Abstract:[Objective] To compare the clinical efficacy of two tractions in open reduction and internal fixation (ORIF) of three-column tibial plateau fractures. [Methods] From May 2018 to January 2021, 30 patients received ORIF with double plates for three-column tibial plateau fractures. According to the results of doctor-patient communication before surgery, 15 had ORIF performed under a novel self-de- veloped traction device (NTD) , while the other 15 patients were under conventional manual traction. The perioperative, follow-up and imag- ing data were compared between the two groups. [Results] All patients were successfully operated on without serious complications. The NTD group proved significantly superior to the conventional group in terms of operation time, fracture reduction time, total incision length and intraoperative blood loss (P＜0.05) . As time went during follow up lasted for (16.03±3.17) months, the VAS scores decreased significant- ly (P＜0.05) , while knee extension-flexion range of motion (ROM) , HSS score and Rasmussen clinical score increased significantly in both groups (P＜0.05) . At 1 week and 1 month postoperatively, the NTD group was significantly superior to the conventional group in abovesaid items (P＜0.05) , whereas which became not statistically significant between the two groups at the latest follow-up (P＞0.05) . There was no significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05) . Radiographically, there was no a significant difference in fracture healing time between the two groups (P＞0.05) , additionally, no significant differences were noted in Ras- mussen anatomical score, medial proximal tibial angle (MPTA) and posterior tibial slope (PTS) between the two groups at any corresponding time points (P＞0.05) . [Conclusion] This novel self-developed traction device is safely and effectively used in ORIF for three-column tibi- al plateau fractures, with advantages of using in supine, lateral and prone position, improving the operation efficiency and speeding up the postoperative functional recovery.

Abstract:[Objective] To evaluate the clinical outcome of tendon graft composed with bone marrow concentrate (BMC) and gelatin sponge (GS) in anterior cruciate ligament (ACL) reconstruction. [Methods] From January 2018 to January 2020, a total of 90 patients who were undergoing single-band ACL reconstruction with quadrupled hamstring tendon graft were enrolled in this study, and were divided into 3 groups with 30 cases in each group by random number table method. In the BMC-GS group the two ends of the tendon graft was coated with GS and injected by BMC, while in the BMC group the two ends of the graft were injected with BMC only, while conventional graft pre- pare was conducted in the control group. The perioperative, follow-up and imaging data were compared among the three groups. [Results] There were no significant differences in operative time, total incision length, intraoperative blood loss and incision healing grade among three groups (P＞0.05) . As time went during the follow-up lasted for more than 12 months, the VAS, IKDI and Lysholm scores, as well as the anterior drawer test, Lachman test and pivot-shift test improved significantly in all the three groups (P＜0.05) . At 6 months after sur- gery, VAS, IKDC and Lysholm scores were significantly ranked from superior to inferior as follows: BMC-GS group ＞ BMC group ＞ the con- trol group (P＜0.05) , but which became not statistically significant among the three groups 12 months postoperatively (P＞0.05) . As results of MRI assessment, the signal intensity of intra-tunnel graft increased significantly (P＜0.05) , whereas the signal to noise ratio (SNR) signifi- cantly decreased in all the 3 group over time (P＜0.05) . At 3 and 6 months postoperatively, the BMC-GS group proved significantly superior to the BMC and control groups in terms of signal intensity and SNR (P＜0.05) . [Conclusion] The tendon graft composed with bone marrow concentrate and gelatin- sponge does improve the clinical outcomes of ACL reconstruction, which implies that it promoted graft tendonbone healing.

