In order to restore a congruent tibiotalar joint, we performed the described technique. Results: We record significant improvement of AOFAS Score and range of motion in both cases, with resolution of pain symptoms. Postoperative radiographs show a congruent mortise with syndesmosis reduction. Conclusion: The box resection allowed immediate talus medial translation to its original position. It is a simple and effective solution, with a good functional outcome.

Resumen: Introducción: La consolidación viciosa del maléolo interno es una posible complicación en las fracturas maleolares. Su tratamiento es difícil y controvertido, por el momento no hay una solución estándar. Proponemos una nueva técnica quirúrgica para el tratamiento de estos casos que denominamos «resección en caja¼. Material y métodos: Presentamos dos casos de consolidación viciosa del maléolo interno, asociados con traslación lateral del astrágalo y incongruencia de la sindesmosis, donde aplicamos la técnica quirúrgica descrita. Resultados: En ambos casos, obtuvimos una mejora significativa en el puntaje AOFAS y en el rango de movilidad, así como en la resolución de las molestias por dolor. Las radiografías muestran mortajas congruentes y anatómicas, con una reducción satisfactoria de la sindesmosis. Conclusión: La técnica de «resección en caja¼ es simple y eficaz produciendo un buen resultado clínico y funcional.

Aneurysmal Bone Cyst of the Lateral Malleolus Treated with Intralesional Curettage and Masquelet Technique: A Case Report

@#An aneurysmal bone cyst is a locally destructive lesion considered to be a pseudotumor arising from the bone. Although this benign-like lesion is generally considered rare, several approaches for treatment have been presented. We report a case involving a 15-year-old female diagnosed with aneurysmal bone cyst of the lateral malleolus. Applying the Masquelet technique enabled the treatment of the lesion without causing instability to the ankle joint and the prevention of recurrence through the application of polymethylmethacrylate. To our knowledge this is the first documented case in our region and possibly in the Philippines.

Treatment of Isolated Lateral Malleolar Fractures Using Locking Compression Plate Fixation and Tension Band Wiring Fixation

PURPOSE: The purpose of this study was to compare the clinical and radiological outcomes of locking compression plate (LCP)-screw fixation and tension band wiring (TBW) fixation in isolated lateral malleolar fractures.MATERIALS AND METHODS: From May 2016 to August 2018, 52 patients with isolated lateral malleolar fracture were retrospectively reviewed. They were divided into 30 cases of the LCP fixation group (Group I) and 22 cases of the TBW fixation group (Group II). The clinical and radiological results of those groups were compared. Pearson chi-square tests and independent t-tests were used in the statistical analysis.RESULTS: The mean length of the surgical incision was 8.3 cm in Group I and 4.9 cm in Group II. Radiological union was obtained at a mean of 8.4 weeks in both groups. The mean American Orthopaedic Foot and Ankle Society score was 90 (range, 85–97) and 92 (range, 85–100) in Groups I and II, respectively, at the last follow up.CONCLUSION: Both the LCP-screw and TBW techniques revealed excellent results in isolated lateral malleolar fractures. The tension band technique may be a fine alternative method of fixation in the treatment of isolated lateral malleolar fracture.

Comparison of lag screw fixation on posterior malleolar fractures in different directions and screw-related complication / 中国综合临床

Objective@#To compare the effects of indirect reduction, percutaneous anterior posterior screw and direct reduction, posterior anterior screw in the treatment of posterior malleolus fracture.@*Methods@#A retrospective analysis was made on 58 patients with posterior malleolus fracture treated by cannulated screw fixation from January 2013 to December 2017 in the Department of Orthopedics, Affiliated Hospital of Guangdong Medical University.They were divided into anterior and posterior screw group (26 cases) and posterior and anterior screw group (32 cases) according to different treatment methods.The incidence of poor screw position and other complications were compared between the two groups.Health status and ankle function at the last follow-up were compared between the two groups.@*Results@#The incidence of screw malposition in the anterior and posterior screw fixation group was 23.08%(6/26), which was significantly higher than that in the posterior screw fixation group was 3.85%(1/32). The difference between the two groups has statistically significant (χ2=5.381, P=0.020); there was no significant difference in other complications such as infection, traumatic arthritis, bone nonunion (all P>0.05). At the last follow-up, the OMA scores of AP group were (80.70±8.16)and PA group were(75.23±9.33), There were significant differences between the two scores(t=2.240, P=0.029), the AOFAS scores of AP group were (80.57±7.25) and PA group were(75.38±10.19), There were significant differences between the two scores(t=2.110, P=0.039).@*Conclusion@#The Indirect reduction and percutaneous anterior and posterior screw treatment have a high incidence of malposition of the screw, which has an impact on ankle function.Direct reduction and posterior and anterior screw fixation can significantly reduce the incidence of malposition of the screw and obtain better functional results.

