Abstract:Foot and ankle surgery has developed rapidly in the last decade, and various surgical techniques have gradually matured, making the overall treatment outcome of various foot and ankle injuries and diseases significantly improved. With the further exploration of the field of foot and ankle surgery, the renewal of ideas, the innovation of implants and the empowerment of digital intelligence technology seem to open a new door for foot and ankle surgeons. This issue of Orthopedic Journal of China covers the treatment of various injuries and diseases of the forefoot, midfoot and ankle joint, and discusses and analyzes some new concepts, technical progress and future development, in order to provide guidance and reference for clinical work.

Abstract:[Objective] To compare the clinical efficacy of retrograde tibial intramedullary nail (RTIN) versus minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of extraarticular fractures of the distal tibia. [Methods] A retrospective research was done on 40 patients who received surgical treatment for distal tibial extraarticular fractures in our hospital from June 2021 to December 2022. According to the preoperative doctor-patient communication, 18 patients received RTIN, while the remaining 22 patients were treated with MIPPO. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients were operated on successfully. The RTIN cohort was significantly less than the MIPP cohort in terms of total incision length [(6.7±0.5) cm vs (10.4±1.1) cm, P＜0.001] and hospital stay [(13.9±1.9) days vs (15.6±2.0) days, P=0.012], whereas the former consumed significantly more intraoperative fluoroscopy times than the latter [(14.0±2.7) times vs (11.6±2.6) times, P=0.006]. All patients in both cohorts were followed up from 12 months to 20 months, and the RTIN group regained full weight-bearing activity significantly earlier than the MIPPO group [(85.9±11.3) days vs (98.6±23.5) days, P=0.042]. The VAS and AOFAS scores, as well as ankle flexion-extension ROM in both groups were significantly improved over time (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞ 0.05). The RTIN cohort proved significantly superior to the MIPPO in terms of soft tissue irritation [no/yes, (18/0) vs (15/7), P=0.008], while, the squat capacity and Johner-Wruh scale were not significantly different between the two groups at the last follow-up (P＞0.05). With respect of imaging, the bilateral tibial length discrepancy, lateral distal tibial angle (LDTA) and anterior distal tibial angle (ADTA) were significantly improved in both groups at the latest follow-up compared with those preoperatively (P＜0.05), while which were not significantly different between the two groups at time point accordingly (P＞0.05). All patients in both cohorts had bone healed well at the latest follow-up. [Conclusion] Both percutaneous internal fixation techniques do effectively treat distal tibial extraarticular fractures, in comparison, the retrograde intramedullary nailing achieves better clinical consequence over the minimal invasive percutaneous plate osteosynthesis.

Abstract: [Objective] To search the method of determining the anatomic reduction of the first metatarsal cuneiform joint during open reduction and internal fixation (ORIF) of Lisfranc injury. [Methods] A retrospective study was conducted on 74 patients who received ORIF for closed Lisfranc fracture and dislocation in our hospital from January 2011 to December 2019. Of them, 35 patients in the earlier stage had a single criterion (SC) used in ORIF, which was anatomic restoration of the dorsal and medial cortices alignment, while 39 patients in the later stage had combined criteria (CC) used, in which hallux tibial sesamoid position on the anteroposterior fluoroscopy was added based on abovesaid standard to avoid the rotation of the first metatarsal. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had operation performed successfully without serious complications. There were no significant differences in operation time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times, walking time, incision healing and hospital stay between the two groups (P＞0.05). The end point of postoperative follow-up was of 10~14 months postoperatively, before removal of internal fixation. The CC group regained full weight-bearing activity significantly earlier than the SC group [(61.6±9.0) days vs (69.2±7.2) days, P＜0.001]. At the last follow-up, the rest VAS score and walking VAS score significantly decreased (P＜0.05), while the AOFAS middle foot score was significantly increased in both groups (P＜0.05). At the last follow-up, the CC group proved significantly superior to the SC group in terms of VAS score [(1.4±1.0) vs (2.7±1.5), P＜0.001] and AOFAS score [(98.2±3.9) vs (95.5±6.0), P=0.025]. As for imaging, the step-off sign (SOS), C1-M2 space, M1-M2 space, C1-C2 space, Meary Tomeno angle and Hardy-Clapham sesamoid scale in both groups significantly reduced at the last follow-up compared with those preoperatively (P＜0.05). At the last follow-up, the CC group got significantly less Hardy-Clapham sesamoid scale than the SC group [(2.6±0.5) vs (4.7±0.9), P＜0.001]. [Conclusion] Anatomical reduction is the key to Lisfranc surgical treatment. The alignment of dorsal and medial cortices of the first metatarsal cuneiform joint, combined with the position of the hallux tibial sesamoid, can ensure the sagittal, coronal and rotational anatomical reduction of the first metatarsal cuneiform joint.

