Herniation of intervertebral disc into thoracolumbar fracture vertebral body leads to malunion of fracture and decrease of intervertebral space height / 中国骨伤

OBJECTIVE@#To analyze the clinical characteristics of intervertebral disc tissue injury and herniation into the vertebral body in thoracolumbar fracture on fracture healing, vertebral bone defect volume and intervertebral space height.@*METHODS@#From April 2016 to April 2020, a total of 140 patients with thoracolumbar single vertebral fracture combined with upper intervertebral disc injury treated with pedicle screw rod system reduction and internal fixation in our hospital. There were 83 males and 57 females, aged from 19 to 58 years old, with an average age of (39.33±10.26) years old. All patients were followed up regularly 6 months, 12 months and 18 months after surgery. The patients with injured intervertebral disc tissue not herniated into the fractured vertebral body were the control group, and the patients with injured intervertebral disc and herniated into the fractured vertebral body were the observation group. By detecting the thoracolumbar AP and lateral X-ray films, CT and MRI of the thoracolumbar segment at different follow-up time, calculate the changes of the wedge angle of the fractured vertebral body, the sagittal kyphosis angle and the height of the superior adjacent intervertebral space, the changes of the fracture healing and bone defect volume after the reduction of the vertebral body, and the changes of the intervertebral disc degeneration grade. The prognosis was evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI). Finally, the differences of the above results among different groups were comprehensively analyzed.@*RESULTS@#All the patients had normal wound healing without complications. A total of 87 patients received complete follow-up data, at least 18 months after internal fixation. Thoracolumbar AP and lateral X-ray films showed that 18 months after the reduction and internal fixation operation, the vertebral wedge angle, sagittal kyphosis angle and the height of the upper adjacent intervertebral space in the observation group were greater than those in the control group(P<0.05). CT scanning showed that the deformity of the fracture healed 12 months after the vertebral body reduction in the observation group and formed a "cavity" of bone defect connected with the intervertebral space, and its volume was significantly increased compared with that before (P<0.05). MRI scanning showed that the degeneration rate of injured intervertebral discs in the observation group was more serious than that in the control group 12 months after operation(P<0.05). However, there was no significant difference in VAS and ODI score at each time.@*CONCLUSION@#Herniation of injured intervertebral disc tissue hernias into the fractured vertebral body leads to increased bone resorption defect volume around the fracture and forms a malunion "cavity" connected with the intervertebral space. This may be the main reason for the change of vertebral wedge angle, the increase of sagittal kyphosis angle and the decrease of intervertebral space height after removal of internal fixation devices.

Joint preserving triplane osteotomy for intra-articular calcaneal fracture malunion / 中华创伤骨科杂志

Objective:To observe the curative effects of triplane intra-articular osteotomy in the treatment of malunion of calcaneal intra-articular fracture.Methods:The 16 patients were retrospectively analyzed who had been admitted to Foot and Ankle Surgery Department, Honghui Hospital from January 2016 to December 2019 for malunion of calcaneal intra-articular fracture. They were 12 males and 4 females, with an average age of 43.4 years (from 31 to 58 years). The left side was affected in 10 cases and the right side in 6 cases. All malunions were type Yu Ⅱ (compressed bone fragments on the posterior articular surface) and treated with triplane intra-articular osteotomy. The curative effects were assessed by comparing the radiological parameters, American Orthopaedic Foot and Ankle Surgery Society (AOFAS) ankle-hindfoot score, pain visual analog scale (VAS) and psychological and physical scores in Health Survey 12-item Short Form (SF-12) between preoperation and the final follow-up.Results:All the patients were followed up for 20 to 60 months (average, 42.9 months); the bone healing time was 10 to 14 weeks (average, 11.5 weeks). At the final follow-up, their B?hler angle (25.7°±2.3°), Gissane angle (117.1°±5.8°), Meary angle (2.9°±1.3°), talocalcaneal angle (31.3°±3.0°), hindfoot alignment angle (3.9°±1.8°), ankle height [(82.3±2.6) mm], calcaneus height [(56.9±2.4) mm], calcaneus width [(41.4±2.1) mm], AOFAS ankle-hindfoot score [(82.3±7.3) points], median VAS score [3 (2, 3) points], SF-12 psychological score [(46.6±3.6) points], and SF-12 physiological score [(43.6±3.5) points] were significantly improved than the preoperative values [8.4°±2.7°, 137.5°±9.3°, 8.3°±4.3°, 24.6°±3.7°, -4.6°±3.2°, (76.1±3.1) mm, (53.8±3.0) mm, (50.2±2.2) mm, (51.9±7.7) points, 6 (6, 7) points, (37.5±3.8) points, and (31.0±2.6) points] (all P<0.01) Conclusion:In the treatment of type Yu Ⅱ malunion of calcaneal intra-articular fracture, triplane osteotomy can anatomically reduce the bone fragments of collapsed posterior articular surface, reshape the normal anatomy of the calcaneus, and preserve the subtalar joint, leading to positive short- and mid-term follow-up effects.

