Open reduction and internal fixation of posterior pilon fractures with buttress plate.

OBJECTIVE: Posterior pilon fractures are rare injuries and have not yet gained well recognition. The purpose of this study was to present the treatment outcome for patients with posterior pilon fractures treated with buttress plate. METHOD: In this retrospective study we identified patients with posterior pilon fractures of the distal tibia who had undergone open reduction and internal fixation at our institute. Between January 2007 and December 2009, 10 patients (mean age, 46.5 years) who had undergone buttress plating via either a posterolateral approach or a dual posterolateral-posteromedial approach, were selected. All 10 patients were available for follow-up. The clinical outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS). The radiological evaluation was performed using the osteoarthritis-score (OA-score). RESULTS: Satisfactory reduction and stable fixation were accomplished in all patients. At a mean follow-up of 36.2 months, all patients had good radiological results and showed satisfactory clinical recovery. The mean AOFAS sore was 87.8, the mean OA-score was 0.6, and the mean VAS scores during rest, active motion, and weight-bearing walking were 0.6, 0.8, and 1.4, respectively. CONCLUSION: Buttress plating for posterior pilon fractures gave satisfactory clinical outcomes. It also ensured rigid fixation which in turn enabled earlier postoperative mobilization. Level of Evidence IV, Retrospective Study.

Anatomy and biomechanical properties of the plantar aponeurosis: a cadaveric study.

OBJECTIVES: To explore the anatomy of the plantar aponeurosis (PA) and its biomechanical effects on the first metatarsophalangeal (MTP) joint and foot arch. METHODS: Anatomic parameters (length, width and thickness of each central PA bundle and the main body of the central part) were measured in 8 cadaveric specimens. The ratios of the length and width of each bundle to the length and width of the central part were used to describe these bundles. Six cadaveric specimens were used to measure the range of motion of the first MTP joint before and after releasing the first bundle of the PA. Another 6 specimens were used to evaluate simulated static weight-bearing. Changes in foot arch height and plantar pressure were measured before and after dividing the first bundle. RESULTS: The average width and thickness of the origin of the central part at the calcaneal tubercle were 15.45 mm and 2.79 mm respectively. The ratio of the length of each bundle to the length of the central part was (from medial to lateral) 0.29, 0.30, 0.28, 0.25, and 0.27, respectively. Similarly, the ratio of the widths was 0.26, 0.25, 0.23, 0.19 and 0.17. The thickness of each bundle at the bifurcation of the PA into bundles was (from medial to lateral) 1.26 mm, 1.04 mm, 0.91 mm, 0.84 mm and 0.72 mm. The average dorsiflexion of the first MTP joint increased 10.16° after the first bundle was divided. Marked acute changes in the foot arch height and the plantar pressure were not observed after division. CONCLUSIONS: The first PA bundle was not the longest, widest, or the thickest bundle. Releasing the first bundle increased the range of motion of the first MTP joint, but did not acutely change foot arch height or plantar pressure during static load testing.

Open reduction and internal fixation of posterior pilon fractures with buttress plate

Objective: Posterior pilon fractures are rare injuries and have not yet gained well recognition. The purpose of this study was to present the treatment outcome for patients with posterior pilon fractures treated with buttress plate. Method: In this retrospective study we identified patients with posterior pilon fractures of the distal tibia who had undergone open reduction and internal fixation at our institute. Between January 2007 and December 2009, 10 patients (mean age, 46.5 years) who had undergone buttress plating via either a posterolateral approach or a dual posterolateral-posteromedial approach, were selected. All 10 patients were available for follow-up. The clinical outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS). The radiological evaluation was performed using the osteoarthritis-score (OA-score). Results: Satisfactory reduction and stable fixation were accomplished in all patients. At a mean follow-up of 36.2 months, all patients had good radiological results and showed satisfactory clinical recovery. The mean AOFAS sore was 87.8, the mean OA-score was 0.6, and the mean VAS scores during rest, active motion, and weight-bearing walking were 0.6, 0.8, and 1.4, respectively. Conclusion: Buttress plating for posterior pilon fractures gave satisfactory clinical outcomes. It also ensured rigid fixation which in turn enabled earlier postoperative mobilization. Level of Evidence IV, Retrospective Study. .