Abstract:[Objective] To compare the clinical consequences of tibial periosteum transportation (TPOT) versus tibial cortical bonetransportation (TCBT) in the treatment of diabetic foot. [Methods] A retrospective study was conduced on 78 patients who received TPOTor TCBT for diabetic foot in our hospital from 2018 to 2023. According to preoperative communication between doctors and patients, 39 pa-tients were treated with TPOT, while the other 39 patients received TCBT. The perioperative period, follow-up and auxiliary examinationdata of the two groups were compared. [Results] All patients in both groups had operation performed successfully. The TPOT group provedsignificantly superior to the TCBT group in terms of operation time [(26.5±4.4) min vs (52.4±7.2) min, P＜0.001], intraoperative blood loss[(30.2±11.4) mL vs (81.0±22.4) mL, P＜0.001], and hospital stay [(11.9±2.1) days vs (13.3±3.5) days, P=0.044]. However, there was no sig-nificant difference in wound debridement times, dressing times and wound area between the two groups (P＞0.05). Compared with that at ad-mission, the wound area in both groups was significantly reduced at discharge (P＜0.05). There was no significant difference in wound heal-ing time between the two groups (P＞0.05). At 12 weeks after treatment, the VAS score and foot dorsal skin temperature were significantlyimproved in both groups (P＜0.05), whereas which were not significantly different between the two groups at any time points accordingly (P＞0.05). At 12 weeks after treatment, the WBC, CRP and ESR in both groups were significantly decreased (P＜0.05), which proved not statisti-cally significant between two groups at any matching time points (P＞0.05). [Conclusion] Both tibial periosteum transportation and tibialcortical bone transportation do accelerate the wound healing of diabetic foot by stimulating vascular microcirculation reconstruction,achieve comparable clinical outcomes. In comparison, the tibial periosteum transportation takes considerable advantages in shortening oper-ation time, reducing iatrogenic trauma, and declining surgical difficulty over the tibial cortical bone transportation.

Abstract:[Objective] To compare the clinical efficacy of open reduction and internal fixation with plate through tarsal sinus approachversus closed reduction and percutaneous screw fixation for Sanders type Ⅱ and Ⅲ calcaneal fractures. [Methods] A retrospective analysiswas performed on 43 patients who had Sanders type Ⅱ and Ⅲ calcaneal fractures treated surgically from July 2019 to January 2022. Ac-cording to doctor-patient communication, 23 patients were treated with open reduction and plate fixation through tarsal sinus approach (thetarsal sinus group), while other 20 patients underwent closed reduction and percutaneous screw fixation (percutaneous group). The perioper-ative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had operation completed success-fully. The sinus tarsi group consumed significantly longer operation time [(81.7±12.7) min vs (71.9±13.9) min, P=0.020], with significantlygreater incision length [(5.6±1.1) cm vs (1.9±0.6) cm, P＜0.001], more intraoperative blood loss [(56.7±26.8) mL vs (14.1±8.7) mL, P＜0.001], the hospital stay [(7.3±2.0) days vs (5.5±1.4) days, P＜0.001] and poorer incision healing grade [A/B/C, (17/3/3) vs (20/0/0), P=0.048] than the percutaneous group, whereas the former had significantly less intraoperative fluoroscopy times than the latter [(7.1±2.6)times vs (10.4±2.7) times, P＜0.001]. The patients in both groups were followed up for (18.7±5.9) months in a mean, and the VAS, AOFASscores, as well as inversion-eversion ROM in both groups were significantly improved over time (P＜0.05). The tarsal sinus group had signif-icantly less inversion-eversion ROM than the percutaneous group 1 month postoperatively [(30.9±5.6)° vs (40.0±4.5)°, P＜0.001]. Regardingimaging, the Bohler angle, Gissane angle, calcaneus length, calcaneus width, and calcaneus height were significantly improved in bothgroups immediately after surgery and at the last follow-up compared with those preoperatively. At the last follow-up, the tarsal sinus groupproved significantly better than the percutaneous group in terms of B?hler angle [(29.1±1.6)° vs (27.3±1.8)°, P＜0.001] and calcaneus height [(45.9±2.3) mm vs (43.7±2.3) mm, P=0.003]. Furthermost, the former was also significantly superior to the latter regarding to cartilage sur-

