Objective To study the method and effect of transferring the pedicled second metatarsal base for repairing bone defect of lateral malleolus. Methods Thirty lower limb specimens were anatomized to observe the morphology, structure and blood supply of the second metatarsal bone . Then transferring of thepedicled second metatarsal base was designed and used in 6 patients clinically.All cases were male, aged from 24 to 48 years old, and the area of bone defect was 3-4 cm. Results Followed up for 3-11 months, all patients healed primarily both in donor and recipient sites. There were excellent results in 4 cases and good results in 2 cases . The morphology and function of the malleoli were satisfactory. Conclusion Transferring of the pedicled second metatarsal base for repairing bone defect of lateral malleolus is an effective and reliable operative method.
ObjectiveTo investigate the application of lateral malleolus hook-plate for the treatment of stageⅡsupination-adduction type medial malleolus fractures. MethodsBetween January 2011 and June 2013, 21 patients with stageⅡsupination-adduction type ankle fractures were treated with lateral malleolus hook-plate, including 12 males and 9 females with an average age of 55.5 years (range, 27-65 years). The injury causes were sprain in 17 cases and traffic accident in 4 cases. The mean time between injury and admission was 12.4 hours (range, 2-72 hours). The tibial distal medial articular surface collapse was found in 7 cases by CT examination and in 3 cases by X-ray film. Of 21 cases, there were 12 cases of low transverse fractures of lateral malleolus, 7 cases of short oblique fractures of lateral malleolus, and 2 cases of ankle joint lateral collateral ligament injury without fractures of lateral malleolus. After operation, the clinical outcome was evaluated according to the talus-leg angle, the recovery of Coin-sign continuity, inside-outside and top ankle gap, talus slope, American Orthopedic Foot and Ankle Society (AOFAS) score, Olerud-Molander score, Kofoed evaluation standards, and patient satisfaction. ResultsSeventeen cases were followed up 18.7 months on average (range, 12-25 months). Primary healing was obtained in 16 cases except 1 case of delayed healing. Fracture healed at an average of 14.6 weeks (range, 12-16 weeks). All cases achieved anatomical reduction, the continuity of Coin-sign, and consistency of inside and outside joint gap; no talus tilt occurred. There was no complication of reduction loss, loosening or breakage of internal fixation, or osteoarthritis during follow-up. The talus-leg angle of the affected side was significantly improved to (83.4±1.8)° at 1 week after operation from preoperative (74.8±7.1)° (t=5.370, P=0.000), but no significant difference was found when compared with normal side (83.8±2.3)° (t=0.676, P=0.509). The AOFAS score, Olerud-Molander score, and range of motion at 1 week, 3 months, and 1 year after operation were significantly improved when compared with preoperative ones (P < 0.05). According to Kofoed evaluation standard, the outcome was excellent in 15 cases and good in 2 cases; the excellent and good rate was 100%. According to patient satisfaction, the outcome was excellent in 13 cases, good in 3 cases, and poor in 1 case; the excellent and good rate was 94.1%. ConclusionThe use of lateral malleolus hook-plate for fixation of stageⅡsupination-adduction type medial malleolus fracture not only can effectively maintain anatomical reduction and supporting function, but also can prevent re-collapsing of the reset joint surface. The surgical method can not increase soft tissue complication, so it is a safe and effective method.
Objective To explore the effectiveness of one-stage debridement and two-stage Ilizarov bone transport technology in repairing post-traumatic lateral malleolus defect. Methods Between June 2013 and December 2016, 7 patients with bone defect of lateral malleolus were treated. There were 5 males and 2 females with an average age of 45.9 years (range, 35-60 years). There were 6 cases of traffic accident injury and 1 case of strangulation injury. All patients had extensive soft tissue injury and lateral malleolus bone exposure. There were 4 cases of Gustilo type ⅢB and 3 case of Gustilo type ⅢC. The time from injury to admission was 3-10 hours (mean, 6.3 hours). Through one-stage thorough debridement, exploration and repair of vessels and nerves, external fixation of scaffolds and coverage of wounds, free fibulas were removed in 3 cases at one-stage and fibulas were resected in 4 cases after expansion. The bone defects ranged from 4.5 to 15.0 cm in length (mean, 8.2 cm). The Ilizarov circular external fixators were used to transport with fibula osteotomy for repairing bone defect of lateral malleolus when the wound healing. Results During fibular osteotomy, the stents were adjusted 2-4 times (mean, 2.8 times) and the external fixators were removed after 10-16 months (mean, 12.8 months). The nail tract infection occurred in 2 cases during transporting and was controlled after symptomatic treatment. All patients were followed up 24-48 months (mean, 32.9 months). The shape of lateral malleolus was close to normal without obvious varus or valgus deformity. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score was 86-92 (mean, 90.3), and 5 cases were excellent and 2 cases were good. X-ray film showed that there was no obvious widening of the gap between the ankle points and no sign of absorption of the lateral malleolus. Conclusion The one-stage debridement combined with two-stage Ilizarov bone transport technology can maintain the stability of ankle joint structure and obtain better effectiveness in repairing post-traumatic lateral malleolus defect.
