Early effectiveness of a new minimally invasive plate in treatment of varus-type ankle arthritis / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the early effectiveness of a new minimally invasive plate in the treatment of varus-type ankle arthritis.@*METHODS@#A clinical data of 15 patients with varus-type ankle arthritis who met the selection criteria between March 2021 and October 2021 were retrospectively analyzed. All the patients were treated with medial open-wedge supramalleolar osteotomy and fibular osteotomy. The osteotomies were fixed with the new minimally invasive plate. There were 7 males and 8 females with an average age of 49.8 years (range, 16-71 years). The causes of ankle arthritis included post-fracture deformity in 1 case, sprain in 8 cases, and acquired clubfoot in 1 case; and 5 cases were without obvious factors. The disease duration ranged from 1 to 12 years, with an average of 4.1 years. Comparisons were made between pre-operation and the last follow-up in the Takakura staging, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, foot function index (FFI), visual analogue scale (VAS) score, tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT).@*RESULTS@#All incisions healed by first intention. All patients were followed up 7-18 months (mean, 12.8 months). At last follow-up, the AOFAS ankle-hindfoot score, FFI, VAS score, and Takakura staging significantly improved when compared with the preoperative ones ( P<0.05). X-ray films showed that the osteotomy healed at 3 months after operation. At last follow-up, TAS significantly increased and TT decreased when compared with the preoperative ones ( P<0.05), and the difference in TLS between pre- and post-operation was not significant ( P>0.05). Complications included 1 case of intraoperative screw breakage and 2 cases of nerve injury of the affected foot. None of the patients complained of significant discomfort at the plate placement during follow-up, and no loosening of the internal fixator occurred. Eleven patients were very satisfied with the effeectiveness, while 4 were relatively satisfied.@*CONCLUSION@#The new minimally invasive plate for the varus-type ankle arthritis has good early effectiveness in relieving ankle pain, correcting deformity, improving limb alignment and ankle function, and reducing the incidence of postoperative incisional complications.

Fibula-preserving anterolateral approach for tibiotalocalcaneal arthrodesis: clinical and radiographic outcomes / 中华创伤骨科杂志

Objective:To evaluate the clinical and radiographic outcomes of tibiotalocalcaneal arthrodesis via the fibula-preserving anterolateral approach.Methods:From March 2018 to February 2021, 23 patients underwent tibiotalocalcaneal arthrodesis via the fibula-preserving anterolateral approach at the Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital.Of them, 15 were males and 8 females. Their average age at surgery was 54.4 years (range, from 28 to 72 years). There were 11 cases of traumatic arthritis, 2 cases of Charcot arthropathy, 6 cases of neurogenic equinovarus, 2 cases of traumatic equinovarus, and 2 cases of Kashin-Beck disease. Comparisons were made between preoperation and the last follow-up in ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS), visual analogue scale (VAS), foot function index (FFI), hindfoot alignment angle (HA), hindfoot alignment distance (HD), and hindfoot alignment ratio (HR). The tibia-foot angle on lateral weight-bearing and patient satisfaction at the last follow-up and postoperative complications were documented.Results:This cohort were followed up for an average of 24.7 months (from 12 to 48 months). The AOFAS ankle-hindfoot score (78.2 ± 9.2), VAS [2.0 (0.5, 2.0)], FFI [19.0 (10.5, 35.0)], HA (2.7° ± 5.8°), HD [(0.1 ± 0.8) cm] and HR [44.2 (36.4, 59.2)%] at the last follow-up were significantly improved than the preoperative values [43.4 ± 12.7, 4.0 (4.0, 6.0), 98.0 (60.0, 127.0), 22.0° ± 14.3°, (2.2 ± 1.6) cm and 86.0 (66.3, 100.0)%] (all P<0.05). The tibia-foot angle on lateral weight-bearing was 89.0° (87.1°, 90.4°) at the last follow-up. By the Likert scale, 17 cases were very satisfied with the surgery, 4 cases satisfied and 2 cases tolerate, giving a satisfaction rate of 91.3%(21/23). Infection occurred in one case and nonunion in one. Conclusion:Tibiotalocalcaneal arthrodesis via the fibula-preserving anterolateral approach yields good mid- to short-term clinical and radiographic outcomes, showing a strong capability to correct ankle and hindfoot varus and equinus.