Manejo terapéutico del maléolo posterior en fracturas trimaleolares de tobillo: revisión bibliográfica / Therapeutic management of the posterior malleolus in trimaleolar ankle fractures: review / Manejo terapêutico do maléolo posterior em fraturas do tornozelo trimaleolar: revisão bibliográfica

Introducción: El manejo terapéutico de las fracturas de maléolo posterior en las fracturas trimaleolares de tobillo continúa en debate. Nuestro objetivo fue realizar una búsqueda de la evidencia científica sobre los aspectos terapéuticos de las fracturas de maléolo posterior en el contexto de las fracturas trimaleolares. Materiales y métodos: Se realizó una revisión de la bibliografía sistematizada por dos revisores, centrados en el manejo terapéutico del maléolo posterior. Resultados: Se obtuvieron 16 artículos clínicos de un total de 1029 pacientes, 8 estudios nivel de evidencia II y 8 de nivel IV. Se sistematizaron las indicaciones quirúrgicas y se analizaron los resultados funcionales y las complicaciones. Conclusiones: La comprensión pato-anatómica de estas fracturas es cada día mayor, principalmente por la utilización habitual de tomografías computarizadas (TC). El tratamiento quirúrgico sobre el maléolo posterior está evidenciando buenos y excelentes resultados funcionales. Para una adecuada decisión terapéutica se debería tener en cuenta ciertos factores: inestabilidad tibiotalar y sindesmótica, congruencia articular y características morfológicas del maléolo posterior. La reducción abierta (RA) y fijación interna con placa de sostén es el tratamiento que ha demostrado mejores resultados a corto y mediano plazo, no encontrando estudios con seguimiento a largo plazo.

Introduction: The therapeutic management of posterior malleolus fractures in trimaleolar ankle fractures continues in debate. Our objective was to conduct a search for scientific evidence on the therapeutic aspects of posterior malleolus fractures in the context of trimaleolar fractures. Materials and methods: A review systematic of the literature was carried out by two reviewers, focusing on the therapeutic management of the posterior malleolus. Results: 16 clinical articles were obtained with a total of 1029 patients, 8 studies level of evidence II and 8 studies level IV. The surgical indications were systematized, and the functional results and complications were analyzed. Conclusions: The patho-anatomical understanding of these fractures is increasing every day, mainly due to the usual use of CT scans. Surgical treatment on the posterior malleolus shows good and excellent functional results. For an adequate therapeutic decision certain factors should be taken into account: tibiotalar and syndesmotic instability, joint congruence and morphological characteristics of the posterior malleolus. Open reduction and internal fixation with support plate is the treatment that has shown better results in the short and medium term, not finding studies with long-term follow-up.