Objective To explore the effectiveness of multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repair of amputated palm injury distal to the superficial palmar arch. Methods Between September 2018 and July 2023, 5 patients with amputated palm injury distal to the superficial palmar arch were treated. There were 3 males and 2 females with an average age of 35.4 years (range, 29-52 years). The time from injury to admission was 1-6 hours (mean, 3.2 hours). The multi-segment inverted Y-shaped vein transplantation in the anterior lateral malleolar venous network were used to repair the common and proper palmar digital arteries; the another anterior lateral malleolar venous network was used to repair the dorsal vein of the hand. The soft tissue defect of dorsal hand in 1 patient was repaired with the pedicled ilioinguinal flap, and the wound at the donor site was directly sutured. Postoperative treatment included anti-infection therapy, antispasmodic therapy, and thrombosis prevention measures. Results The partial necrosis of the fingertip of the thumb occurred in 1 case, and the marginal necrosis of the abdominal flap after operation occurred in 1 case. The remaining fingers showed good blood supply with normal tension. The incision at donor site of the abdominal flap healed by first intention. All patients were followed up 8-41 months (median, 19 months). At last follow-up, the hand contour was satisfactory; the grasping function, opposition function, and proprioception recovered, and two-point discrimination ranged from 5 to 7 mm (mean, 6 mm). According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association, the functional outcomes were excellent in 3 cases, good in 1 case, and fair in 1 case. Conclusion The multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repairing defects in the common and proper palmar digital arteries distal to the superficial palmar arch offers advantages such as superficial location, flexible harvesting, and high compatibility. This technique has demonstrated favorable outcomes in complex transmetacarpal amputation reconstruction.
Objective To evaluate the safety and effectiveness of reducing posterior malleolar fractures via the modified Rammelt transfibular approach. Methods A retrospective analysis was conducted on 26 patients with ankle fractures who met the selection criteria and were admitted between September 2023 and May 2024. There were 13 males and 13 females, aged from 14 to 59 years (median, 43.5 years). Causes of injury included traffic accident (1 case), falls (7 cases), and sprains (18 cases). Time from injury to operation ranged from 1 to 13 days (mean, 3.9 days). According to the Lauge-Hansen classification, there were 5 supination-external rotation type Ⅲ fractures and 21 supination-external rotation type Ⅳ fractures. According to the Bartoníček classification for posterior malleolar fractures, there were 12 type Ⅱ fractures, 10 type Ⅲ fractures, and 4 type Ⅳ fractures. During operation, the fracture was exposed via the modified Rammelt transfibular approach; then, the fracture reduction was achieved under direct vision using techniques such as towel clip traction, posterolateral compression, and lifting with a posterior transverse periosteal elevator; finally, the fracture was fixed using anteroposterior cannulated screws or Kirschner wires. The incision healing was observed after operation. At 4 months after operation, X-ray film and CT were reviewed to evaluate the quality of fracture reduction. The medial clear space, tibiofibular clear space, and the anterior/posterior tibiofibular syndesmotic distances were measured. At last follow-up, the ankle function was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the range of motion. Results The marginal necrosis occurred in 2 lateral malleolar incisions, and superficial infection occurred in 1 lateral malleolar incision; the remaining incisions healed by first intention. All 26 patients were followed up 13-21 months (mean, 15.6 months). X-ray films showed that fractures in 25 patients achieved clinical union within 3-8 months (mean, 5.4 months); 1 case had delayed union of the lateral malleolus. At 4 months after operation, no significant difference was found between the injured and healthy sides in the medial clear space, tibiofibular clear space, or the anterior/posterior tibiofibular syndesmotic distances (P>0.05). No malreduction of the posterior malleolus or the tibiofibular syndesmosis occurred. At last follow-up, the AOFAS score ranged from 80 to 100 (mean, 91.9). The range of motion ranged from 17° to 22° (mean, 21.0°) in active ankle dorsiflexion and from 40° to 49° (mean, 44.6°) in plantar flexion. Internal fixator was removed in 12 patients at 1 year after operation, with no ankle instability occurring. Ankle joint degeneration was observed in 1 patient at last follow-up. Conclusion The modified Rammelt transfibular approach is a safe and reliable technique. It enables precise reduction under direct vision, improves the quality of reduction for the distal tibial articular surface and the tibiofibular syndesmosis, and provides satisfactory ankle functional recovery in short-term follow-up.