Surgical treatment of chronic Lisfranc injuries: short- and mid-term clinical outcomes / 中华创伤骨科杂志

Objective:To explore the short- and mid-term clinical outcomes of surgical treatment of chronic Lisfranc injuries.Methods:A retrospective analysis was conducted of the clinical and imaging data of the 19 patients with chronic Lisfranc injury who had been treated surgically from April 2013 to September 2020 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 13 males and 6 females, aged from 25 to 58 years (mean, 49 years). The median course of disease before operation was 24 months (from 3 to 312 months). All patients underwent fusion of the 1st, 2nd and 3rd tarsometatarsal joints (TMTJ) plus reduction and fixation or arthroplasty of the 4th and 5th TMTJ by the same surgeon. The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS) and Lublin score between pre-operation and the final follow-up and by Likert satisfaction scale and post-operative complications as well.Results:The 19 patients were followed up for (66.1±23.2) months (from 12 to 104 months). At the final follow-up, the AOFAS midfoot score was 87 (79, 90), the VAS score 1 (0, 2), and the Lublin score 70 (60, 75), all significantly improved compared with their preoperative corresponding values [51 (44, 63), 4 (4, 6) and 50 (40, 55), respectively] ( P<0.05). Sixteen patients were satisfied with their surgery. Fusion was not healed in 3 cases; plate breakage happened in one case but none of the cases had infection or other complications related to the skin or wound. Conclusion:Fusion of the 1st, 2nd and 3rd TMTJ plus reduction and fixation or arthroplasty of the 4th and 5th TMTJ can lead to good short- and mid-term clinical outcomes in the surgical treatment of chronic Lisfranc injuries.

Supramalleolar dome osteotomy for varus-type ankle arthritis: radiologic and clinical outcomes / 中华创伤骨科杂志

Objective:To evaluate the radiologic and clinical outcomes of supramalleolar dome osteotomy in the treatment of varus-type ankle arthritis.Methods:From June 2018 to December 2019, 13 patients with varus-type ankle arthritis underwent supramalleolar dome osteotomy at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. Of them, 13 (5 males and 8 females) were included in the study. Their average age at surgery was 47.2 years (range, from 16 to 65 years). By the modified Takakura staging for arthritis, 3 cases were stage 2, 4 cases stage 3a and 6 cases stage 3b. Comparisons were made between preoperation and the last follow-up in ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS), foot function index (FFI), visual analogue scale (VAS), Takakura staging, dorsal extension, plantar flexion, range of motion (ROM), tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT).Results:This cohort were followed up for 12 to 29 months (average, 17.2 months). At the last follow-up, AOFAS score (86.5±8.0), FFI (14.5±1.6), VAS score (1.5±1.0), Takakura staging (2.7±1.3), ROM (39.4°±8.0°), TAS (92.4°±6.0°), TT (3.7°±4.4°) were significantly improved than the preoperative values (68.3±14.4, 43.7±3.0, 4.2±1.4, 3.2±0.8, 43.3°±7.6°, 78.2°±8.3° and 7.0°±5.1°), and dorsal extension (10.9°±4.4°) was significantly smaller than the preoperative value (13.6°±5.1°) (all P<0.05). There were no significant differences between preoperation and the last follow-up in plantar flexion (29.7°±4.6° versus 28.5°±5.2°) or TLS (77.8°±4.5° versus 78.1°±5.3°) ( P>0.05). Conclusions:Supramalleolar dome osteotomy has shown promising short-term clinical efficacy in the treatment of varus-type ankle arthritis. It can significantly relieve pain, improve function, substantially correct deformity and retard progression of arthritis, but it may affect dorsal extension.

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.

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.

Prognostic characteristics of the patients of different ages and genders after pilon fracture / 中华创伤骨科杂志

Objective To analyze the associations of age and gender with post-operative outcomes after pilon fracture and the effect of interaction between age and gender on the outcomes.Methods A retrospective cohort study was performed of the 101 successive patients with pilon fracture who had been treated by open reduction and internal fixation from March 2009 to November 2013 and completely followed up.The distributions of potential prognostic factors (diabetes,injury mechanism,open fracture,Rüedi-Allg(o)wer classification and AO classification) were analyzed in different age and gender groups.The outcomes were evaluated in terms of reduction quality by the Burwell-Charnley criteria,time for return to work,traumatic osteoarthritis by Kellgren-Lawrence grading scale and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.The odds ratio and regression coefficients were estimated by Logistic regression and linear regression model;P values for interaction between age and gender were estimated by likelihood ratio tests.Results Of all the 101 pilon patients,84 were male and 12 were the aged.The distributions of gender (P =0.028) and mechanism (P =0.032) were significantly different between the aged and the younger patients,showing there were more females in the aged patients and low-energy injury was more likely to cause a pilon fracture in the aged patients.As multivariate analyses suggested,with the above influencing factors controlled,a median follow-up of 41.2 months revealed age was an independent favorable prognostic factor for reduction quality (OR =3.919,P =0.041).The association between gender and time for return to work was significantly different between the aged and the younger patients,as indicated by interaction analyses (P =0.030).Conclusions There may be more females in the aged patients with pilon fracture than in the younger ones.It is likely that the aged patients sustain a pilon fracture because of low-energy injury and achieve a fracture reduction of poorer quality.Although the quality of reduction may be poorer for the aged,there may be no significant difference between the aged and the younger patients in the mid-long-term AOFAS score.It is advisable for surgeons to provide personalized treatment to better help the patients.