Abstract:[Objective] To compare the clinical outcome of closed reduction and percutaneous three-dimensional cannulated screw fix-ation (PTDCSF) versus open reduction and plate fixation (ORPF) in the treatment of Sanders type II and III calcaneal fractures. [Methods]A retrospective research was done on 99 patients who received surgical treatment for Sanders type II and III calcaneal fractures in our hospi-tal from December 2019 to December 2021. According to the doctor-patient communication before surgery, 51 patients received PTDCSF,while other 48 patients had ORPF performed. The documents regarding to perioperative period, follow-up and imaging were compared be-tween the two groups. [Results] The PTDCSF group was significantly superior to the ORPF group in terms of surgery time [(50.2±1.8) minvs (87.6±1.8) min, P＜0.001], incision length [(3.1±0.5) cm vs (14.3±0.4) cm, P＜0.001], blood loss [(15.0±1.8) mL vs (164.9±1.8) mL, P＜0.001], hospital stay [(4.0±0.2) days vs (9.9±0.2) days, P＜0.001]. However, the former had significantly greater intraoperative fluoroscopytimes than the latter [(17.1±1.9) times vs (4.9±1.8) times, P＜0.001]. In addition, the PTDCSF group resumed postoperative ambulation andfull weight-bearing activity significantly earlier than the ORPF group (P＜0.05). The VAS, AOFAS score and inversion-eversion range ofmotion (ROM) in both groups were significantly improved over time (P＜0.05). The PTDCSF group was also significantly better than the OR-PF group regarding VAS score [(2.9±0.8) vs (5.8±1.1), P＜0.001; (0.9±1.0) vs (2.0±1.0), P＜0.001], AOFAS ankle and hindfoot score [(63.4±2.9) vs (60.6±2.6), P＜0.001; (94.9±2.2) vs (91.1±2.5), P＜0.001] and ROM [(15.4±0.6)° vs (11.7±0.7)°, P＜0.001; (54.6±1.8)° vs (51.5±1.6)°,P＜0.001] 3 days after surgery and at the last follow-up. As for imaging, the B?hler angle, Gissane angle, cartilage surface collapse, calcane-us length, calcaneus width and calcaneus height were significantly improved in both groups at the last follow-up compared with those preop-eratively (P＜0.05). Although there was no statistical significance in calcaneus length between the two groups at the last follow-up (P＞0.05),the remaining radiographic items in the PTDCSF group were also significantly better than those in the ORPF group at the latest follow-up(P＜0.05). [Conclusion] Percutaneous three-dimensional cannulated screw fixation is multidimensional intraosseous fixation, with orienta-tion of the screws based on the stress distribution of calcaneus. Therefore it is more consistent with the biomechanical characteristics of cal-caneus, and does effectively fix fracture, and maintain the position and shape of the bone, with higher safety.

Abstract:With the widespread use of 3D printing technology in clinical practice, total talar replacement (TTR) using customized pros-theses has become an effective option for the treatment of ankle disorders, such as talar avascular necrosis (AVN) and osteoarthritis. Overthe past 20 years, TTR procedures have been conducted successfully with a satisfactory overall survival rate. However, the TTR is still in itsinfancy and need to be evaluated over time. The aim of this review is to summarize the literature on TTR and provide an recent advances onhistorical survey, indications and contraindications, the use of 3D printing technology in talar prosthetic manufacture, survival rates, andfunctional outcomes.

