It is difficult to treat the intra-articular fracture of distal tibia or Pilion’s fracture. From 1987 to 1995, 43 cases of Pilon’s fracture were admitted and treated with different methods. After treatment, they had been followed up for 1 to 8 years. According to Riiedi’s Classification, , there were type Ⅰ 12 cases, type Ⅱ 21 cases and type Ⅲ 10 cases. The methods used on these patients included manual reduction and plaster of paris immobilization, calcaneous tubercle traction and plaster of paris immobilization, open reduction and internal fixation with Kirschner wires, and open reduction and internal fixation with AO plate. The outcome was evaluated according to Ovadias criteria, for type I fracture, 8 cases were treated with conservative method with a satisfactory rate of 79.17% and 4 cases were treated with operation with a satisfactory rate of 91.67%; for type Ⅱ, conservative method for 12 cases and the satisfactory rate was 33.33%, and operation for 9 cases witha satisfactory rate of 70.37%; for type Ⅲ, conservative method for 2 cases, with poor result, and operation for 8 cases with satisfactory rate of 79.17%. The indication for conservative treatment was type I fracture. It showed that for Pilons fracture, the outcome of open reduction and internal fixation was superior to that of the conservative treatment, especially in those having internal fixation with AO plate.
Objective
To explore the effectiveness of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defect and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture.
Methods
Between October 2009 and June 2011, 10 cases of Achilles tendon and soft tissue defects were treated. There were 7 males and 3 females, aged from 5 to 60 years (median, 40 years). Injury was caused by spoke in 5 cases, by heavy pound in 3 cases, and by traffic accident in 2 cases. The time between injury and admission was 2-24 hours (mean, 8 hours). The size of wound ranged from 11 cm × 7 cm to 18 cm × 10 cm; the length of Achilles tendon defect was 4-10 cm (mean, 7 cm). Three cases complicated by calcaneal tuberosity defect. After admission, emergency debridement and vacuum sealing drainage were performed for 5-7 days, anterolateral thigh fasciocutaneous flap transplantation of 11 cm × 7 cm to 20 cm × 12 cm was used to repair skin and soft tissue defects, and improved method of ilio-tibial bundle suture was used to reconstruct Achilles tendon. The flap donor site was closed directly or repaired with skin grafting to repair.
Results
All flaps and the graft skin at donor site survived, healing of wounds by first intention was obtained. All patients were followed up 6-18 months (mean, 10 months). The flap was soft and flexible; the flap had slight encumbrance in 3 cases, and the others had good appearance. At last follow-up, two-point discrimination was 2-4 cm (mean, 3 cm). The patients were able to walk normally. The range of motion (ROM) of affected side was (24.40 ± 2.17)° extension and (44.00 ± 1.94)° flexion, showing no significant difference when compared with ROM of normal side [(25.90 ± 2.33)° and (45.60 ± 1.84)° ] (t=1.591, P=0.129; t=1.735, P=0.100). According to Arner-Lindhoim assessment method for ankle joint function, all the patients obtained excellent results.
Conclusion
A combination of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defects and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture is beneficial to function recovery of the ankle joint because early function exercises can be done.
OBJECTIVE: To investigate the reparative and reconstructive method of post-traumatic lateral instability of the ankle. METHODS: From January 1992 to June 2000, 7 cases of male patients with ankle injury (aged 25-43 years) underwent Wetson-Jones modification. A bone tunnel was drilled through 2.5 cm upside the lateral malleolus tip and talus, and short peroneal tendon was cut to pass the tunnel to fix twining. RESULTS: All patients were followed up 2-10 years, 5 cases mineworkers changed to work on the ground, 2 patients returned to the original work, no traumatic arthritis occurred. According to Baird ankle joint scoring standard, the ankle function was excellent in all cases. CONCLUSION: Reformed Wetson-Jones modification can repair and reconstruct perfectly the traumatic instability of the ankle.
Objective
To evaluate the effectiveness of Ilizarov technique and tibiotalar or tibiocalcanean arthrodesis for one-stage treatment of ankle joints infection and bone defects.
Methods
Between January 2014 and April 2016, 14 patients with ankle joints infection and bone defects were treated by Ilizarov technique and tibiotalar or tibiocalcanean arthrodesis for one-stage. There were 12 males and 2 females with an average age of 39.8 years (range, 25-61 years). The causes of ankle infection included falling from height injury in 5 cases, falling injury in 4 cases, traffic accident injury in 1 case, crushing injury in 1 case, sprain injury in 1 case, and hematogenous reason in 2 cases. All the patients received surgery for 0-8 times (mean, 3.7 times) before admission. The modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was 30.25±3.54 before operation. The disease duration was 1-30 months (mean, 10.3 months).
