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<p><b>OBJECTIVE</b>To explore clinical outcomes of buttress plating in treating posterior Pilon fracture by amodified posteromedial approach.</p><p><b>METHODS</b>From July 2014 to January 2015, 10 patients with posterior Pilon fracture were respectively analyzed, including 7 females and 3 males, aged from 31 to 54 years old. One patient were type , 3 patients were type IIand 6 patients were type III according to classification of Pilon fracture by YU Guang-rong. All patients were treated by buttress plating through amodified posteromedial approach. Postoperative complications, fracture healing and reduction were observed, AOFAS score were used to evaluate function recovery at 1 year after operation.</p><p><b>RESULTS</b>All patients were followed up for 12 to 18 months with an average of(14.1±3.2) months. All incisions were primarily healed at stage I without wound complication, neurovascular injuries or musculus flexor contracture. According to Burwell-Charnley imaging scoring, 8 patients got anatomical reduction and 2 patients got moderate reduction. All fracture got healing from 12 to 16 weeks with an average of(13.2±1.8) weeks. According to AOFAS score at 1 year after operation, 8 got excellent results and 2 moderate. All patients returned to work at about(4.7±1.4) months (ranged from 3 to 6 months) after operation.</p><p><b>CONCLUSIONS</b>Buttress plating using a modified posteromedial approach in treating posterior Pilon fractures is an effective method, has less complications, and could recovery early weight-bearing functional exercise.</p>
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<p><b>OBJECTIVE</b>To investigate clinical effects of chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft.</p><p><b>METHODS</b>From September 2014 to November 2016, 28 patients with chronic anterolateral ankle instability underwent lateral ligament reconstruction with semitendinosus autograft. Among them, including 20 males and 8 females with an average age of 28.6 years(18 to 47 years old). Preoperative complications were recorded. AOFAS and VAS score were used to evaluate clinical outcomes.</p><p><b>RESULTS</b>Twenty-eight patients were followed up from 6 to 28 months with an average of 18.2. No iatrogenic fracture or infection occurred. There was no ankle instability or limited at the latest follow-up. AOFAS score was improved from 53.1±6.8 before operation to 90.4±5.9 at the latest follow-up , and had statistical difference(<0.05); while VAS score was increased from 6.3±1.7 before operation to 0.8±0.5 at the lastest follow-up(<0.05).</p><p><b>CONCLUSIONS</b>Chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft has advantages of simple operation, good recovery, less compilations and good clinical effects. It is one of stable methods for the treatment of chronic anterolateral ankle instability.</p>
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Chronic ankle instability is a common disease which is caused by missed diagnosis or inappropriate treatment of acute ankle sprain. It could lead to long-term pain, traumatic arthritis and malfunctions. While the consistent standard for its diagnosis and treatment has not yet formed. There are a lot of inspection items, such as X-ray, MRI, B ultrasoud. For the treatment of CAI, surgery is the primary method for treatment of chronic ankle instability, but clinicians may be confused with variety operation ways, which were reported with different clinical efficacy. In recent years, the non-anatomical repair has been turn to anatomy reconstruction in the surgical treatment of CAI.
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<p><b>OBJECTIVE</b>To evaluate the early clinical and radiographic outcome of scaphoid non-unions treated with Acutrak headless compression screw.</p><p><b>METHODS</b>From January 2008 to July 2011,21 patients with scaphoid non-union were treated in our department. There were 18 males and 3 females with a mean age of (23.6 +/- 4.6) years; 12 cases were on right hand and 9 were on left. According to Herbert-Fisher classification, there were 10 cases with type D1, 7 cases with type D2, 3 cases with type D3, and 1 case with type D4. The mean time from injury to operation was (12.4 +/- 2.7) months. All patients were treated with Acutrak headless compression screw fixation (6 cases received 2 screws fixation, 15 cases received 1 screw fixation, and Matti-Russe bone grafting was applied in 7 cases). The carpal height, the scaphoid index and changes of the scapholunate angle were assessed before and after the operation. Range of motion and grip strength were recorded and the wrist function was assessed according to the Patient-Rated Wrist Evaluation (PRWE).</p><p><b>RESULTS</b>Average duration of follow-up was (21.3 +/- 3.6) months. All the patients attained radiological union in a mean time of (13.3 +/- 2.4) weeks following the operation. No obvious complications were recorded. The surgical treatment allowed the preoperative mean scaphoid index of 0.61 +/- 0.13 and the preoperative mean scapholunate angle of (59.4 +/- 6.8) degree to be improved to 0.69 +/- 0.10 and (44.3 +/- 8.2)degree postoperatively, respectively. There was a substantial improvement in grip strength and pain amelioration after surgery. The preoperative mean PRWE score of 45.2 +/- 4.7 was improved to 76.1 +/- 5.2 postoperatively. All patients returned back to the original work,the average time from surgery to work was (6.0 +/- 1.1) months.</p><p><b>CONCLUSION</b>For scaphoid non-unions, Acutrak headless compression screw fixation can provide anatomical reduction, provide satisfactory results with a high union rate, well return of function and minimal complications in the early stage.</p>