Introdução: O tratamento terapêutico das fraturas do maléolo posterior nas fraturas do tornozelo trimaleolar continua em debate. Nosso objetivo foi realizar uma pesquisa de evidências científicas sobre os aspectos terapêuticos das fraturas do maléolo posterior no contexto das fraturas trimaleolares. Materiais e métodos : Uma revisão sistemática da literatura foi realizada por dois revisores, com foco no manejo terapêutico do maléolo posterior. Resultados: foram obtidos 16 artigos clínicos com um total de 1029 pacientes, 8 estudos com nível de evidência II e 8 estudos com nível IV. As indicações cirúrgicas foram sistematizadas e os resultados e complicações funcionais foram analisados. Conclusões: O entendimento anatomopatológico dessas fraturas está aumentando a cada dia, principalmente devido ao uso habitual de tomografias computadorizadas. O tratamento cirúrgico do maléolo posterior mostra bons e excelentes resultados funcionais. Para uma decisão terapêutica adequada, certos fatores devem ser levados em consideração: instabilidade tibiotalar e sindesmótica, congruência articular e características morfológicas do maléolo posterior. A redução aberta e a fixação interna com placa de suporte é o tratamento que apresenta melhores resultados no curto e médio prazo, não encontrando estudos com acompanhamento a longo prazo.

Morphological analysis of posterior malleolus fracture fragments under different injury mechanisms / 国际外科学杂志

Objective@#To explore the morphological characteristics and differences of posterior malleolus fracture fragments in ankle fracture combined with posterior malleolus fracture and spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture, and to analyze the relationship between the posterior malleolus fracture fragments and the above two types of fracture injury.@*Methods@#A retrospective analysis was performed. One hundred patients with ankle fracture were admitted to Beijing Jishuitan Hospital from January 2011 to December 2011, including 59 males and 41 females, aged (42.0±14.1) years, with an age range of 17-73 years. Among them, 57 patients who were ankle fracture combined with posterior malleolus fracture were in Group A. Meanwhile, 90 patients with spiral fracture of middle and lower third of tibial were admitted to Beijing Jishuitan Hospital from January 2013 to December 2013, including 42 males and 48 females, aged (45.2±13.0) years, with an age range of 18-77 years. Among them, 35 patients who were spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture were in group B. A total of 92 patients in the two groups were examined by CT before operation. The patient′s fracture classification was determined according to Haraguchi classification. On axial plane, the angle between posterior malleolus fracture line and medial and lateral malleolus axis was defined as Ⅰa in Haraguchi Ⅰ, angles between posterior malleolus fracture line and medial and lateral malleolus axis were defined as Ⅱa and Ⅱb in Haraguchi Ⅱ, and angle Ⅰc and Ⅱc were angles between posterior malleolus fracture line and tibial axis on sagittal CT. Measurement data were expressed as mean±standard deviation (Mean±SD). Mann-whitney and Chi-square test were used to compare the differences of different angles in type I and type Ⅱ, and whether there were statistical differences in different angles between the two groups.@*Results@#In the 92 cases, 75 were type Ⅰ, 12 were type Ⅱ and 5 were type Ⅲ. The angle of Ⅰa was (26.6±5.6)°, the angle of Ⅰc was (15.4±4.1)°, the angle of type Ⅱa was (22.1±3.3)°, and the angle of Ⅱc was (16.4±5.4)°. The difference between Ⅰa and Ⅱa data was statistically significant (P=0.003), but there was no significant difference between Ⅰc and Ⅱc(P=0.667). In group A and group B, the angle of Ⅰa was (26.6±5.9)°and (26.6±5.1)°, the angle of Ⅰc was (15.7±4.2)°and (14.9±3.9)°, the angle of Ⅱa was (22.0±3.0)°and (22.2±4.3)°, the angle of Ⅱb was (45.4±9.0)°and (46.5±10.0)°, the angle of Ⅱc was (17.0±5.4)°and (15.3±6.2)°, respectively. There were no significant differences in the angles of Ⅰa, Ⅰc, Ⅱa, Ⅱb and Ⅱc between the two groups (P values were 0.862, 0.387, 1.000, 0.932 and 0.444, respectively).@*Conclusion@#The posterior malleolar fragments is not associated with fracture type of ankle fracture combined with posterior malleolus frature and the spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture.

