Objective To give a review and commentary on the treatment of acute foot and ankle injuries. Methods Based on the treatment experience and recent l iterature, a commentary on acute foot and ankle injuries were given, included the basic and cl inical research results, evaluation before operation, and treatment methods of the soft tissue and bone injuries. Results The treatment of acute foot and ankle injuries is still a hot point in orthopaedic surgery. Operative and non-operative treatment of fresh Achilles tendon rupture can achieve satisfactory results, and early weight-bearing do not increase the re-rupture rate. The time delay between first debridement and injury within 24 hours does not increase the infection rate. For the treatment of severe ankle fractures, attentions should be paid to the cartilage injury, and anatomic reduction, good real ignment, and the congruity recovery are very important. The treatment determination of calcaneal fractures depends on the fully understanding injury mechanisms, classifications, and treatment method. Talus fractures should try to be treated by experienced surgeons. Operation and fixation methods of Lisfranc injury depends on different injury types. Conclusion Acute foot and ankle injuries are common in cl inical, to achieve a satisfactory result in evaluation and treatment, it is important to have a fully evaluation of the injury type, and choose the best operation time and suitable treatment methods, as well as to fully understand the biomechanical characteristics of different regions.
Objective To review the progress in the diagnosis and treatment of chronic disorders of achilles tendon. Methods Recent l iterature concerning the diagnosis and treatment of chronic disorders of achilles tendon was revi ewed. Results Ultrasonography and MRI were commonly used for diagnoses, and MRI could provide extensive informationfor the choice of therapy protocol. Nonsurgical therapy was the mainstay of treatment for most patients with overuse syndromes, surgical techniques for patients due to no effect in the conservative treatment and with chronic rupture, the cl inical treatment project should be determined based on the cl inical evaluation. Conclusion The surgical indication of chronic disorders of achilles tendon remains controversial, the long-term results of each treatment method are unknown, the randomized prospective studies are still required.
ObjectiveTo explore the classification, diagnosis, and clinical treatment of Achilles tendinopathy.MethodsThe literature about Achilles tendinopathy at home and abroad was reviewed. The research results of classification and terms, imaging diagnosis, and clinical treatment of Achilles tendinopathy were summarized.ResultsThe classification and name of Achilles tendinopathy are not completely unified, and the concept is vague, the cause of disease is not clear. There are many treatment plans, but there is no effective evidence-based medicine research.ConclusionThe diagnosis and treatment of Achilles tendinopathy is complicated. According to the characteristics of Achilles tendon anatomy and etiology, the classification and definition of Achilles tendinopathy need to be further studied in order to guide clinical treatment more effectively and facilitate experience exchange and learning.
Objective To summarize the diagnosis and treatment of fibular fracture in ankle fracture. MethodsRelevant literature at home and abroad in recent years was widely consulted, and various types of fractures were discussed and summarized according to Danis-Weber classification. ResultsConservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment. ConclusionFirst of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.
Objective To evaluate the short-term effectiveness of talonavicular arthrodesis for Müller-Weiss disease. Methods Between May 2013 and February 2015, 13 patients with Müller-Weiss disease were treated with talonavicular arthrodesis. There were 11 females and 2 males with an average age of 59 years (range, 42-67 years). The disease duration was 8-20 years (mean, 13 years). According to Maceira stage, there were 7 cases of stage Ⅲ, 6 cases of stage Ⅳ. The foot longitudinal arch height measured on weight-bearing X-ray films was (43.1±1.8) mm; the Meary angle and talocalcaneal angle measured on lateral X-ray films were (–2.8±2.3)° and (5.8±2.4)°, respectively; the calcaneal valgus angle measured on Saltzman position X-ray films was (–2.0±0.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.5±12.4, and visual analogue scale (VAS) score was 7.3±1.5. Results All the patients were followed up 14-39 months (mean, 20 months). The symptoms of foot pain and intermittent claudication disappeared in all patients. All cases achieved bony union, the fusion time was 12-16 weeks (mean, 13 weeks). There was no complications such as wound infection, skin necrosis, or internal fixator broken. At last follow-up, the foot longitudinal arch height, Meary angle, talocalcaneal angle, and calcaneal valgus angle were (52.5±2.2) mm, (1.3±2.2)°, (16.5±3.7)°, and (0.4±0.7)°, respectively; the AOFAS score and VAS score were 83.8±9.1 and 1.0±0.4, respectively; all were significantly improved when compared with preoperative ones (P<0.05). Conclusion If the subtalar and calcaneocuboid joints are relatively healthy, talonavicular arthrodesis may be a reliable and effective surgical option for Müller-Weiss disease that is resistant to conservative treatment.