Application of corrective calcaneal osteotomy in treatment of malunited calcaneal fractures / 中华创伤骨科杂志

Malunion is a common complication following a calcaneal fracture which was not treated or treated inappropriately.It is a therapeutic target and a great challenge as well to relieve pain, correct deformity and restore the function of the affected foot in clinical treatment of calcaneal malunion. As a result of researches by scholars at home and abroad focusing on the biomechanical mechanisms underlying the symptoms caused by calcaneal malunion, a variety of corrective calcaneal osteotomy has been widely applied in clinical practice to specifically correct the calcaneal deformity and restore normal calcaneal morphology. This review expounds on the techniques, outcomes, indications and complications of corrective calcaneal osteotomies commonly used in clinic.

Selective column arthrodesis based on three-column theory for malunion of Lisfranc injury / 中华创伤骨科杂志

Objective:To investigate the mid-term clinical outcomes of selective column arthrodesis based on the three-column theory in the treatment of malunion of Lisfranc injury.Methods:The 28 patients with malunion of Lisfranc injury were analyzed retrospectively who had been treated by selective column arthrodesis at Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine from January 2011 to January 2020.They were 18 males and 10 females, with an average age of 37.2 years(from 18 to 65 years). Twelve left and 16 right sides were affected. According to Myerson's three-column classification, one case was medial column injury (type A), 4 ones middle column injury (type B), 7 ones medial plus middle columns injury and 16 ones three-column injury. Medial column arthrodesis was conducted in 7, middle column arthrodesis in 4 and medial plus middle columns arthrodesis in 17. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) were compared between preoperation and the last follow-up to evaluate the improvements in foot function and pain. The operation-related complications were recorded.Results:All patients were followed up for an average of 35.6 months (from 18 to 60 months). The AOFAS midfoot score increased from 43.1±4.1 at pre-operation to 84.1± 7.4 at the last follow-up and the VAS score decreased from 5.7±1.3 at pre-operation to 2.0±0.9 at the last follow-up (both P<0.001). The wounds healed in 28 patients, 3 of whom had postoperative wound exudation but responded to dressing change. There were no such complications as injury to the deep peroneal nerve or deep venous thrombosis. The internal fixation was removed in 5 patients at about one year after arthrodesis. Conclusion:Selective column arthrodesis based on the three-column theory can result in satisfactory med-term clinical outcomes in the treatment of malunion of Lisfranc injury.