Abstract:[Objective] To compare the clinical outcomes of modified direct anterior arthroscopy versus double small incisions for re- duction and fixation of acute acromioclavicular by using self-made adjustable suture loop and double mini plates. [Methods] A retrospec- tive study was conducted on 38 patients who received reduction and fixation of acute acromioclavicular with self-made adjustable suture loop and double mini plates in our department from January 2017 to July 2020. According to preoperative patient-doctor communication, 21 patients underwent modified direct anterior arthroscopy (the MDA group) , while the remaining 17 patients received open small doubleincision procedure (the SDI group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the 38 patients had surgical procedures performed smoothly without serious complications, such as neurovascular injuries. The MDA group proved significantly superior to the SDI group in terms of total incision length and intraoperative fluoroscopy (P＜0.05) . All the patients were followed up for 12-30 months, with an average of (16.37±3.56) months, without a statistically significant difference in the time to re- sume full-weight bearing activity between the two groups (P＞0.05) . The VAS score significantly decreased, whereas the Constant-Murley score and UCLA score significantly increased in both groups at 1 month, 6 months after surgery and at the last follow-up compared with those preoperatively (P＜0.05) , however, which were not statistically different between the two groups at any matching time points (P＞0.05) . Radiographically, the acromioclavicular distance (AC) and coracoclavicular distance measured in both groups decreased significantly 6 months after surgery and at the latest follow-up compared with those preoperatively (P＜0.05) , whereas which were not significantly differ- ent between the two groups at any corresponding time point (P＞0.05) . [Conclusion] Both modified direct anterior arthroscopy and open pro- cedure with double small incisions for reduction and fixation of acute acromioclavicular dislocation by using self-made adjustable suture loop and double mini plates do achieve satisfactory clinical outcomes, the former has advantages of smaller incision and less fluoroscopy.

Abstract:[Objective] To explore the impact of obesity on the clinical outcome of primary unicompartmental knee arthroplasty (UKA) for medial knee osteoarthritis. [Methods] A retrospective study was done on 196 patients who underwent primary unilateral UKA for medial knee osteoarthritis from July 2016 to June 2018. According to preoperative body mass index (BMI), the patients were divided into three groups, including normal group (n=41) (BMI 18.50~24.99 kg/m² ) , overweight group (n=113) (BMI 25.00~29.99 kg/m² ) , and obese group (n= 42) (BMI ≥30.00 kg/m² ) . The documents regarding to perioperative period, follow- up and radiographs were compared among the three groups. [Results] All patients in three groups had UKA performed successfully, without serious complications. Perioperative adverse events were of 2/41 (4.88%) in the normal group, 6/113 (5.31%) in the overweight group, and 2/42 (4.76%) in the obesity group, which did not lead serious consequences after corresponding treatment, and were not statistically significantly different among the three groups (P＞0.05) . All the patients in the three groups got well incision healing, without postoperative wound infection in anyone of them. During the follow up last- ed for more than two years, with an average of (35.12±6.53) months, no prosthetic failure, nor revision surgery happened in anyone of the pa- tients in three groups. Compared with that preoperatively the WOMAC score in the three groups was significantly improved at the latest fol- low-up (P＜0.05) , whereas which proved not significantly different among the three groups at any corresponding time points (P＞0.05) . At the last follow-up, all patients in the three groups were satisfied with the operation without significant difference in subjective satisfaction score among the three groups (P＞0.05) . In terms of imaging, the hip- knee-ankle angle (HKAA) at the last follow- up was of (175.86± 2.50) ° in the normal group, (177.30±2.66)° in the overweight group, and (176.23±2.52)° in the obese group, with a significant overall differ- ence among the three groups (P=0.010) . However, there was no significant difference in HKAA between the obese group and the normal group (P=0.563) . [Conclusion] Obesity does not impact clinical outcome of UKA significantly for medial knee osteoarthritis, in other word,the obese patients can still get good clinical outcome after UKA.

Abstract:[Objective] To compare the clinical outcomes of transverse versus oblique placements of fusion cage in transforaminal lum- bar interbody fusion (TLIF) . [Methods] From March 2018 to August 2020, a total of 57 patients received TLIF for lumbar degenerative dis- eases in our department. According to preoperative doctor- patient communication, 23 patients had the fusion cage placed transversely, while the remaining 34 patients had the cage inserted obliquely. The perioperative, follow-up and imaging results were compared between the two groups. [Results] All the patients in both groups had operation performed successfully without serious complications such as injures to the nerve, blood vessel and dural sac. There were no significant differences in operative time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, postoperative walking time and hospital stay between the two groups (P＜0.05) . All the patients in both groups were followed up for (30.44±10.55) months on an average, with no significant difference in the time to resume full weight-bearing ac- tivity between the two groups (P＞0.05) . The VAS and ODI scores significantly decreased (P＜0.05) , whereas the JOA score significantly in- creased in both groups at the latest follow-up compared with those before surgery (P＜0.05) . However, there were no significant differences in VAS, ODI and JOA scores between the two groups at any corresponding time points (P＞0.05) . Radiographically, there were no statisti- cally significant differences in intervertebral space height, Lenke fusion grade and fusion volume scale between the two groups at any corre- sponding time points (P＞0.05) . The transverse group proved significantly superior to the oblique group in term of fusion rate at the area pos- terior to the cage at the latest follow up (P＜0.05) , despite of the fact that no significant differences were noticed in fusion rate at the latest follow up in the remaining intervertebral areas between the two groups (P＞0.05) . [Conclusion] Both transverse and oblique cage place- ments in TLIF do achieve satisfactory clinical outcomes for degenerative diseases, by contrast, the transverse cage placement got better fu- sion in the area posterior the cage.