Results
All the incisions healed by first intension without recurrence of infection, and two-stage bone grafting operation did not performed. One case felt slight local pain and swell of ankle joint after weight-bearing walking more than 30 minutes, and without special treatment. All the patients had different degree skin redness and swelling of Kirschner wire pinhole for 0-3 times, and relieved after symptomatic treatment. All the patients were followed up 6-27 months (mean, 16.8 months). Except for 2 cases who did not remove the external fixator (with external fixation time of 6 months and 8 months respectively), the other patients removed the external fixator at 6-14 months (mean, 9 months) after operation, all patients recovered the walk function and without ankle pain. The modified AOFAS ankle and hindfoot score after removal of external fixator (70.92±1.0) was significantly higher than preoperative one (t=–10.992, P=0.000).
Conclusion
It is a simple and effective method for one-stage treatment of ankle joints infection and bone defects by Ilizarov technique and tibiotalar or tibiocalcanean arthrodesis.
ObjectiveTo study the effect of different degrees of distal tibial varus and valgus deformities on the tibiotalar joint contact, and to understand the role of fibular osteotomy.
MethodsEight cadaveric lower legs were used for biomechanical study. Nine conditions were included: normal ankle joint (group A), 10° varus (group B), 5° varus (group C), 5° valgus (group D), 10° valgus (group E) with fibular preserved, and 10° varus (group F), 5° varus (group G), 5° valgus (group H), and 10° valgus (group I) after fibular osteotomy. The joint contact area, contact pressure, and peak pressure were tested; and the translation of contact force center was observed.
ResultsThe joint contact area, contact pressure, and peak pressure had no significant difference between group A and groups B to E (P>0.05). After fibular osteotomy, the contact area decreased significantly in groups F and I when compared with group A (P < 0.05); the contact pressure increased significantly in groups F, H, and I when compared with group A (P < 0.05); the peak pressure increased significantly in groups F and I when compared with group A (P < 0.05). There were two main anterior-lateral and anterior-medial contact centers in normal tibiotalar joint, respectively; and the force center was in anterior-lateral part, just near the center of tibiotalar joint. While the fibula was preserved, the force center transferred laterally with increased varus angles; and the force center transferred medially with increased valgus angles. However, the force center transferred oppositely to the medial part with increased varus angles, and laterally with increased valgus angles after fibular osteotomy.
ConclusionFibular osteotomy facilitates the tibiotalar contact pressure translation, and is helpful for ankle joint realignment in suitable cases.
Objective To investigate the surgical techniques and the cl inical outcomes of treating severe pronationexternal rotation ankle fractures combined with deltoid l igament injuries. Methods Between July 2005 and April 2007, 17 patients with grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries were treated by open reduction and internal fixation with l igament repair by using suture anchors. There were 13 males and 4 femaleswith an average age of 36.5 years (21-56 years). All cases were closed injuries with l imitation of motion after initial physical examination. The X-ray and CT showed that all patients were characterized with lateral and posterior malleolus fractures and significant lateral shift of talus, but without medial malleous fracture before operation. All fractures were classified into grade-IV pronation- external rotation or type C according to Lauge-Hansen criterion and Danis-Weber standard respectively. The disease course was from 4 days to 7 days with an average of 5.6 days. Results All incisions healed by first intention Seventeen patients were followed up 11-24 months (mean 15.6 months). The X-ray films showed that all patients achieved bony heal ing. The heal ing time was 11-16 weeks (mean 14.8 weeks). According to the Baird-Jackson’s scoring system, the results were excellent in 5 cases, good in 9 cases, fair in 2 cases and poor in 1 case, the excellent and good rate was 82.4%. No operation compl ication occurred. Medial clear space was significantly decreased postoperatively compared with that before operation [(3.16 ± 0.37) mm vs. (4.87 ± 0.43) mm] (P lt; 0.01). In gravity stress radiographs, there was no significant difference in medial clear space between collateral ankle and injured ankle after operation [(3.47 ± 0.43) mm vs. (3.55 ± 0.44) mm] (P gt; 0.05). Conclusion It is emphasized that full attention should be given to reconstruction of medial l igament structures as well as open reduction and internal fixation in treating grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries.