Osteotomías de alargamiento para realineación en maluniones postraumáticas de peroné / Lengthening osteotomy for realignment in posttraumatic fibular malunions

El acortamiento y la rotación del peroné son las deformidades más frecuentemente encontradas cuando se presentan maluniones postraumáticas del tobillo resultando en ensanchamiento de la mortaja e inestabilidad astragalina, con consecuentes cambios artrósicos. Los pacientes acuden por presentar dolor y limitación en sus actividades diarias y deportivas. En el presente estudio retrospectivo se hace una evaluación de los resultados clínicos y radiológicos de 9 pacientes que se sometieron a tratamiento quirúrgico posterior a maluniones de fracturas de peroné, en los cuales se realizaron osteotomías de alargamiento y desrotación para reconstrucción del tobillo, en la Unidad de Cirugía de Pie y Tobillo del Hospital Universitario de Caracas, entre junio de 2014 y agosto del 2019. Se realizaron mediciones radiológicas pre y postoperatorias de los ángulos de inclinación astragalina, talocrural y bimaleolar, y se reportaron los cambios degenerativos articulares. Para la evaluación clínica y funcional se aplicó la Escala Análoga Visual (VAS) para el dolor, y la Escala AOFAS de retropié, evidenciándose mejoría en cuanto a dolor, función y alineación. El objetivo del tratamiento fue restituir la longitud inicial del peroné, mediante osteototomías oblicuas en el sitio de la fractura anterior, o transversas suprasindesmales, con lo cual también se corrige la alineación del astrágalo, y de esta manera prevenir o disminuir los síntomas y signos inherentes a degeneración articular progresiva(AU)

The shortening and rotation of the fibula are the most frequent deformities found when post-traumatic ankle malunions occur, resulting in widening of the mortise and talus instability, with consequent arthritic changes. Patients have pain and limitation in their daily activities and sports. In the present retrospective study, an evaluation of the clinical and radiological results of 9 patients who underwent surgical treatment after fibular fracture malunions was performed, in which osteotomies of lengthening and de-rotation were performed for reconstruction of the ankle, in the Unit of Foot and Ankle Surgery at the University Hospital of Caracas, between June 2014 and August 2019. Pre and postoperative radiological measurements of the astragaline, talocrural and bimaleolar inclination angles were performed, and degenerative joint changes were reported. For the clinical and functional evaluation, the Visual Analog Scale (VAS) was applied for pain, and the AOFAS Hindfoot Scale, evidencing improvement in pain, function, and alignment. The objective of the treatment was to restore the initial length of the fibula by means of oblique osteotomies at the site of the previous fracture or suprasindesmal transverse osteotomy, which also corrects the alignment of the talus and thus prevents or decreases the symptoms and signs inherent to joint progressive degeneration(AU)

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.

Valgus Osteotomy with DHS Fixation in the Management of Malunited Intertrochanteric Fractures in a Rural Population

@#Introduction: Malunited intertrochanteric fractures are frequently seen in rural populations as they tend to go in for native treatment with traditional bone setters. The resulting Coxa vara is associated with shortening, abductor weakness, limp and decreased range of movement of the affected hip. The aim of this study was to evaluate the role of Valgus osteotomy with Dynamic hip screw (DHS) fixation in the management of these fractures and to evaluate the functional outcome using the Harris hip score. Materials and Methods: Fifteen patients with malunited intertrochanteric fractures who presented between January 2011 to January 2013 were managed by Valgus osteotomy with DHS fixation and were followed-up for a minimum period of three years. Results: There was a male preponderance seen in our study with the right hip being more commonly affected. The most common mode of injury was slip and fall followed by road traffic accidents. The duration of native treatment ranged from seven to 12 weeks and the time of presentation to the hospital ranged from four to nine months following injury. Pre-operative mean neck shaft angle was 94.73° while it was 134.6° post-operatively. The mean pre-operative Harris hip score was 72.33 and it was 91 at follow-up. All patients were happy with the procedure and the functional outcome. Conclusion: Valgus osteotomy with DHS fixation is an effective procedure in the management of malunited intertrochanteric fractures. It corrects the limb length discrepancy, restores the decreased neck shaft angle, improves range of movement, restores the integrity of the abductor mechanism of the hip and gives good functional results.