Abstract:Articular cartilage defect is a common condition met in orthopedic practice, and improper treatment of it often further aggra- vates the development of osteoarthritis. A large number of previous studies have shown that mesenchymal stem cells play an important role in the repair of articular cartilage defects, but the specific mechanism remains incomplete. In recent years, studies have found that a variety of exosomes secreted by mesenchymal stem cells play an important role in anti-inflammatory, immune regulation and cell repair. This arti- cle reviews the repair effects of exosomes derived from different mesenchymal stem cells on articular cartilage defects and their clinical transformation-related exosome tissue engineering techniques to provide references for further research.

Abstract:Patellar dislocation is common in adolescents, with main risk factors including rapid bone growth, inherent anatomical fac- tors, early sport specialization, increased levels of high-risk activity, and trauma. Currently, medial patellofemoral ligament reconstruction is the main treatment for patellofemoral dislocation in adolescent, despite of vatiation in surgical techniques. In addition, the femoral inser- sion of reconstructed medial patellofemoral ligament is close to the distal femoral epiphyseal, so it is very important to locate the isometric point on the femur during operation to avoid potential epiphyseal injury.

Abstract:[Objective] To compare the influence of lamina replantation with different internal fixations for spinal canal reconstruction on segmental range of motion (ROM) of the lumbar spine. [Methods] The lumbar L_2~4 three-dimensional finite element models were estab- lished respectively, including normal model group (NM group) , laminectomy group (LE group) , laminectomy and H-shaped titanium plate fixation group (H-plate group), laminectomy and L-shaped titanium plate fixation group (L-plate group) and laminectomy and two-hole tita- nium plate fixation group (TH plate group) . A 10 Nm loading was applied to the L₂ vertebral body, the ROMs of L_2/3 and L_3/4 segments in six degrees of freedom were measured. [Results] In terms of overall comparison among the 6 degrees of freedom, the ROMs of L_2/3 were ranked in descending order: left bending ＞ forward flexion ＞ right bending ＞ extension ＞ right rotation ＞ left rotation, with statistically significant overall difference in all the 5 model groups (P＜0.05) . The ROMs of L3/4 were ranked in descending order: forward flexion ＞ left bending ＞ right bending ＞ extension ＞ right rotation ＞ left rotation, with statistically significant overall difference in all the 5 model groups (P＜0.05) . However, in terms of overall comparison among the 5 model groups, the ROM of L_2/3 and L_3/4 were arranged in descending order of: LE group ＞ TH plate group ＞ L-plate group ＞ H- plate group ＞ NM group, which all were statistically significant in 6 degrees of freedom (_P＜ 0.05) . In the left bending, right bending, left and right rotations, the ROM of H-plate group had significantly lower ROMs than that of Lplate group and TH plate group (P＜0.05) . [Conclusion] The lamina replantation with different internal fixations for spinal canal reconstruc- tion does effectively reduce the abnormal increase of segmental ROMs caused by laminectomy. Of them, H-shaped titanium plate fixation achieves better stability than L-shaped plate and two-hole titanium plate in terms of resistance of bending and rotation.