Total ankle replacement for end-stage ankle arthritis: outcome and indications / 中华骨科杂志

Objective To explore the clinical results of total ankle replacements with the Scandinavian Total Ankle Replacement (STAR) prosthesis for end-stage ankle arthritis.Methods Data of 73 cases with end-stage ankle arthritis who received Scandinavian total ankle replacement from January 2005 to May 2013 were retrospectively analyzed.They were 34 males and 39 females,with an average age of 59.6 years old (range,37-76 years old),average body mass index (BMI) of 25.3 kg/m2 (range,21.8-28.0 kg/m2).All patients were classified into stage-3 arthritis according to Morrey-Wiedeman.Kofoed,American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scale (VAS) were used to evaluate the function of foot and ankle.Patients with a hindfoot deformity below 10° were compared with those who above 10°;and patients above 55 years old were compared with those who below it.Results 5 replacement failed (2 liner ruptured and received replacement;2 metal components displaced,1 received TTC fusion and the other underwent revision with inferior tibiofibular joint fusion,the last patient suffered from deep infection and received the STAR removal and secondary fusion) in 73,and the rest were followed up for 12 to 110 months (average,55.2 months).59 patients were satisfied with or without reservations.The satisfaction rate was 80.8％ (59/73).The pre-op values of AOFAS,Kofoed,VAS and range of motion (ROM) were 46.6±3.5,43.0±4.7,8.7±0.7,34.4°±7.1° and the post-op values were 86.6±4.3,82.6±4.6,3.0±1.0,45.1°±8.2° respectively,and all were significantly improved compared with before.The AOFAS,AOFAS Function and ROM values of patients below 55 years old were 86.1±3.8,47.0±2.7,45.7°±7.0°,and the same values of patients above 55 were 86.7±4.6,46.8±3.1,44.9°±8.8°.The AOFAS,AOFAS Function and ROM values of patients with above 10° coronal deformity were 86.1±4.7,47.0±2.7,43.0°±7.7°,and the same values of patients below 10° were 86.8±4.2,46.8±3.1,46.1°±8.2°.There was no difference between the groups.Conclusion The STAR is the preferable surgical treatment option in patients with end-stage ankle arthritis,showing high reliability and effectivity in pain relieving and function improvement.

Ankle arthrodesis for posttraumatic ankle arthritis / 中华骨科杂志

Objective To explore the short-term clinical outcomes of ankle arthrodesis for the treatment of posttraumatic ankle arthritis.Methods Retrospectively study the data of 47 patients with posttraumatic ankle arthritis who were followed up after receiving ankle arthrodesis from January 2008 to May 2012.There were 28 males and 19 females,with an average age of 44 years (range,14-72 years).All of them wereclassified into stage-3 arthritis according to Morrey-Wiedeman,among whom 31 had obvious foot varus deformity or equines deformity,and 16 were almost normal in appearance.The ankle joint function of patients were assessed by Kofoed,American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score,Maryland foot score systems and visual analog scale (VAS) preoperatively and at the last follow-up.Results The patients were followed up from 5 to 52 months (average,25 months).All the ankles got fused at the last follow-up,with one receiving removal of internal fixation and debride because of infection.Forty-three patients were satisfied with or without reservations; the others thought it so.The satisfaction rate was 91.5％(43/47).The Kofoed,AOFAS,Maryland foot scores and VAS were significantly improved from 48.11 ±5.00,53.38±5.52,49.74±5.71,7.89±0.87 to 80.96±6.07,82.21±4.26,88.94±5.14,2.28±1.10 respectively at the last follow-up.The normotopia X-ray of ankle joint showed that there were 22 cases in which the ankle got fused at neutral position,19 cases in which the eversion was less than 5°,3 cases in which the eversion was between 5° to 10°,2 cases in which the varus was less than 5°,and 1 case in which the varus was between 5° to 10°.Lateral X-ray showed that there were 32 cases in which the ankle got fused in dorsiflexion neutral position,12 cases plantar flexion 5°,and 3 cases plantar flexion 5° to 10°.Conclusion Ankle arthrodesis is still the preferable surgical treatnent option in patients with end-stage ankle arthritis,which shows high reliability and effectively in correcting deformity,pain relieving and function improvement.