Valgus Malalignment Due to Internally Malrotated Trochanteric Nail Placement, with Rotational Malalignment in Femoral Shaft Segmental Fracture Fixation, an Underestimated Avoidable Technical Error: A Case Report

@#Coronal malalignment due to malrotated trochanteric nail placement in femoral fracture fixation has never been reported. We present a case of a femoral segmental fracture fixed with a trochanteric nail, with a malrotated placement resulting in a valgus malaligned nail and femur, associated with a rotational malalignment. Knowledge of the modern nail design with proper intra-operative precautions, would avoid this underestimated technical error.

Traditional Bone Setters and Their Relevance in the Present- Day Orthopaedic Care - A Manipur Experience

Background: Traditional bone setters (TBSs) occupy an important role in the management of musculoskeletal injuries in the societies of many developing countries and Manipur society is no exception to this. This study was conducted to evaluate the reasons for patronising TBSs and their relevance in modern society. Methods: An observational cross-sectional study was conducted during 2015-17 in a teaching medical college in Imphal, Manipur. Patients with fractures and dislocations attending the orthopaedic department after ‘treatment’ by TBSs were included in this study. They were evaluated clinically and radiologically for presence or absence of any complication. Appropriate treatment was provided to all the patients according to the hospital protocol. Results: There were 302 males and 150 females with maximum number of patients belonging to the age group 1-20 yrs. There were 320 closed fractures, 90 compound/open fractures and 42 dislocation cases. Upper limb was involved in 290 patients, lower limb in 110 patients and axial bones in 52 patients. Most of the patients were educated and most of them had a firm belief in traditional bone setting (TBS) system. Mal-union was the most common complication (53%) which was followed by non-union (13.2%). Conclusion: In spite of availability of state of the art modern orthopaedic care facilities in Imphal, Manipur the general population still used to continue to patronize TBS for any musculoskeletal injury as they have an age-old firm belief in this system of treatment (46.5%). Easy availability and affordability made their service all the more attractive to the people (23.5%). Educational status of the patient had no role in patronizing TBS. Perhaps it is high time the TBS are imparted basic training on bone and joint care in order to minimise the associated complications, in the line of training “dais” to “trained birth attendants”.

Analysis of Pelvic Fracture Healing Status in 198 Cases / 法医学杂志

Objective To analyze the relationship between the number of pelvic ring fractures, the location of fracture and Tile type of pelvic fracture and pelvic fracture healing status. To discuss how to understand the pelvic malunion, severe pelvic malunion and bony pelvis deformity （destruction） in Classification of the Impairment Related to Injury. Methods One hundred and ninety-eight cases of evaluation of body impairment class of pelvic fracture caused by traffic accident accepted by Zhongcheng Institute of Forensic Science in 2016 were collected. The cases were statistically analyzed in terms of the distribution of the number of pelvic ring fracture, the location of pelvic ring fracture and Tile type of pelvic fracture in various healing statuses. Results There were 16 cases without pelvic ring fracture, 18 cases of single pelvic ring fracture, 91 cases of 2 pelvic ring fractures, 73 cases of 3 or more pelvic ring fractures, 136 cases of anterior or posterior pelvic ring fractures, 46 cases of simultaneous anterior and posterior ring fractures. There were 34 cases of Tile A type, 130 cases of Tile B type and 24 cases of Tile C type. Statistical analysis results showed that, the differences in distribution of the number of pelvic ring fracture, the location of pelvic ring fracture and Tile type of pelvic ring fracture in various healing statuses had statistical significance （P<0.05）. Conclusion In determination of the healing status of pelvic fracture, preliminary judgment can be made by using the number of pelvic ring fracture, status of pelvic ring fracture and Tile type of pelvic fracture. Caution is required when dealing with single pelvic fractures （including dislocations）, and determining the destruction of bony pelvis.