One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect / 中国修复重建外科杂志

Objective: To explore the effectiveness of one-stage debridement and two-stage Ilizarov bone transport technology in repairing post-traumatic lateral malleolus defect. Methods: Between June 2013 and December 2016, 7 patients with bone defect of lateral malleolus were treated. There were 5 males and 2 females with an average age of 45.9 years (range, 35-60 years). There were 6 cases of traffic accident injury and 1 case of strangulation injury. All patients had extensive soft tissue injury and lateral malleolus bone exposure. There were 4 cases of Gustilo type ⅢB and 3 case of Gustilo type ⅢC. The time from injury to admission was 3-10 hours (mean, 6.3 hours). Through one-stage thorough debridement, exploration and repair of vessels and nerves, external fixation of scaffolds and coverage of wounds, free fibulas were removed in 3 cases at one-stage and fibulas were resected in 4 cases after expansion. The bone defects ranged from 4.5 to 15.0 cm in length (mean, 8.2 cm). The Ilizarov circular external fixators were used to transport with fibula osteotomy for repairing bone defect of lateral malleolus when the wound healing. Results: During fibular osteotomy, the stents were adjusted 2-4 times (mean, 2.8 times) and the external fixators were removed after 10-16 months (mean, 12.8 months). The nail tract infection occurred in 2 cases during transporting and was controlled after symptomatic treatment. All patients were followed up 24-48 months (mean, 32.9 months). The shape of lateral malleolus was close to normal without obvious varus or valgus deformity. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score was 86-92 (mean, 90.3), and 5 cases were excellent and 2 cases were good. X-ray film showed that there was no obvious widening of the gap between the ankle points and no sign of absorption of the lateral malleolus. Conclusion: The one-stage debridement combined with two-stage Ilizarov bone transport technology can maintain the stability of ankle joint structure and obtain better effectiveness in repairing post-traumatic lateral malleolus defect.

Anatomy and clinical application of anterior and posterior terminal perforators of peroneal artery / 中国修复重建外科杂志

Objective: To investigate the anatomy of anterior and posterior terminal perforators of the peroneal artery and its clinical applications. Methods: Six lower limb specimens were obtained from 3 fresh cadavers. The anterior and posterior terminal perforators and the perforator of terminal peroneal artery were exposed under surgical microscope, and the distances from the beginning of each perforator branch to the lateral malleolus tip and the external diameter of each perforator were measured. With these anatomical knowledge and contrast-enhanced ultrasound (CEUS) guidance, the pedicle flaps with above-mentioned perforators were rationally selected and precisely designed for 18 patients with skin defects in the ankle and foot region between October 2016 and December 2018. Among the patients, there were 14 males and 4 females, aged 28-62 years, with an average age of 40 years. The area of wound ranged from 4 cm×3 cm to 13 cm×10 cm and the area of skin flap ranged from 5 cm×4 cm to 14 cm×10 cm. The anterior peroneal artery terminal perforator flap were applied in 13 cases and the posterior peroneal artery terminal perforator flap in 5 cases. The donor sites were closed directly in 7 cases and repaired with full thickness skin graft in 11 cases. Results: The distance from the beginning of the anterior terminal perforator to the lateral malleolus tip was (5.1±0.5) cm, the external diameter of the anterior terminal perforator was (1.51±0.05) mm. The distance from the beginning of the posterior terminal perforator to the lateral malleolus tip was (4.9±0.9) cm, the external diameter was (1.78±0.17) mm; the distance from the beginning of the perforator of terminal peroneal artery to the lateral malleolus tip was (1.7±0.7) cm, the external diameter was (0.58±0.12) mm. Clinical application results: The edge of the flap was dark in 2 cases after operation and healed after surgical dressing, and 1 case of wound infection healed gradually after debridement. The other flaps survived and healed by first intention. Three patients underwent plastic surgery at 3 months after operation due to flap swelling. All patients were followed up 3-18 months. During the follow-up period, the flaps had good texture and appearance, and partial recovery of sensation. All cases were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) score at last follow-up. The results were excellent in 9 cases, good in 6 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 83.3%. Conclusion: Further classification of peroneal artery perforators in the lateral malleolus region can improve clinical understanding and be helpful to selection and application of perforator flaps in the lateral malleolus.