Abstract:[Objective] To describe the relationship between the nerve root and intervertebral space of the upper lumbar spine under unilateral biportal endoscopy, and to provide an evidence for the real surgical treatment of spinal stenosis. [Methods] Radiographic docu- ments were obtained from 21 patients with lumbar spinal stenosis, including lumbar CT myelography, CT three-dimensional reconstruction. From L_1/2 to L_3/4 segment, the distances were measured including those between the laminar inferior edge-facet medial edge and the laminar superior edge-facet medial edge to the lateral edge of the dural sac, the lower endplate of the upper lumbar spine, the upper endplate of the lower lumbar spine, the lower edge of the nerve root origin, and the facet lateral edge-herringbone crest edge. In addition, the distance be- tween the upper and lower lumbar endplates at the lower edge of the nerve root origin, as well as the distance from the lateral edge of the in- ferior articular process of the upper lumbar spine to the medial edge of the isthmus of the pedicle of the lower lumbar spine were measured. [Results] From L1/2 to L3/4 segment, the laminar inferior edge-facet medial edge and the laminar superior edge-facet medial edge points were within the outer edge of the dural sac, the lower intervertebral space and inferior edge of the nerve root, the smaller the distance (P＜ 0.05) . The distance from the laminar inferior edge-facet medial edge point and the laminar superior edge-facet medial edge point to the facet lateral edge-herringbone crest edge gradually increased with the segment downward (P＜0.05) . The lower edge of the nerve root origin was below the level of intervertebral space, and the lower the segment, the smaller the distance (P＜0.05) . The projection of the lateral edge of the inferior articular process of the upper lumbar spine was adjacent to the medial edge of the isthmus of the pedicle of the lower lumbar spine (P＞0.05) . [Conclusion] There are obvious anatomical characteristics of the upper lumbar spine. In lumbar spinal stenosis, with larg- er upper and lower decompression range, and the hemi-laminal defect might be induced by decompression of adjacent segments on the same side and slightly larger laminal fenestration, while futher decompression might result in partial defect of inferior articular process and isthmus.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of robot combined with lifting pin for re- duction and cannulated screw internal fixation of refractory femoral neck fracture. [Methods] From January 2018 to December 2020, 15 pa- tients were treated with the above techniques for refractory femoral neck fracture. First of all, 3 cannulated screw guide pins were placed un- der the guidance of robot, without passing through the fracture line, and a lifting pin was placed into the femoral head. The reduction force was applied by the lifting pin and manipulations to achieve satisfactory reduction of the fracture. Subsequently, the guide pin for cannulated screw guide were driven to pass through the fracture line into the femoral head, and finally the cannulated screws was inserted to finish the internal fixation. [Results] All the 15 patients had operation completed successfully, without neurovascular injury and other serious compli- cations, and were marked Harris score of (88.67±14.04) one year postoperatively. Except a patient who failed fixation due to premature walking, all the patients returned to their pre-injury activity level at the latest follow-up. In terms of imaging, all patients achieved grade I reduction based on Garden alignment scale after surgery. Except the patient abovementioned, all patients achieved fracture healing without femoral head necrosis. [Conclusion] The robot combined with lifting pin for reduction and cannulated screw internal fixation does effective- ly treat the refractory femoral neck fracture, with advantages of low radiation exposure, high fracture reduction quality and accurate internal fixation placement.

Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of combined minimally invasive hemiar- throplasty (HA) of the hip for intertrochanteric fractures in the elderly. [Methods] A 95-year-old female received abovementioned surgical treatment for comminuted intertrochanteric fracture of the right femur. The patient was placed in lateral decubitus and a small incision was made superior to the right hip to expose the piriformis fossa, superior aspect of the femoral neck, and margin of the femoral head. After open- ing the medullary cavity at the piriform fossa, the femoral reamer was placed into the cavity for reamming in seral. A wedge osteotomy was conducted on the femoral neck with two cuts within the capsule, the wedge bone block was removed firstly, followed by remove of the femo- ral head. After the bipolar heed component was place into the acetabulum, the femoral stem was inserted with a specific- designed mini plate attached with it. As the stem was pushed in place, the greater trochanter fracture was fixed by screw with the plate. Finally, the femo- ral stem was reduced into the bipolar femoral head component. [Results] The patient was successfully operated without intraoperative com- plications, whereas with operation time of 50 min, incision length of 6 cm, and intraoperative blood loss of 50 ml. The patient resumed ac- tive hip activity including active hip flexion and abductive function training in bed 3 hours after the operation, ambulation the next day, and walking easily out room 1 month later. [Conclusion] This novel technique permits placement of HA prosthesis and fixation of the intertro- chanteric fracture in the same stage through the small incision. It takes the advantages of reducing iatrogenic trauma, intraoperative bleed- ing and fluoroscopy without traction table, as well as achieving good postoperative stability to allow early weight-bearing walking and wide range of motion.