Outcome of corrective osteotomy of shortened medial foot column after old talar neck fracture / 中国修复重建外科杂志

Objective: To investigate the effectiveness of corrective osteotomy for shortened medial foot column after old talar neck fracture. Methods: The clinical data of 10 patients with shortened medial foot column after old talar neck fracture between June 2012 and May 2017 was retrospectively analyzed. There were 7 males and 3 females with an average age of 45.8 years (mean, 21-67 years). The time from fracture to corrective osteotomy was 9-60 months (mean, 20.9 months). The preoperative visual analogue scale (VAS) score was 7.1±1.2, the American Orthopaedic Foot and Ankle Society (AOFAS) score was 48.5±12.3, and the short-form 36 health survey scale (SF-36) score was 46.7±10.5. All 10 cases received open wedge osteotomy of medial talus. Among them, 2 received subtalar fusion and Achilles tendon lengthening, 2 lateralizing calcaneal osteotomy, and 2 Achilles tendon lengthening. Results: All incisions healed by first intention. All patients were followed up 13-72 months (mean, 38.0 months). The X-ray film showed that the angle between longitudinal axis of 1st metatarsal bone and talus increased from (-9.6±4.5) ° before operation to (1.3±2.7) ° at last follow-up ( t=16.717, P=0.000); the angle between longitudinal axis of calcaneus and tibia increased from (-12.0±7.4) ° before operation to (-1.5±4.8) ° at last follow-up ( t=5.711, P=0.000). At last follow-up, the VAS score, AOFAS score, and SF-36 score were 1.6±1.0, 88.3±5.4, and 85.4±9.2, respectively, which increased significantly when compared with the preoperative scores ( t=13.703, P=0.000; t=14.883, P=0.000; t=16.919, P=0.000). X-ray film and CT showed that the osteotomy and arthrodesis sites healed well at 2-4 months after operation. Conclusion: It's a proper procedure of anatomic reduction and reconstruction for patients with shortened medial foot column and good articular cartilage morphology after old talar fracture. Opening wedge osteotomy of medial talus is recommended and can obtain satisfactory clinical and radiographic results.

Treatment Of Fractures And Its Complications By Traditional Bone Setters: In A Tertiary Care Hospital.

Background: Fracture of bone is a persistent problem encountered in orthopedic practice globally and its management depends on reduction and immobility at the fracture site. Traditional bone setters are accepting this procedure as a familiar custom to formulate their own methods and practices for the management of fractures. Aim of the Study: The aim of the study is to evaluate and manage the complications occurred during the treatment given by TBS. Methods: One hundred and twenty cases coming to OPD during the period of Aug.2014 to Nov.2016 with some kind of prior treatment received from TBS are included in the study. Each case was subjected to detailed clinical and radiological examinations to evaluate the outcomes of the interventions by TBSs. Results: Malunion is the predominant form of presentation with 54 cases (46%) followed by non union in 24 (20%) cases. 33 cases (28%) presented with impending ischemia at initial stages of treatment. 8 cases (6%) presented with chronic osteomylitis and infected nonunion. Eventually 13 cases ended with gangrene and amputation. Cost of surgery emerged as the major cause (42%) followed by fear of surgery (23%) to receive treatment from TBS. Conclusion: The results in our study vindicate the fact that TBS play a major role in providing health care to the fracture patients. Multiple factors contribute to the wide spread acceptance of TBS in society. Lack of knowledge about the basic anatomy and referral system by TBS is responsible for complications. So it is required to create public awareness and integrating TBS in the healthcare system through proper training and due legislation is the possible aim to be achieved.

