Application of one-third tubular steel plates and screws for fixation of medial column in pilon fractures.

Background: The present study sought to explore the efficacy of one-third tubular steel plates and screws for the treatment of medial column of pilon fractures. Methods: The present retrospective study comprised 40 subjects with Rüedi-Allgöwer type III pilon fractures that attended Northern Jiangsu People's Hospital from April 2016 to April 2019. Patients were assigned to 2 groups based on reconstruction and fixation components used on the medial column. The medial column of participants in the control group (n=20) was anchored using screws. The medial column for subjects in the treatment group (n=20) was reconstructed using a one-third tubular steel plate. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at 1, 2, 3, 6, 12 and 24 months after operation, intraoperative blood loss, fracture healing time, preoperative detumescence duration, operation time, postoperative weightbearing duration, and postoperative Burwell-Charnley radiological score of the 2 groups were compared. Results: The findings showed that intraoperative blood loss, preoperative detumescence time, and operation time for the treatment group were not statistically different relative to the control group (P>0.05). The fracture healing time and postoperative weightbearing time in the treatment group were 15.07±0.98 weeks and 6.91±0.61 weeks, respectively, while those in the control group were 15.84±0.59 weeks and 8.60±0.53 weeks, respectively (P<0.05). Patients in the treatment group showed markedly higher AOFAS scores relative to the AOFAS scores of subjects in the control group at month 1, 2, and 3 post-operation (P<0.05). AOFAS scores for the 2 groups were not significantly different at month 6, 12 and 24 post-operation. Subjects in the control group had a significantly lower Burwell-Charnley number radiology score relative to that of subjects in the treatment group (P<0.05). Conclusions: The present findings show that the medial column of subjects with Rüedi-Allgöwer type III pilon fracture can be repaired using a one-third tubular steel plate. Compared with simple screw fixation, the use of a one-third tubular steel plate allows earlier postoperative weightbearing, decreases the rate of postoperative reduction loss, and leads to better clinical effects and prognosis.

Comparison of navigated and conventional high tibial osteotomy for the treatment of osteoarthritic knees with varus deformity: A meta-analysis.

BACKGROUND: High tibial osteotomy (HTO) is a usefully surgical procedure to correct the malalignment and delay the progression of osteoarthritis. It is still controversy whether navigation system can offer more accuracy of targeted alignment and achieve better clinical outcomes than conventional method. The purpose of present meta-analysis was to investigate whether navigation system was superior to conventional method with regard to clinical and radiographic outcomes. METHOD: The included studies compared the clinical and radiographic outcomes between navigated HTO group and conventional group. The clinical assessments were Lysholm Score, AKS Function Score and Arc of motion, and the radiographic outcomes were Mechanical axis (MA), Weight bearing line ratio (WBL), Outliers of alignment and Change in TPS used to evaluate alignment correction. The meta-analysis was performed using Review Manager 5.3 software. Downs and Black and the Newcastle-Ottawa Scale (NOS) were used to evaluate the study quality. RESULT: Sixteen studies were eligible in present meta-analysis, including thirteen studies concerning opening wedge HTO and three studies involving closing wedge HTO. Clinical outcomes were only reported in studies which used opening wedge HTO. No significant differences were observed in all clinical outcomes between navigated and conventional HTO. Regarding radiographic outcomes, no significant difference in WBL ratio was observed between navigated and conventional HTO. Patients undergoing navigated HTO were associated with significantly greater in MA and lower in Outliers of alignment compared with those undergoing conventional HTO. Compared with conventional HTO, increase in TPS was significantly lower in navigated HTO group using opening wedge HTO, but decrease in TPS was significantly greater in navigated HTO group using closing wedge HTO. CONCLUSION: Our meta-analysis demonstrated that navigated HTO offered more accuracy and precision of alignment correction, except WBL ratio. However, better clinical outcomes were not observed in navigation group.

[Classification and treatment of syndesmotic injury].

The distal tibiofibular syndesmosis is a critical structure in maintaining the ankle stability. Syndesmotic injuries are usually associated with ankle fractures and high fibula fractures. Non-isolated and partially isolated syndesmotic injuries are involved in unstable injuries, which need to operative treatment. Partially isolated syndesmotic injuries belong to stable injuries, which should be treated with non-operative management. It is becoming clear that early fixation and stabilization for unstable injuries are probably better than non-treatment or delayed treatment. It still remains without consensus of accurately defining stable from unstable injuries and sufficiently differentiating between acute and chronic injuries. Because of stability, fixation type, and duration, the clinical efficacy is different. Screw fixation is a gold standard treatment of syndesmotic injury. However, it remains controversial that whether removal of the syndesmotic screw is required and effect of the level of syndesmotic screw insertion, limited micro-movement is one of disadvantages of screw fixation. Micro-movement of the distal tibiofibular syndesmosis has been paid more and more attention. Dynamic fixation is a viable alternative to the static fixation device, with lower re-operation rates and less complications, which has obtained a great short-term clinical efficacy. However, further long-term studies should be carried out to confirm this clinical efficacy. Optimized treatment strategies considering stability of syndesmotic injury, duration, and fixation type can help to improve clinical efficacy.