【Abstract】 Objective To summarize the technique and effect of the therapy for severe fracture and dislocation ofankle joint by operation. Methods From March 2003 to February 2006, 76 cases were treated with primary open restorationand internal fixation for dislocated ankle joint fracture, with 47 males and 29 females, with the average age of 36.4 years (ranging from 18 years to 65 years). According to AO criterion, these fresh fractures were classified into 13 cases for type C3-1, 45 cases for type C3-2 and 18 cases for type C3-3. Based on the Gustilo-Anderson standard, 23 open fractures were classified into 17 cases for type II and 6 cases for type Ⅲ A. The operation was delayed from 1 hours to 24 hours after the injury. Results All incisions healed at the first stage except 4 cases which delayed union because of simple infection by revision with ointment. A total of 72 cases were followed up, with the average time of 18.5 months (from 12 months to 35 months). The time of bone union was from 12 weeks to 24 weeks. The screws of fixation for lower tibia-fibula joint were found to be ruptured in 2 cases when further consultation was performed in the 16th and 20th week after the operation, respectively, and were broken within 1 year after the operation. These screws were taken out 12 weeks postoperative in 28 cases, while the whole internal fixations of the rest caseswere taken out 1 year after the operation. The postoperative function of malleolus extended from 21.7o to 26.8o and flection from 38.5o to 44.7o. Assessed by the American Orthopaedic Foot and Ankle Society Cl inical Rating Scales, 23 cases were excellent, 36 good, 13 fair, and the choiceness rate reached 81.94%. Conclusion These procedures, together with reduction by twist after hospital, open and internal fixation in time, and parenchyma managed with internal fixation, are important to attain satisfactory effect for the treatment of severe fracture and dislocation of ankle joint.
Objective To summarize the function of fibula in stability of ankle joints.Methods Recent original articles were extensively reviewed, which were related to the physiological function and biomechanical properties of fibula, the influence of fibular fracture on stability of ankle joints and mechanism of osteoarthritis of ankle joints. Results The fibula had the function of weightbearing; and it was generally agreed that discontinued fibula could lead to intra articular disorder of ankle joint in children; but there were various viewpoints regarding the influence of fibular fracture on the ankle joint in adults. Conclusion Fibula may play an important role in stability of ankle joint.
Objective To evaluate the operative procedure and the cl inical effectiveness of open reduction and internal fixation in the treatment of posterior malleolus fractures. Methods Between June 2005 and December 2008, 46 patients with posterior malleolus fractures were treated with open reduction and internal fixation and followed up. There were 29 males and 17 females with an average age of 47.7 years (range, 19-76 years). Fractures were caused by sprain in 17 cases, by fallingin 15 cases, by traffic accident in 12 cases, and by other reasons in 2 cases. The locations were left ankle in 25 cases and right ankle in 21 cases. There were 6 simple posterior malleolus fractures, 13 lateral and posterior malleolus fractures, and 22 trimalleolar fractures, and 5 lateral and posterior malleolus fractures accompanying by injury of deltoid l igament of ankle. According to Lauge- Hansen classification system, 13 cases and 9 cases were rated as supination-external rotation type III and type IV respectively, and 18 cases as pronation-external rotation type IV. According to Naoki’s classification of posterior malleolus fractures, there were 29 cases of posterolateral-obl ique type, 11 cases of medial-extension type, and 6 cases of small-shell type. Seven patients underwent emergency operation and 39 patients underwent selective operation. Results Two patients developed superficial infection, which was cured after dressing change, and the other incisions healed by first intention. Forty-six patients were followed up 37 months on average (range, 18-63 months). All fractures healed after 3 to 6 months (mean, 4.3 months). One patient developed lateral suralcutaneous nerve injury, and 9 patients had mild weight-bearing pain or discomfort. The results of American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score were excellent in 17 cases, good in 21 cases, and fair in 8 cases with an excellent and good rate of 83%. The mean visual analogue scale (VAS) score was 1.9 (range, 0-5). Conclusion The anatomic reduction and internal fixation can achieve the satisfactory results in the treatment of posterior malleolus fractures. The best treatment and fixation methods should be chosen based on different types of posterior malleolus fractures.
To evaluate the surgical techniques of open reduction and internal fixation performed for ankle fracture retrospectively and the corresponding cl inical outcomes. Methods From March 2001 to January 2006, 242 patients with ankle fracture were treated. A total of 85 patients with complete cl inical data were analyzed. According to the Lauge-Hansen classification system, the fractures were classified into pronation-external rotation(grade II) in 12 cases and grade IV in 9 cases, supination-external rotation(grade II) in 34 cases and grade IV in 16 cases, supination-adduction (grade II) in 8 cases, and pronation-abduction in 6 cases.The reduction and internal fixation started with lateral malleolus, then medialmalleolus and posterior malleolus, and distal tibiofibular syndesmosis in sequence. Among 10 cases, 5 of the distal tibiofibular syndesmosis were fixed with one screw through 3 layers of bone cortexes. All cases were auxil iarily fixed with plaster pad for 4 to 6 weeks after operation. Results The follow-up period varied from 6 to 36 months, with an average of 10 months. There were no local compl ications such as malunion or nonunion of the fractures and deformity of the ankle. The inserted screw to distal tibiofibular syndesmosis was not broken. The patients were evaluated with Baird-Jackson scoring system.The numbers of the patients who had excellent, good, fair and poor results were 53, 23, 6, 3, respectively.The excellent and good rate was 89.4 %. Conclusion Operative treatment may provide satisfactory cl innical outcomes for ankle fracture.Proper internal fixation and correct fracture pattern estimation are of importance to achieve and gain better long-term results.