Research progress of surgical treatment for lateral malleolus defect / 中国修复重建外科杂志

Objective: To review the research progress of the surgical treatment for lateral malleolus defect. Methods: The related literature about surgical treatment and effectiveness of lateral malleolus defect at home and abroad was reviewed, summarized, and analysed. Results: Lateral malleolus defects are often caused by severe trauma or wide resection of fibular neoplasms. Although the incidence is not high, the defects are difficult to handle. These bony defects should be reconstructed to prevent an abnormal gait induced by ankle instability and avoid the occurrence of traumatic arthritis. Various repair methods have been developed, including bone transplantation, fibula lengthening, and ankle arthrodesis. Conclusion: There are various surgical methods to repair the defect of lateral malleolus, but each has its own advantages and disadvantages. In order to achieve the best results, the surgeon should choose the appropriate operation according to his own level, the patient's specific injury, and age.

Morphological analysis of posterior malleolus fracture fragments under different injury mechanisms / 国际外科学杂志

Objective To explore the morphological characteristics and differences of posterior malleolus fracture fragments in ankle fracture combined with posterior malleolus fracture and spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture,and to analyze the relationship between the posterior malleolus fracture fragments and the above two types of fracture injury.Methods A retrospective analysis was performed.One hundred patients with ankle fracture were admitted to Beijing Jishuitan Hospital from January 2011 to December 2011,including 59 males and 41 females,aged (42.0 ± 14.1) years,with an age range of 17-73 years.Among them,57 patients who were ankle fracture combined with posterior malleolus fracture were in Group A.Meanwhile,90 patients with spiral fracture of middle and lower third of tibial were admitted to Beijing Jishuitan Hospital from January 2013 to December 2013,including 42 males and 48 females,aged (45.2 ± 13.0) years,with an age range of 18-77 years.Among them,35 patients who were spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture were in group B.A total of 92 patients in the two groups were examined by CT before operation.The patient's fracture classification was determined according to Haraguchi classification.On axial plane,the angle between posterior malleolus fracture line and medial and lateral malleolus axis was defined as Ⅰ a in Haraguchi Ⅰ,angles between posterior malleolus fracture line and medial and lateral malleolus axis were defined as Ⅱ a and H b in Haraguchi Ⅱ,and angle Ⅰ c and Ⅱ c were angles between posterior malleolus fracture line and tibial axis on sagittal CT.Measurement data were expressed as mean ± standard deviation (Mean ± SD).Mann-whitney and Chi-square test were used to compare the differences of different angles in type Ⅰ and type Ⅱ,and whether there were statistical differences in different angles between the two groups.Results In the 92 cases,75 were type Ⅰ,12 were type Ⅱ and 5 were type Ⅲ.The angle of Ⅰ a was (26.6 ± 5.6)°,the angle of Ⅰ c was (15.4 ±4.1)°,the angle of type Ⅱa was (22.1 ±3.3)°,and the angle of Ⅱc was (16.4 ±5.4)°.The difference between Ⅰ a and Ⅱa data was statistically significant (P=0.003),but there was no significant difference between Ⅰ c and Ⅱ c (P =0.667).In group A and group B,the angle of Ⅰ a was (26.6 ± 5.9)°and (26.6±5.1)°,the angle of Ⅰcwas (15.7 ±4.2)°and (14.9±3.9)°,the angle of Ⅱa was (22.0± 3.0)°and (22.2±4.3)°,the angle of Ⅱb was (45.4 ±9.0)°and (46.5 ± 10.0)°,the angle of Ⅱc was (17.0 ±5.4)°and (15.3 ±6.2)°,respectively.There were no significant differences in the angles of Ⅰ a,Ⅰ c,Ⅱ a,Ⅱ b and Ⅱ c between the two groups (P values were 0.862,0.387,1.000,0.932 and 0.444,respectively).Conclusion The posterior malleolar fragments is not associated with fracture type of ankle fracture combined with posterior malleolus frature and the spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture.