Abstract:Digital medicine is an emerging frontier science that combines digital medical diagnosis, treatment and detection technolo-gy with the help of information technology and modern medical research and practice in recent years. Digital medicine includes 3D modelreconstruction, surgical navigation systems, 3D printing technology, personalized surgical guides and surgical robots. Three dimensionalprinting, also known as 3D printing, is a rapid prototyping technology that constructs objects by printing them layer by layer, based on digi-tal model files and using adhesive materials. From customized foot and ankle orthotics to customized osteotomy guides and screw guides, 3Dprinting technology has been gradually applied in the field of foot and ankle surgery. From preoperative planning and education, medical ed-ucation, and then to the application of clinical medical practice, the advantages of 3D printing technology involve various aspects. Withmore detailed preoperative planning, more streamlined surgical procedures, and more efficient doctor-patient communication, the contribu-tion of 3D printing technology to the implementation of precision medicine is significant. Current research shows that 3D printing technolo-gy may significantly improve the clinical skills of foot and ankle surgeons, optimize the surgical process, enhance the doctor-patient rela-tionship, improve doctor-patient communication, build up patients' cognition of the disease, and have a positive role in improving the over-all medical behavior.

Abstract:Knee osteoarthritis (KOA) is a common degenerative disease in the elderly, and the end-stage KOA usually has knee flex-ion deformity (KFD), which may lead the original sagittal plane imbalance of the human body. Therefore, human body maintains balancethrough compensatory changes in the areas, such as the spine, pelvis, and lower limbs. However, total knee arthroplasty (TKA) is a primari-ly surgical procedure aimed at correcting KFD. This type of surgery not only affects the anatomical structure and function of the surgicalsite, but may also have certain impacts on the spine, pelvis, hip joint, and ankle joint to adapt to the new knee function and stability. This ar-ticle provides a review of the research progress on the sagittal biomechanical changes in the spine, pelvis, lower limbs, and other areas be-fore and after TKA.

Abstract:[Objective] To search the incidence and extent of lateral femorotibial deviation (LFTD) of the knee in normal lower limbs inChinese population, and analyze its correlation with other imaging parameters. [Methods] A retrospective study was conducted on the thefull length weight-bearing X-rays of both lower limbs taken in our hospital with Huayi Regional Medical imaging System from October2020 to October 2023. The LFTD, mechanical medial proximal tibial angle (mMPTA), hip knee ankle angle (HKA), mechanical axis devia-tion (MAD), mechanical lateral distal femoral angle (mLDFA) and joint line congruence angle (JLCA) were measured and compared be-tween the male and female genders. The incidence and extent of LFTD were assayed in this population, additionally, the correlation be-tween LFTD and other imaging parameters was analyzed. [Results] A total of 387 full-length X-rays of normal unilateral lower limbs wereincluded in the study, involving 123 males and 264 females. The overall LFTD was of (3.8±2.0) mm. According to Nayak's criteria, amongthe 387 normal knees included in this study, 91 (74.0%) male knees and 170 (64.4%) female knees had LFTD ＞3 mm, which meant theknee had constitutional coronal lateral alignment deviation, and only 6 male knees and 2 female knees had negative LFTD. In terms of gen-der comparison, the male was significantly yonger than the female [(53.3±19.4) years vs (59.6±15.3) years, P=0.001], the male had signifi-cantly greater LFTD than the female [(4.2±1.9) mm vs (3.6±2.1) mm, P=0.005], and the male proved significantly less JLCA than the female[(1.9±1.9)° vs (2.5±2.3)°, P=0.023]. However, there were no significant differences regarding to HKA, mLDFA, mMPTA and MAD betweenmen and women (P＞0.05). As results of pairwise correlation analysis between LFTD and other image parameters, all the other image mea-surements were correlated with LFTD, and the correlation extent was ranked as mMPTA (r=-0.343, P＜0.001). HKA (r=0.334, P＜0.001),and MAD (r=0.323, P＜0.001), mLDFA (r=0.123, P=0.016) and JLCA (r=0.110, P=0.030). [Conclusion] Most of the normal knee in Chi-nese population have some extent of lateral femorotibial deviation of the knee in coronal plane, which is correlated with mMPTA, HKA andMAD.cantly greater LFTD than the female [(4.2±1.9) mm vs (3.6±2.1) mm, P=0.005], and the male proved significantly less JLCA than the female[(1.9±1.9)° vs (2.5±2.3)°, P=0.023]. However, there were no significant differences regarding to HKA, mLDFA, mMPTA and MAD betweenmen and women (P＞0.05). As results of pairwise correlation analysis between LFTD and other image parameters, all the other image mea-surements were correlated with LFTD, and the correlation extent was ranked as mMPTA (r=-0.343, P＜0.001). HKA (r=0.334, P＜0.001),and MAD (r=0.323, P＜0.001), mLDFA (r=0.123, P=0.016) and JLCA (r=0.110, P=0.030). [Conclusion] Most of the normal knee in Chi-nese population have some extent of lateral femorotibial deviation of the knee in coronal plane, which is correlated with mMPTA, HKA andMAD.