Abstract:[Objective] To introduce the surgical technique and primary clinical outcomes of free thinned sensate anterolateral thigh perforator flap for repair of large tissue defect on the foot and ankle. [Methods] A total of 9 patients received free thinned sensate anterolat- eral thigh perforator flap for repair of large tissue defect on the foot and ankle. Color ultrasound was conducted to localize the vascular ves- sels and nerves before surgery. During harvesting the graft, the proximal side of the flap was cut firstly, and then the lateral femoral cutane- ous nerve and perforating vessels were dissected, finally the distal edge was cut to complete dissociation, Subsequently, the fat tissue was trimmed until the thickness of the flap achieved 5~8 mm. The free flap was covered wound on foot and ankle, and anastomose the blood ves- sels and nerves. [Results] All the 9 patients had the flap survived and were followed up for 10~60 months. At the last follow-up, the num- ber of mono-filar tactile discrimination and blunt acute pain discrimination was lower than that of the healthy side (P＜0.05) . However, the recovery of tactile sensation and acute pain sensation in the central part of the flap was significantly better than that in the surrounding area (P＜ 0.05) . The Vancouver scar score in the donor area was of (4.78±1.48) . [Conclusion] The free thinned sensate anterolateral thigh perfo- rator flap for repair of large tissue defect on the foot and ankle has advantages of relatively moderate donor side morbidity, sufficient sensory recovery of the skin, proper size of recipient foot matching with the opposite side to permit the painless walking with ordinary shoes wearing.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of 3D printed guider assisted posterior at- lantoaxial screw fixation for the treatment of odontoid fractures. [Methods] A total of 31 patients underwent posterior atlantoaxial screw fixa- tion for type Ⅱ odontoid fractures from January 2017 to December 2019. After preoperative thin-slice CT scanning, the data was imported into Mimics software to reconstruct the 3D model, and then transferred into Geomagic Studio software by using the STL format to locate the 3D reference plane, design the guiders for the screw, finally print the actual guider by 3D printer. Skull traction was applied continuously for 7-10 days before surgery, and bedside radiographs were taken regularly until the fracture was reduced. In the real surgical procedure, a midline incision was made to reveal C₁ and C₂. As the 3D printed guider were placed properly, suitable screws were inserted bilaterally into the atlas and axial pedicles respectively, and then connecting rods was installed to fix them. [Results] All the 31 patients were successfully operated on without serious complications. A total of 124 screws were inserted with operation time of (102.90±4.21) min, and the intraopera- tive blood loss of (123.23±11.91) ml. The postoperative CT showed that all 124 pedicle screws were placed correctly as Neo grade 0. [Conclusion] This 3D printed guider does significantly improve the accuracy of posterior atlantoaxial screw placement for odontoid fractures.

Abstract:[Objective] To investigate the clinical outcomes of blocking screws for hypertrophic nonunion secondary to interlocking in- tramedullary nailing of tibial shaft fracture. [Methods] A retrospective study was done on 34 patients who underwent additional blocking screws for hypertrophic nonunion secondary to interlocking intramedullary nailing of tibial shaft fracture from January 2014 to December 2019. Of them, 15 males and 19 females aged (39.55±10.85) years on average, and suffered closed AO type A in 12 cases, type B in 17 cas- es and type C in 5 cases. The clinical and imaging data of additional blocking screw therapy were summarized. [Results] All the patients were successfully operated on without any serious complications, such as vascular and nerve injury, whereas with operative time of (41.18± 11.53) min, the incision length of (2.09±0.79) cm, intraoperative blood loss of (4.58±2.36) ml, and the intraoperative fluoroscopy of (4.32± 1.25) times. As time went during the follow-up period lasted for (20.21±6.26) months, the VAS score significantly decreased, whereas the knee HSS score and ankle AOFAS score increased significantly (P＜0.05) . All patients got nonunion healed in (5.71±1.40) months, except 3 patients were prone to remain fracture nonunion, which finally healed after revision surgery of replacement of a larger diameter intramed- ullary nail and bone grafting. [Conclusion] Additional blocking screw is a minimally invasive, safe and efficient treatment for hypertrophic nonunion secondary to interlocking intramedullary nailing of tibial shaft fracture.