Incidence and surgical fixation-related factors of posterior malleolus fracture in treatment of ankle fractures / 中华创伤骨科杂志

Objective To investigate the incidence and surgical fixation-related factors of posterior malleolus fracture in the treatment of ankle fractures.Methods A retrospective study was conducted of the 703 inpatients with ankle fracture at Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital from June 1,2017 to May 31,2018.Of them,464 suffered posterior malleolus fracture.The incidence and surgical fixation rate of posterior malleolar fracture were calculated.Of the patients with posterior malleolus fracture,the gender,age,injury energy,Lauge-Hanse classification,Bartonícek classification,talar backward subluxation,fragment area ratio (FAR) of posterior malleolus fracture on X-ray film and CT cross section,fragmental dislocation,and Die-punch fragment were analyzed to screen out the risk factors related to surgical internal fixation for posterior malleolus fracture.Results In this study,the incidence of posterior malleolus fracture was 66.00％ (464/703) and the surgical fixation rate 43.97％ (204/464).The gender,age,injury energy,Lauge-Hanse classification,direction of talar subluxation and displacement of Die-punch fragments were not the risk factors related to the surgical internal fixation for posterior malleolus fracture (P ＞ 0.05) while the Bartonícek classification,talar backward subluxation,FAR of posterior malleolus fracture on X-ray film and CT cross section,lateral fragmental displacement and Die-punch fragment were the risk factors related to the surgical internal fixation for posterior malleolus fracture (P ＜ 0.05).Logistic regression analysis indicated that the talar backward subluxation (OR =5.580,95％ CI:1.623 ～ 19.181,P =0.006) and the FAR ≥ 15％ on CT cross section (OR =9.103,95％ CI:3.342 ～ 24.800,P =0.000) were independent risk factors for surgical internal fixation of posterior malleolus fracture.Conclusions The incidence and surgical fixation rate of posterior malleolar fracture are very high.The talar backward subluxation and the fragment area ratio ≥ 15％ on CT cross-section are independent risk factors for surgical internal fixation of posterior malleolus fracture.

Anterior superior malleolus flap and second toe transplantation for thumb reconstruction with soft tissue and first web defect / 中华显微外科杂志

Objective To explore the clinical efficacy of anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair or first web reconstruction.Methods A total of 13 cases were underwent anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair from June,2008 to January,2016.There were 9 males and 4 females.The average age was 25 years old,ranging from 18 to 52.There were 3 cases of Ⅲ-degree thumb defect with soft tissue defect of hand,6 cases of Ⅳ-degree thumb defect with soft tissue defect of hand,3 cases of single Ⅴ-degree thumb defect and 1 Ⅴ-degree thumb defect with soft tissue defect.There were 5 patients accompanied with injury of other fingers of the affected hand.And the thenar muscles were also damaged to a varied degree.There were 10 patients with soft tissue defect before surgery,with the wound surface ranging from 3 cm × 5 cm-6 cm × 13 cm.And the wound of other 3 cases was closed.After the surgery,follow-up visit was conducted on the appearance,sensation,function,daily life and working condition of reconstructed thumb,the appearance and function condition of donor site.Results The reconstructed thumbs and anterior superior malleolus flaps in 13 cases survived and healed primarily.The average post-operative followed-up time was 5.5 years,ranging from 2.5 to 10.0 years.The appearance of reconstructed thumb was satisfactory,and the temperature sensation,pain sensation and touch sensation were recovered.The two-points discrimination was 8-18 mm.Moreover,the flexion and extension function,opposing function and finger-to-thumb function was recovered,which could meet the demand of daily life and work.The appearance of donor site was satisfactory,without claudication,pain or dysfunction.The survival of transplanted skin area in the calf was good,with no ulcer noticed.According to the Trial Standard for Thumb and Finger Reconstitution Functional Assessment of Hand Surgery Society of Chinese Medical Association,there were 10 cases excellent results,2 good and 1 fair.Conclusion Application of anterior superior malleolus flap and second toe transplantation for first-stage thumb reconstruction and soft tissue defect repair or thenar muscles and first web reconstruction is an effective therapeutic approach.