Abstract:[Objective] To evaluate the clinical efficacy of open reduction and internal fixation (ORIF) with mini locked titanium platefor Lisfranc injury complicated with cuboid compression fractures. [Methods] A retrospective study was performed on 21 patients who re-ceived ORIF for Lisfranc injury complicated with cuboid compression fractures in our hospital from October 2015 to January 2018, includ-ing 13 males and 8 females. The clinical and imaging data were evaluated. [Results] All patients had ORIF conducted successfully withoutvascular and nerve injury, and followed up for a mean of (29.3±8.9) months. During the follow-up, 1 patient of them underwent revision tar-sometatarsal fusion due to significant pain in the middle foot during walking. Compared with those preoperatively, the VAS scores [(5.3±0.6), (1.2±0.9), P＜0.001] and AOFAS ankle-hindfoot score [(50.1±3.4), (83.0±6.3), P＜0.001] were significantly improved at th last followup.The clinical outcome were marked as excellent in 3 cases, good in 14 cases, fair in 4 cases poor in 0 case by the time of latest followup,with excellent and good rate of 94.4%. As for imaging, the step-off sign (SOS) [(4.7±1.2) mm, (1.3±0.5) mm, P＜0.001], M1-M2 distance[(13.4±1.9) mm, (2.3±0.6) mm, P＜0.001], C1-C2 distance [(3.1±1.4) mm, (1.7±0.5) mm, P＜0.001], and Meary's angle [(18.8±8.9)°, (2.8±0.9)°, P＜0.001] were significantly improved at the last follow-up compared with those preoperatively. Up to the last follow-up, 2 patientshad mild lateral column shortening deformity and 11 patients had signs of metatarsal arthritis in varying extent. [Conclusion] ORIF withmini locking titanium plate for Lisfranc injury complicated with cuboid bone compression fractures do effectively restore the length of thelateral column and avoid the occurrence of secondary foot deformities, and achieve satisfactory clinical consequence.

Abstract:[Objective] To investigate the short and medium term outcome of arthroscope-assisted repair of the anterior talofibular liga-ment (ATFL) and deltoid ligament (DL) simultaneously for rotational instability of the ankle. [Methods] A retrospective study was conduct-ed on 18 patients who had ATFL and DL repaired simultaneously under arthroscope in our hospital from January 2018 to December 2021,with complete follow-up data. The clinical and imaging data were evaluated at the time points preoperatively and at the latest follow-up.[Results] All the 18 patients had operation performed successfully with the operation time of (56.7±7.2) min, intraoperative blood loss of(9.4±1.4) mL, ambulation time of (14.9±0.5) days. All patients got incisions healed well without major neurovascular injury, deep incisioninfection, or other serious complications, and followed up for a mean of (16.4±2.1) months. Compared with those preoperatively, the AOFASscore [(65.1±8.3), (93.7±4.4), P＜0.001] and ankle dorsal extension-plantar flexion ROM [(61.3±3.7)°, (68.0±2.3)°, P＜0.001] increasedsignificantly; while pain VAS score [(3.8±1.0), (0.7±0.7), P＜0.001] and ankle inversion-eversion ROM [(47.2±2.2)°, (44.2±1.7)°, P＜0.001] significantly decreased at the latest follow-up. In addition, the ankle anterior drawer test, valgus test, and varus test significantly im-proved at the last follow-up compared with the preoperative test (P＜0.001). As for imaging, there were no significant changes in talocruralangle (TCA) and medial clear space (MCS) at the last follow-up (P＞0.05). All patients had no significant degenerative changes in the anklejoint. [Conclusion] The simultaneous arthroscopic ATFL and DL repair do effectively improve the rotational instability of the ankle.