Desfechos clínicos de tratamento cirúrgico de más uniões ou não consolidadas do tálus / Clinical outcomes of surgical treatment for talar malunions and nonunions

Objetivo: apresentar nossas experiências no tratamento de más uniões ou não consolidações talares. Método: entre janeiro de 2000 e setembro de 2009, 26 pacientes com má união ou nãounião depois de fraturas do tálus foram submetidos a tratamento cirúrgico de acordo com os diferentes tipos de deformidade talar. Os desfechos do tratamento foram avaliados pela escala tornozelo-retropé da AOFAS, assim como por radiografias simples. Resultados: 20 pacientes ficaram disponíveis para acompanhamento por 30 (24 a 60) meses. Não houve problema de cicatrização ou infecção das feridas e foram obtidas uniões sólidas em todos os pacientes. As uniões radiológicas foram atingidas em tempo médio de 14 (faixa de 12 a 18) semanas. O tempo médio para concluir o apoio de carga foi 16 (faixa de 14 a 20) semanas. O escore AOFAS médio aumentou significantemente de 36,2 (27 a 43) para 85,8 (74 a 98). Conclusão: as intervenções cirúrgicas das fraturas mal-unidas ou não consolidadas dos tálus podem produzir resultados satisfatórios e o procedimento apropriado deve ser adotado, de acordo com diferentes tipos de deformidades pós-traumáticas. Nível de Evidência: IV, Estudo Retrospectivo.

Objective: To present our experiences of treating talar malunions and nonunions. Method: between January 2000 and September 2009, 26 patients with malunions or nonunions after talar fractures underwent surgical treatment according to different types of talar deformities. The treatment outcomes were evaluated using AOFAS ankle-hindfoot scale as well as plain radiographs. Results: 20 patients were available for follow-up for 30 (range, 24 to 60) months. No wound healing problems or infections occurred and solid unions were achieved in all patients. Radiological unions were achieved at a mean time of 14 (range, 12 to 18) weeks. The mean time to complete weight-bearing was 16 (range, 14 to 20) weeks. The mean AOFAS score increased significantly from 36.2 (range, 27 to 43) to 85.8 (range, 74 to 98). Conclusion: surgical interventions for malunions and nonunions after talar fractures can bring about satisfactory outcomes, and the appropriate procedure should be adopted according to different types of posttraumatic deformities. Level of Evidence: IV, Retrospective Study.

Clinical outcomes of surgical treatment for talar malunions and nonunions.

OBJECTIVE: To present our experiences of treating talar malunions and nonunions. METHOD: Between January 2000 and September 2009, 26 patients with malunions or nonunions after talar fractures underwent surgical treatment according to different types of talar deformities. The treatment outcomes were evaluated using AOFAS ankle-hindfoot scale as well as plain radiographs. RESULTS: 20 patients were available for follow-up for 30 (range, 24 to 60) months. No wound healing problems or infections occurred and solid unions were achieved in all patients. Radiological unions were achieved at a mean time of 14 (range, 12 to 18) weeks. The mean time to complete weight-bearing was 16 (range, 14 to 20) weeks. The mean AOFAS score increased significantly from 36.2 (range, 27 to 43) to 85.8 (range, 74 to 98). CONCLUSION: Surgical interventions for malunions and nonunions after talar fractures can bring about satisfactory outcomes, and the appropriate procedure should be adopted according to different types of posttraumatic deformities. LEVEL OF EVIDENCE: IV, Retrospective Study.

Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis.

BACKGROUND: There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture-operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures. METHODS: We searched multiple databases in English (including EMBASE, PubMed, and OVID) and in Chinese (including CNKI, WANFANG, and VIP), as well as reference lists of articles and main orthopaedic and sports medical journals. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by RevMan 5.0 software. RESULTS: Eight randomized controlled trials (RCTs) involving 777 patients met the inclusion criteria. The rerupture rate in non-operative group was significantly higher (Z = 3.33, P < 0.01). However, the moderate (Z = 4.27, P < 0.01) and minor (Z = 5.59, P < 0.01) complication rate in the operative group were significantly higher. No significant difference in comparing the major and total complication rates. The return to work time in the operative group was shorter (Z = 2.65, P < 0.01). The inability to return to previous level sporting rate and ankle joint decreased range of motion (ROM) rate showed no significant difference in the two groups. Other functional outcomes were similar in the two groups. CONCLUSIONS: Operation could significantly reduce the risk of rerupture; however, it was associated with a higher risk of other complications. The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively. Thus operative treatment is preferable for patients with good physical condition. Non-operative treatment is an acceptable alternative especially for the older and patients with lower sporting requirements.