Operative treatment of Sneppen Ⅴ talus fracture through approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation / 中华创伤骨科杂志

Objective@#To report the effects of operative treatment of Sneppen Ⅴ talus fracture through the approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation.@*Methods@#From January 2015 to January 2019, 16 patients with Sneppen Ⅴ talus fracture were treated at Department Ⅱ of Hand & Foot Microsurgery, The Second Affiliated Hospital to Inner Mongolia Medical University. They were 14 men and 2 women with a mean age of 38.4 years (range, from 20 to 55 years). All fractures were fixed with hollow compression screws through the approach for malleolus medialis Ⅴ osteotomy. The ankle and hindfoot functional scoring system developed by American Orthopaedic Foot and Ankle Society (AOFAS) was used to evaluate the clinical outcomes.@*Results@#All patients were followed up for a mean time of 12.6 months (range, from 6 to 30 months). The mean operation time was 68.4 minutes (range, from 52 to 96 minutes); the mean amount of hemorrhage during operation was 96.8 mL (range, from 48 to 122 mL); the mean period of bone union was 4.8 months (range, from 3 to 8 months). The postoperative mean AOFAS score was 75.3 points (range, from 43 to 91 points). Complications occurred in 4 cases, including one case of talus ischemic necrosis, one case of partial talus ischemic necrosis accompanied by tibial arthritis, one case of subtalar arthritis, and one case of combined tibial, talar and subtalar arthritis. All incisions obtained primary healing, with no complications like infection, screw breakage, delayed union or nonunion.@*Conclusion@#Operative treatment of Sneppen Ⅴ talus fracture through the approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation can provide sufficient operative exposure to facilitate reduction and fixation of the talus fracture so that the ischemic necrosis of the talus and traumatic arthritis can be effectively reduced.

Operative treatment of Sneppen Ⅴ talus fracture through approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation / 中华创伤骨科杂志

Objective To report the effects of operative treatment of Sneppen Ⅴ talus fracture through the approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation.Methods From January 2015 to January 2019,16 patients with Sneppen Ⅴ talus fracture were treated at Department Ⅱ of Hand & Foot Microsurgery,The Second Affiliated Hospital to Inner Mongolia Medical University.They were 14 men and 2 women with a mean age of 38.4 years (range,from 20 to 55 years).All fractures were fixed with hollow compression screws through the approach for malleolus medialis Ⅴ osteotomy.The ankle and hindfoot functional scoring system developed by American Orthopaedic Foot and Ankle Society (AOFAS) was used to evaluate the clinical outcomes.Results All patients were followed up for a mean time of 12.6 months (range,from 6 to 30 months).The mean operation time was 68.4 minutes (range,from 52 to 96 minutes);the mean amount of hemorrhage during operation was 96.8 mL (range,from 48 to 122 mL);the mean period of bone union was 4.8 months (range,from 3 to 8 months).The postoperative mean AOFAS score was 75.3 points (range,from 43 to 91 points).Complications occurred in 4 cases,including one case of talus ischemic necrosis,one case of partial talus ischemic necrosis accompanied by tibial arthritis,one case of subtalar arthritis,and one case of combined tibial,talar and subtalar arthritis.All incisions obtained primary healing,with no complications like infection,screw breakage,delayed union or nonunion.Conclusion Operative treatment of Sneppen Ⅴ talus fracture through the approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation can provide sufficient operative exposure to facilitate reduction and fixation of the talus fracture so that the ischemic necrosis of the talus and traumatic arthritis can be effectively reduced.

Treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via posterolateral and posteromedial approaches / 中华创伤骨科杂志