ObjectiveTo explore the effectiveness of modified internal fixation and fusion in treatment of type Ⅱ painful accessory navicular (PAN) in adults.MethodsBetween January 2016 and December 2017, 29 patients (37 feet) with type Ⅱ PAN were treated with modified internal fixation and fusion. There were 12 males and 17 females with an average age of 41.4 years (range, 18-50 years). The injury caused by sprain in 24 cases and no obvious inducement occurred in 5 cases. All patients received conservative treatment for more than 6 months with no significant improvement. The effectiveness was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score before operation and at last follow-up. The inclination angle of calcaneus, the first metatarsal angle of talus, the inclusion angle of talonavicular joint, and the second metatarsal angle of talus were measured on X-ray films.ResultsSuperficial infection of incision occurred in 1 case after operation, and the incision healed after enhanced dressing change. The incisons of the other patients healed by first intention. There was no deep infection or osteomyelitis. All patients were followed up 12-33 months (mean, 25.1 months). X-ray films showed that the articular surfaces healed at 2-5 months after operation, with an average of 3.4 months. No loosening or rupture of internal fixator was found during the follow-up. At last follow-up, the pain, function, alignment scores, and total score of AOFAS were significantly improved when compared with those before operation (P<0.05). The inclusion angle of talonavicular joint, the first metatarsal angle of talus, and the second metatarsal angle of talus were also significantly improved when compared with those before operation (P<0.05). But there was no significant difference in the inclination angle of calcaneus between pre- and post-operation (t=1.097, P=0.276).ConclusionModified internal fixation and fusion in treatment of type Ⅱ PAN can effectively relieve the symptoms and obtain good recovery of feet function with less complications.
Objective To investigate the effectiveness and biomechanical analysis of 3 fixation methods of screw anterior-posterior fixation (SAPF), screw posterior-anterior fixation (SPAF), and buttress plate fixation (BPF) in treatment of posterior Pilon fractures. Methods Fifteen fresh-frozen skeleto-ligamentous lower leg specimens were harvested to establish the models of posterior Pilon fracture, and then fracture was fixed with BPF (n=5), SAPF (n=5), and SPAF (n=5). Vertical force was loaded to internal fixation failure in a speed of 1 cm/minute with servohydraulic testing machine. The instantaneous loads of 1 mm and 2 mm steps and the failure modes were recorded. Between May 2008 and December 2011, 56 patients with posterior Pilon fracture were treated with SAPF (SAPF group) in 11 cases, or SPAF (SPAF group) in 26 cases, or BPF (BPF group) in 19 cases. There was no significant difference in age, gender, injury cause, side, disease duration, and complications among groups (P gt; 0.05). Clinical and radiographic examinations were used to assess the reduction and healing of fracture; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. Results No breaking or bending was observed in all specimens, fixation failure was caused by cancellous bone compression. The instantaneous loads of 1 mm and 2 mm steps were the largest in BPF group, larger in SPAF group, and smallest in SAPF group, showing significant differences among 3 groups (P lt; 0.05). A total of 47 cases were followed up 16-54 months (9 in SAPF group, 22 in SPAF group, and 16 in BPF group), with a mean time of 35.2 months. Fixation failure was found in 2 cases of SAPF group; the other cases obtain bony union within 3 to 4 months (mean, 3.2 months) with no fixation failure. The AOFAS score was significantly lower in SAPF group than in SPAF and BPF groups (P lt; 0.05), but no significant difference was found between SPAF and BPF groups (P gt; 0.05). The VAS score was significantly higher in SAPF group than in SPAF and BPF groups (P lt; 0.05), but no significant difference was found between SPAF and BPF groups (P gt; 0.05). Conclusion SAPF could not reach enough fixation strength for the posterior Pilon fracture; both SPAF and BPF could reach rigid fixation, and have good effectiveness. And from the biomechanical points, BPF could reach better fixation strength than screw fixations.