Objective To investigate the method and effect of compound grafting of vascularized fibular head and flaps to repair compl icated lateral malleolus defects. Methods From July 2000 to April 2006, 6 patients with lateral malleolus bone defect underwent the repairing treatment. There were 5 males and 1 female, aged 9-47 years. The causes of injuries was traffic accident in 4 cases and crash in 2 cases. And 5 cases were in the left side and 1 in right side. The bone defect ranged 3.5-8.5 cm in size and the skin defect ranged 14 cm × 4 cm-18 cm × 7 cm in size. The time from injury to surgery rangedfrom 15 to 30 days. The compl icated lateral malleolus defects were repaired by transplanting the fibular head pedicled with the lateral inferior genicular artery 5-10 cm, and the peroneal perforator flaps or latissimus dorsi flaps 16 cm × 5 cm-20 cm × 8 cm. The raw surfaces of donor site were inflated and packaged with intermediate spl it thickness skin graft. Results One flap with 1 cm distal edge dry necrosis healed after change of dressing and others all survived. The free skin grafts survived and the incision healed by the first intention. All the cases were followed up for 4 to 15 months, and all patients achieved the bony heal ing within 8-16 weeks and the transplanted fibular head grew well. The shape of reconstructed lateral ankles was similar to the normal one and the ankle mortise moved well. The texture of flaps was soft without diabrosis and abrasion. According to Baird-Jackson criterion, the results were excellent in 3 cases, good in 2 cases and fair in 1 case and the excellent and good rate was 83.3%. Conclusion The fibular head pedicled with the lateral inferior genicular artery has good blood supply and the reconstructed lateral malleolus is similar to the normal. The peroneal perforator flaps and latissimus dorsi flaps have adequate blood supply and big dermatomic area. So this operation is an effective method to repair lateral malleolus defect.
To evaluate the biomechanical action of lateral malleolar’s anatomical hook-plate in treatingWeber A-type ankle fracture. Methods Forty-eight cadaveric specimens of adult’s inferior extremities from June 2005to October 2006 were observed, consisting of 26 males and 22 females and aged 18-55 years. The external malleolus of the specimens were transected by using a wire saw at the ankle joint level, and then were divided into 4 groups randomly (groups A, B, C and D). Four distinct internal fixation instruments were used: lateral malleolar’s anatomical hook-plate in group A, general screws in group B , 1/3 tubular plate in group C and standard tension band in group D. Each group was further divided into 2 subgroups, A1-D1 and A2-D2. A1-D1 groups underwent anti-pressure and A2-D2 groups underwent anti-torsion biomechanically comparative analysis. Results The peak values of anti-pressure experiments in groups A1-D1 were (799.83 ± 105.47), (699.17 ± 63.81), (598.83 ± 123.14) and (453.00 ± 111.67) N respectively, group A1 was significantly higher than groups B1, C1 and D1 (P lt; 0.01); meanwhile, the peak values of anti-torsion experiments in groups A2-D2 were (37.17 ± 1.81), (30.33 ± 2.22), (20.50 ± 2.92), (24.83 ± 3.47) Nm respectively, group A2 was significantly higher than groups B2, C2 and D2 (P lt; 0.01). Conclusion The lateral malleolar’s anatomical hook-plate represents a definite biomechanical superiority, when compared with other 3 internal fixation instruments in treating fracture of external mlleolus.