Objective To evaluate the treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.Methods From January 2014 to January 2017,26 patients were operatively treated at Department of Orthopaedics,Tongji Hospital for posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.They were 10 men and 16 women,aged from 53 to 67 years(average,61.5 years).The surgery was conducted in prone position via the posterolateral and posteromedial approaches to expose simultaneously the fractures ends at medial,lateral and posterior malleoli for open reduction.The lateral malleolar fractures were fixated with plate,the medial malleolar fractures with screws and posterior malleolar fractures with plate or cannulated screws depending on the size of the fracture blocks.The outcomes were assessed using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society(AOFAS) and the visual analogue scale(VAS).Results Of this cohort,22 were followed up for 30 months on average(range,from 18 to 48 months).All the cases healed by the first intension without any infection.Their postoperative X-ray showed bone union after an average of 12.5 weeks(range,from 10 to 15 weeks).No nonunion,loosening or breakage of implants was found.The mean time for walking with full weight-bearing was 13 weeks(range,from 11 to 16 weeks).Their AOFAS ankle-hindfoot scores at the final follow-ups were 85.4(range,from 80 to 92),yielding 13 excellent and 9 good cases with a good to excellent rate of 100%.Their mean VAS scores were decreased significantly from preoperative 8.6±0.6 to postoperative 1.7±0.3(f=153.000,P=0.000).Conclusion In treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures,a combination of posterolateral and posteromedial approaches in prone position can expose and reduce simultaneously the fractures ends at medial,lateral and posterior malleoli,leading to satisfactory clinical outcomes.

Triamcinolone Acetonide Injections for Lateral Malleolar Bursitis of the Ankle / 대한족부족관절학회지

PURPOSE: This study examined the clinical outcomes and usefulness of triamcinolone acetonide (TA) injections as an option in the conservative treatment of patients with lateral malleolar bursitis of the ankle. MATERIALS AND METHODS: A total of 27 patients (27 ankles), in whom TA injection had been performed between March 2016 and June 2017, were reviewed retrospectively. After the aspiration of fluid in the lateral malleolar bursal sac, 1 mL (40 mg) of TA was injected into the malleolar bursal sac. After the injection, the ankle was compressed with an elastic cohesive bandage for 2 to 4 weeks. The clinical outcomes and side effects were evaluated at the following time points: 2 weeks, 4 weeks, 3 months, 6 months, and 1 year after TA injection therapy. The responses to treatment were assessed according to the degree of fluctuation, shrinkage of the bursal sac, and soft tissue swelling. RESULTS: The mean age was 62.1 years (range, 41~81 years); there were 19 males and 8 females. Complete resolution was observed in 26 patients (96.3%) after the first or second application of a TA injection, and a partial response was observed in 1 patient (3.7%) after the first TA injection. The physical component scores of Medical Outcomes Study 36-item Short-Form Health Survey improved from 71.1 to 76.0 at the last follow-up (p=0.001). Associated complications were 1 patient (3.7%) with skin atrophy and 3 patients (11.1%) with transient hyperglycemia in diabetes mellitus. CONCLUSION: TA injection is a useful and safe procedure for patients not responding to the usual conservative treatment of lateral malleolar bursitis of the ankle.

Different reverse points of forward lateral malleolus perforator flap in the repair of skin and soft tissue defect of ankle or dorsal foot / 中华显微外科杂志

Objective To discuss the clinical effects of forward lateral malleolus perforator flap in the repair of skin and soft tissue defect of ankle or dorsal foot.Methods From November,2014 to June,2017,16 cases of skin and soft tissue defect in ankle or dorsal foot had been repaired,which were 11 males and 5 females,aged from 25to 58 years old(average,32.5 years).The rotation points were on proximal 5 cm of the lateral malleolus in 11 cases and on the level of tarsal sinus in 5 cases.The largest flap was 10.0 cm×18.0 cm and the smallest flap was 6.0 cm×4.0 cm.The color,thickness,texture,sensation,appearance,donor site shape and functional were followed-up after operation.Results All the 16 patients were followed-up from 1 to 24 months.The distal flap appeared dark in 1 case 2 days after operation,and blood supply was improved after stitches;One case was superficial necrosis and healed after dressing.All the flaps had good appearance and texture,no pigmentation,scar contracture,and so on.Conclusion The forward lateral malleolus perforator flaps have perforator constantly and the color,thickness are similar with the receiving areas,the rotation point could on proximal 5 cm of the lateral malleolus and on the level of tarsal sinus,which is a good method to repair skin and soft tissue defect of ankle or dorsal foot.