Abstract:[Objective] To evaluate the clinical efficacy of plate internal fixation combined with percutaneous Kirschner wire fixationfor Chopart fracture and dislocation. [Methods] A retrospective study was conducted on 13 patients who had Chopart fracture and disloca-tion treated by open reduction and plate internal fixation combined with percutaneous Kirschner wire fixation in our hospital from January2019 to December 2022. The clinical and imaging documents were evaluated. [Results] All the 13 patients had operation performed suc-cessfully without important nerve, vascular injury and other complications, and followed up for (20.0±5.4) months in an average. The AO-FAS score was of (83.2±6.7), while the Karlson-Peterson score was of (78.2±7.1) on average. Compared with that preoperatively, the VASscore significantly reduced at the latest follow up [(8.0±0.7), (2.5±1.4), P＜0.001]. As for Imaging, the Meary Angle [(15.2±3.2)°, (3.2±2.4)°,P＜0.001] and step-off sign (SOS) [(9.0±2.1) mm, (1.0±0.8) mm, P＜0.001] on the lateral X-rays with weight bearing significantly reduced atthe last follow-up compared with those before operation. [Conclusion] Plate internal fixation combined with percutaneous Kirschner wirefixation is safe and satisfactory regarding clinical consequence for Chopart fracture and dislocation.

Abstract:[Objective] To investigate the clinical outcome of tarsometatarsal fusion in the treatment of hidden Lisfranc injury. [Methods] A retrospective study was conducted on 19 patients who had hidden Lisfranc injury treated by tarsometatarsal fusion in our hospitalfrom April 2010 to May 2020 . The clinical and imaging data were analyzed. [Results] All the patients had operation performed successful-ly without neurovascular injury and other complications, and followed up from 12 months to 24 months. The VAS score significantly re-duced [(5.2±1.6), (1.5±0.8), (1.1±0.7), P＜0.001], while the AOFAS score [(48.5±5.2), (75.8±8.7), (80.8±6.7), P＜0.001], SF-36 score [(40.1±5.9), (70.7±4.0), (75.4±6.3), P＜0.001] increased significantly over time. In terms of image, the clearance between the cuniform 1 and meta-tarsal 2 (C1-M2) in X ray of non weight bearing position [(3.6±1.4), (1.2±0.2), (1.0±0.3), P＜0.001] and the clearance of M1-M2 [(4.6±1.1),(1.6±0.3), (1.4±0.4), P＜0.001] significantly reduced with time. [Conclusion] Tarsometatarsal fusion is a safe and effective operation for hid-den Lisfranc injury,

Abstract:[Objective] To investigate the clinical outcome of single plane valgus retrograde intramedullary nail used in tibiotalocalca-neal arthrodesis (TTCA) for end-stage ankle arthrosis with hind foot deformity. [Methods] A retrospective study was conducted on 26 pa-tients who underwent TTCA with single plane valgus retrograde intramedullary nail for terminal ankle arthrosis in our hospital from January2017 to November 2022. The clinical and imaging documents were evaluated. [Results] All the patients were operated on successfully with-out neurovascular injury and other complications, and followed up for an average of (38.5±21.9) months. With time preoperatively, 3 monthspostoperatively and at the latest follow-up, the VAS score was significantly decreased [(6.1±1.5), (3.7±0.7), (1.6±0.6), P＜0.001], while AO-FAS score [(45.3±4.9), (73.9±6.5), (77.8±5.9), P＜0.001] increased significantly. As for imaging, the varus coronal tibiocalcaneal angle (CT-CA) [(14.2±7.8)°, (4.4±1.1)°, (4.7±0.7)°, P=0.014], and the valgus CTCA [(10.4±1.1)°, (3.9±0.5)°, (4.5±0.5)°, P=0.002] significantly re-duced, while the sagittal tibiocalcaneal angle (STCA) had no significant changes (P＞0.05). Up to the last follow-up, 25 patients had good fu-sion, with an average fusion time of (3.8±0.9) months, and the fusion rate of 96.2%. [Conclusion] For end-stage ankle arthrosis with hindfoot deformity, single plane valgus retrograde intramedullary nail used in TTCA achieves satisfactory clinical consequence with less risk ofintraoperative neurovascular injury.