Double support technique in malar reduction surgery / 中华整形外科杂志

Objective@#To present a new method for correction of prominent malar complex via intraoral approach by double support technique osteotomy which can provide a stable support.@*Methods@#According to the anatomical characteristics of malar complex and relevant masseter muscle, we designed a malar reduction technique including anterior and posterior support. The reduction procedure entailed an L-shaped osteotomy ofthemalarbody and oblique osteotomy of malar arch. On the basis of prominence degree, bone fragment was moved inward and upward to form double support, which could reduce malar and zygomatic arch effectively.@*Results@#A total of 76 patients subjected to double support technique for malar reduction between January 2015 and January 2017 were retrospectively reviewed.The follow-up period ranged from 10 to 12 months. All patients were satisfied with aesthetic outcomes without major complications, such as facial nerve damage or bone ununion.@*Conclusions@#Double support technique is an effective method to correct malar prominence andreduce the zygomatic complex which can prevent saggy cheek and bony malunion.

Postoperative malocclusion after maxillofacial fracture management: a retrospective case study / 대한악안면성형재건외과학회지

PURPOSE: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. MATERIALS AND METHODS: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors’ department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery. RESULTS: One patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration. CONCLUSIONS: Considering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40902-018-0167-z) contains supplementary material, which is available to authorized users.

Fibular osteotomy and distal tibiofibular joint fusion for treatment of chronic malunited ankle fracture / 中华创伤骨科杂志

Objective To report the clinical treatment of chronic malunited ankle fractures by fibular osteotomy and distal tibiofibular joint fusion.Methods A retrospective analysis was done of the 36 patients with chronic malunited ankle fracture who had been treated from March 2013 to January 2016 in our hospital.They were 20 men and 16 women,aged from 25 to 59 years (average,36.7 years).They were treated by open reduction,fibular osteotomy to correct their rotation deformity,and distal tibiofibular joint fusion.The therapeutic efficacy was assessed postoperatively by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results They were followed up for 10 to 36 months (average,26.5 months).No nonunion,implant failure or infection was observed.The AOFAS ankle-hindfoot score increased significantly from preoperative 36.4 ± 7.8 to 82.1 ± 9.4 at the final follow-up (t =73.379,P =0.000).An excellent and good rate of 86.1％ was achieved,giving 9 excellent,22 good and 5 fair cases.Mild limitation in ankle flexion and extension was observed in 5 cases.No significant differences were found between final follow-ups and preoperation regarding the ankle plantar flexion (32.0°± 2.4° versus 31.8° ± 3.5°) or the ankle dorsal extension (18.2° ± 1.7° versus 17.4° ± 2.4°) (P ＞ 0.05).Conclusion Fibular osteotomy and distal tibiofibular joint fusion can result in fine clinical effects in the treatment of chronic malunited ankle fractures.

Wedge osteotomy and subtalar arthrodesis for rockbottom malunion after calcaneal fracture / 中华创伤骨科杂志

Objective To evaluate the clinical results of wedge osteotomy and subtalar arthrodesis for rockbottom malunion after calcaneal fracture.Methods From February 2014 to February 2015,9 cases of rockbottom malunion after calcaneal fracture were treated with wedged osteotomy and subtalar arthrodesis.They were 8 men and one woman,aged from 31 to 49 years (average,40.5 years).Weight-bearing X-rays were taken before surgery and at final follow-ups.Talar declination,lateral talocalcaneal angle,lateral talo-first metatarsal angle and B(o)hler's angle were used to evaluate correction of the malunion.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and visual analogue scale (VAS) for pain were used to assess functional recovery.Results Eight of them were fully followed up for an average time of 30.6 months (from 27 to 38 months).All the osteotomy sites and subtalar joints obtained bony union after an average of 17.1 weeks (from 12 to 22 weeks).The talar declination was improved from 2.5° (from-6° to 13°) preoperatively to 13.2° (from 5° to 19°) postoperatively,the lateral talocalcaneal angle from-0.2° (from-15° to 10°) preoperatively to 20.2° (from 7° to 25°) postoperatively,the talo-first metatarsal angle from 21.1° (from 10° to 30°) preoperatively to 9.9° (from 5° to 14°) postoperatively,and the calcaneal B(o)hler' s angle from-25.6° (from-39° to-10°) preoperatively to 22.4° (from 10° to 35°) postoperatively.The AOFAS score averaged 26.6° (from 12 to 53) preoperatively and 79.7 (from 72 to 89) at the final follow-up;the VAS score averaged 7.5 (from 6 to 9) preoperatively and 2.6 (from 2 to 3) at the final follow-up.Both scores demonstrated improvements after operation.Conclusions Since the pathoanatomy of rockbottom malunion after calcaneal fracture consist in severe loss of calcaneal height,resulting in horizontalization of the talus and anterior ankle impingement,wedge osteotomy and sutalar arthrodesis can effectively correct the malunion,restore the loss of calcaneal height and hindfoot malalignment,and relieve the symptoms.