Abstract:[Objective] To compare the clinical outcomes of open reduction and internal fixation (ORIF) with Kirschner wire versus headless screw for humeral capitellar fractures in adolescents. [Methods] From September 2017 to April 2021, a total of 22 adolescents un- derwent ORIF for capitellar fractures. According to preoperative doctor-patient communication, 12 patients had fracture fixed with Kirsch- ner wire (KW) , while the other 10 patients were treated with headless screw (HS) . The clinical and imaging documents were compared be- tween the two groups. [Results] All the patients were successfully operated on with no significant differences in operative time, incision length, intraoperative blood loss, number of fluoroscopy and hospital stay between the two groups (P＜0.05) , but the HS group got signifi- cantly higher hospitalization cost than the KW group (P＜0.05) . At the latest follow up lasted for (31.04±4.05) months on average, all the ad- olescents in both groups got good appearance of elbow, without obvious varus deformity, and limitation of elbow flexion, and there were no significantly differences in terms of Mayo and Quick-Dash score between the two groups (P＜0.05) . Radiographically, there were no signifi- cant differences in fracture reduction quality, radiographic fracture healing time, as well as the carrying angle and humeral-capitellar angle measured on radiographs at the latest follow up between the two groups (P＞0.05) . [Conclusion] Both Kirschner wire and headless screw used for internal fixation do achieve satisfactory clinical outcomes for humeral capitellar fractures in the adolescents

Abstract:[Objective] To evaluate the clinical efficacy of proximal humeral internal locked system plates (PHILOS) for internal fixa- tion of Vancouver type B1 and B2 periprosthetic femoral fractures. [Methods] From September 2017 to January 2019, 7 patients had peri- prosthetic femoral fractures fixated with PHILOS plate, including 5 cases of Vancouver type B1 and 2 cases of type B2. Of them, 5 males and 2 females aged 57 to 86 years with an average of (71.71±9.11) years. [Results] All the 7 patients were successfully operated on without serious complications, such as postoperative incision infection and deep venous thrombosis. The patients were followed up for 12~24 months, with an average of (17.29±3.86) months. The Harris scores increased significantly over time postoperatively (P＜0.05) . At the latest follow-up, 5 patients were able to walk freely, while the remaining 2 patients resumed full weight-bearing walking with the aid of a walker. Radiographically, all patients had periprosthetic fractures healed, without loosening of the femoral prosthesis, and with no failure of PHI- LOS plate. [Conclusion] The PHILOS plate used for the treatment of Vancouver type B1 and B2 periprosthetic femoral fractures has bene- fits of simplifying surgical operation and decreasing medical cost.

Abstract:[Objective] To report the clinical results of oblique lateral interbody fusion (OLIF) for treatment of degenerative scoliosis ac- companied with a single-segment spinal stenosis. [Methods] From August 2016 to December 2018, OLIF was performed on 18 patients with degenerative scoliosis accompanied with single-segment spinal canal stenosis. The clinical and imaging documents of the 18 patients were summarized. [Results] All the patients had the operations completed successfully, without serious complications, such as nerve and blood vessel damages. All patients were followed up for 12~24 months, with an average of (16.32±3.72) months. Compared with those preop- eratively, the VAS and ODI scores decreased significantly at the latest follow-up (P＜0.05) . In terms of imaging assessment, the height of the responsible intervertebral space and foraminal area increased significantly at the last follow-up (P＜0.05) ; while the Cobb angle of sco- liosis decreased, but without a statistically significant difference, compared with those preoperatively (P＞0.05) . Within 16 weeks after sur- gery, all patients achieved intervertebral fusion. [Conclusion] OLIF does effectively relieve the nerve root compression or irritation caused by a single-segment spinal canal or nerve root canal stenosis in degenerative scoliosis, with minimalized surgical trauma and satisfactory clinical results.