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.
Objective To compare the functional and radiological outcomes of supramalleolar osteotomy (SMOT) between with and without fibular osteotomy for varus ankle osteoarthritis. Methods Between April 2009 and April 2014, 41 patients (41 feet) with mid-staged varus ankle osteoarthritis were treated with SMOT. Fibular osteotomy was not performed in 19 cases (group A), and fibular osteotomy was performed in 22 cases (group B). There was no significant difference in gender, age, side, body mass index, osteoarthritis stage, pathogeny, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind score, ankle osteoarthritis scale (AOS) pain and function scores, range of motion (ROM) of the ankle joint, tibial articular surface angle (TAS), talar tilt angle (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) between 2 groups (P>0.05). The bone union was observed after operation, and functional and radiological outcomes were compared between 2 groups at last follow-up. Results All incisions healed by stage I, and no surgery related complications occurred. The mean follow-up time was 36.6 months (range, 16-55 months). Pain and limited activity were observed in 1 case of groups A and B respectively, and ankle arthrodesis was performed. All cases achieved bony union; the bone union time was (3.6±0.4) months in group A and (3.9±0.7) months in group B, showing no significant difference (t=1.61,P=0.12). At last follow-up, no significant difference was found in TAS, TLS, TT, and TC between groups (P>0.05). However, group B was significantly better than group A in improvement of TT and TC (P<0.05). The AOFAS ankle-hind score, AOS pain and function scores, ROM of the ankle joint showed no significant difference between groups (P>0.05). According to the modified Takakura stage, the improvement rates of groups A and B were 55.6% and 57.1%, respectively; no significant difference was found between 2 groups (χ2=0.01,P=0.92). Conclusion SMOT with fibular osteotomy is helpful in correction of TT and TC in patients with relative longer fibula.
Objective To investigate the functional outcomes of buttress plate fixation and simple screws fixation for the treatment of supination-adduction type-II medial malleolar fractures so as to provide reference for selection of internal fixation. Methods Between March 2009 and December 2012, 53 patients with supination-adduction type-II medial malleolar fractures were treated with open reduction and internal fixation. Of them, buttress plate fixation was used in 30 cases (buttress plate fixation group), and screws fixation was used in 23 cases (screw fixation group). There was no significant difference in age, gender, injury cause, injury side, disease duration, and combined injuries between 2 groups (P>0.05). Complications and full weight-bearing time were recorded; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. Post-operative anteroposterior and lateral X-ray films were taken to evaluate fracture reduction and union condition. And the treatment failures were recorded. Results There was no significant difference in incision related complication rate and infection rate between 2 groups (P>0.05). The patients were followed up 46-91 months (mean, 64.5 months) in buttress plate fixation group and 44-86 months (mean, 59.5 months) in screw fixation group. The full weight-bearing time of the buttress plate fixation group was significantly shorter than that of screw fixation group (t=2.05,P=0.04). During follow-up time, malunion and nonunion occurred in 2 cases and 1 case of screw fixation group; anatomic reduction and bony union were observed in the other patients of 2 groups. The union time showed no significant difference between 2 groups (t=1.06,P=0.30). No significant difference was found in AOFAS score and good and excellent rate, VAS score, operation failure rate, and traumatic osteoarthritis rate between groups (P>0.05). Conclusion For patients with supination-adduction type-II medial malleolar fracture, the angle between fracture line and tibial axial line is too small to be fixed firmly with simple screws fixation, with a relatively higher failure rate. And buttress plate fixation can reach rigid fixation, and has better functional outcomes.