Diagnosis and treatment of malunited ankle fractures / 中华创伤骨科杂志

Incidence of ankle fractures is relatively high.Malunited ankle fractures result from inappropriate nonoperative treatment and incorrect surgery as well.It is not difficult to diagnose a malunited ankle fracture when taking history,symptoms and imaging examinations into consideration.Orthopaedic surgeons used to do ankle fusion for this kind of patients as the effect of reconstructive surgery is not clear.This article summarizes the diagnostic and therapeutic methods for ankle fracture malunion based on the articles from 1976 to 2015.More detailed therapeutic methods for deformities involving lateral malleolus,tibiofibular syndesmosis,medial malleolus and posterior malleolus are also reviewed.

Fibular osteotomy and distal tibiofibular joint fusion for treatment of chronic malunited ankle fracture / 中华创伤骨科杂志

Objective To report the clinical treatment of chronic malunited ankle fractures by fibular osteotomy and distal tibiofibular joint fusion.Methods A retrospective analysis was done of the 36 patients with chronic malunited ankle fracture who had been treated from March 2013 to January 2016 in our hospital.They were 20 men and 16 women,aged from 25 to 59 years (average,36.7 years).They were treated by open reduction,fibular osteotomy to correct their rotation deformity,and distal tibiofibular joint fusion.The therapeutic efficacy was assessed postoperatively by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results They were followed up for 10 to 36 months (average,26.5 months).No nonunion,implant failure or infection was observed.The AOFAS ankle-hindfoot score increased significantly from preoperative 36.4 ± 7.8 to 82.1 ± 9.4 at the final follow-up (t =73.379,P =0.000).An excellent and good rate of 86.1％ was achieved,giving 9 excellent,22 good and 5 fair cases.Mild limitation in ankle flexion and extension was observed in 5 cases.No significant differences were found between final follow-ups and preoperation regarding the ankle plantar flexion (32.0°± 2.4° versus 31.8° ± 3.5°) or the ankle dorsal extension (18.2° ± 1.7° versus 17.4° ± 2.4°) (P ＞ 0.05).Conclusion Fibular osteotomy and distal tibiofibular joint fusion can result in fine clinical effects in the treatment of chronic malunited ankle fractures.

Malunion: Deformity Correction of the Upper Extremity

Malunions after fractures are classified as shortened, angulated, torsion, or rotational deformities that is outside the acceptable range, regardless of the location, whether upper or lower extremity. The distinct feature of a malunion in the upper extremity is that it is free from weight bearing; thus, some degree of shortening is allowed compared with the contralateral normal side in long bones, such as the humerus, radius, or ulna. However, malunions associated with functional impairment, especially angulated or rotational deformities, are more likely to develop instability, degenerative lesions, or rarely, compressive neuropathy. Hence, malunions with such association may occasionally require correction.

A Correction of Malunion or Deformity in the Lower Extremity

The incidence of malunion in the long bone with has been reduced because of the advancements in surgical technique. However, nonunion or malunion are still observed in mechanical axis deformation of the lower limb, resulting in the overload of cartilage and instability of the joint, requiring surgical correction. Preoperative planning for malunion is very important, and accurate evaluation of the deformity is essential. Herein, we describe the indications of corrective osteotomy, choice of patients, and various surgical methods for the treatment of malunion of the long bone.