Abstract:[Objective] To explore the clinical outcomes of tarsal sinus approach for open reduction and internal fixation (ORIF) of cal- caneal fractures involving subtalar articular surface. [Methods] From June 2017 to June 2020, a total of 24 patients (26 feet) received ORIF with plate and screws through tarsal sinus approach for acute closed calcaneal fractures involving subtalar articular surface. The clinical and imaging results were evaluated. [Results] All patients were successfully operated on without serious complications, with operative time of (53.27±2.48) min, intraoperative blood loss of (22.35±2.10) ml, and incision healing well. At the latest follow up lasted for (14.33±7.27) months on average, both active dorsal flexion range of motion (ROM) and plantar flexion ROM on the affected side were lower than those on the healthy side, whereas which was not statistically significant (P＞0.05) . According to AOFAS score, the clinical outcome was marked as excellent in 16, good in 8 and fair in 2 feet, with the excellent and good rate of 92.31%. Radiographically, the B?hler and Gissane angles significantly increased (P＜0.05) , calcaneal width significantly decreased (P＜0.05) , calcaneal height increased significantly (P＜0.05) , whereas calcaneal length remained unchanged at the latest follow up compared with those preoperatively (P＞0.05) . [Conclusion] The tar- sal sinus approach for open reduction and internal fixation with plate and screws does achieve satisfactory clinical outcomes for calcaneal fractures involving subtalar articular surface.

Abstract:[Objective] To explore the relationship between fracture of the medial process of the calcaneal tuberosity (plantar medial avulsion, PMA fracture) and tongue-type fractures by radiographic measurement. [Methods] A retrospective study was conducted on imag- ing data of 157 patients who underwent treatment for calcaneal fractures in our hospital from January 2016 to January 2020. Radiographs and CT images were reviewed to determine the Essex-Lopresti classification and measure the fracture displacement. [Results] Of the 157 patients, tongue-type fracture (TT) was found in 73 cases, accounted for 46.50%; joint depression (JD) fracture was in 48 cases, accounted for 30.57%; while the fractures not classified by the Essex- Lopresti classification was seen in 36 cases, accounted for 22.93%. Among them, PMA fracture was noted in 34 patients of the TT group (46.58%) , 11 cases of JD group (22.92%) , whereas 17 cases of unclassified fracture group (47.22%) , which was statistically significant (P＜0.05) . The displacement of PMA fragment was of (5.12±0.71) mm in TT group, whereas (4.83±0.33) mm in the JD group, which was not statistically significant (P＞0.05) . [Conclusions] The tongue-type fracture has considerably higher chance to accompany with PMA fracture than the joint depression fracture. The more displacement of tongue frag- ment, the more possibility of combined PMA fracture.

Abstract:[Objective] To investigate the clinical efficacy of Ilizarov technique for simultaneous treatment of tibial infectious bone de- fect accompanied with foot drop. [Methods] From January 2013 to September 2020, 45 patients received debridement, resection of infected bone segment, bone transport and foot stretch correction by Ilizarov external fixator for infectious tibial bone defect complicated with foot drop deformity. The clinical and imaging results were summarized. [Results] All patients were successfully operated on without any impor- tant vascular or nerve injury, while with wound healing time of (36.22±11.24) days, the external frame adjustment time of (3.26±1.32) months, the bone transport length of (6.74±3.26) cm, and the bone defect healing time of (20.22±5.84) months. As time went in the followup lasted for (28.6±12.4) months, the VAS score decreased significantly (P＜0.05) , whereas the AOFAS score and ankle ROM increased sig- nificantly (P＜0.05) . Radiographically, the tibial shaft angulation was corrected significantly over time (P＜0.05) , whereas the mMPT and mLDTA remained unchanged (P＞0.05) , and the discrepancy in bilateral tibial length was significantly decreased (P＜0.05) , with bony heal- ing of the bone defects and osteotomy sites finally in all patients. [Conclusion] The Ilizarov technique does achieve satisfactory clinical out- comes for treating osteomyelitis, repairing large bone defect and correcting foot drop simultaneously.