Abstract:[Objective] To measure the safe height and angle of anteroposterior screw placement in distal articular dome of the tibia.[Methods] The vertical distance of distal articular surface dome to the connecting line of the lowest point of the anterior and posterior tibiallips, and the angle between the tangent line of the anterior and posterior lips of the distal tibia were measured on the T2 weighted MRI imag-ines in 100 patients, including 64 males and 36 females. The differences between male and female groups and left and right groups werecompared and analyzed. [Results] The male had significantly greater vertical distance of distal articular surface dome to the connecting lineof the lowest point of the anterior and posterior tibial lips on the right side than the female, with statistically significant difference [(5.6±0.9)mm vs (5.1±0.8) mm, P=0.035]. The male had less angle between the tangent line of the anterior and posterior lips of the distal tibia on theleft and right sides than the female, but the difference was not statistically significant (P＞0.05). In both male and female, the vertical dis-tance of distal articular surface dome to the connecting line of the lowest point of the anterior and posterior tibial lips on the left side wasgreater than that on the right side, despite of the fact that difference was not statistically significant (P＞0.05). Both male [(37.6±5.0)° vs(32.2±8.2)°, P=0.003] and female [(37.8±4.6)° vs (32.7±7.3)°, P=0.026] had significantly greater angle between the tangent line of the ante-rior and posterior lips of the distal tibia on the left side and the right side. [Conclusion] As anteroposterior screw placement on the distaltibia, the lower edge of the screw should be at least 7 mm above the edge of the anterior lip of the tibia, which in male should be higher thanthat in the female on the right side. If further longer screws are implanted, tilting the screw at least 42° to the proximal tibia, with the leftside more tilting than the right side in both men and women.

Abstract:[Objective] To evaluate the clinical consequence of Tightrope combined with lateral plate fixation for Lisfranc injury.[Methods] A retrospective analysis was performed on 30 patients who had Lisfranc injury treated by the above methods from January 2020to October 2023. Clinical and imaging data were evaluated. [Results] All the patients were successfully operated on without any seriouscomplications such as vascular and nerve injury, while with the average operation time of (40.2±10.7) min, and average blood loss of (30.3±5.0) mL. All the patients were followed up for an average of (12.8±2.0) months. With time preoperatively, 3 months after surgery and the lastfollow-up, the VAS score [(5.6±1.2), (3.0±0.8), (1.9±1.1), P＜0.001], AOFAS score [(39.8±3.6), (60.3±6.0), (86.0±4.3), P＜0.001] were sig-nificantly improved. As for imaging, lateral shifting of the second metatarsal base [Y/N (30/0), (0/30), (0/30), P＜0.001], dorsal steps [Y/N,(18/12), (0/30), (0/30), P＜0.001] were significantly corrected over the time period abovementioned. However, the distance between the bas-es of the first and second metatarsals [(5.7±1.3) mm, (1.9±0.3) mm, (1.6±0.2) mm, P＜0.001] was significantly reduced. [Conclusion] Thetight rope combined with lateral plate fixation does achieve satisfactory clinical consequence in the short term for Lisfranc injury, and is asafe and reliable surgical technique.

Abstract:[Objective] To verify the impact of accessory navicular bone of foot (AN) on posterior tibialis tendon dysfunction (PTTD) byquantitative measurement of posterior tibialis tendon (PTT) thickness with MRI. [Methods] From January 2019 to August 2022, 116 pa-tients who received MRI examination of PTT in our hospital were included in this study. The patients with medial foot pain and MRI presen-tation of PTT injury or effusion around the tendon insertion were defined as the abnormal group, while those with no symptoms and normalMRI were defined as normal group. In addition, the two groups were further defined into 4 subgroups according to different AN types, in-cluding non AN group, type I AN group, type II AN group and type III AN group. The measurement results of the two groups were com-pared, and ROC analysis was performed according to whether abnormality and PTT thickness. [Results] There was no significant change inPTT thickness of all subgroups in normal group (P＞0.05). PTT thickness of type II AN subgroup in abnormal group was significantly in-creased (P＜0.05). Compared with the normal group, the type II AN subgroup in abnormal group had significantly greater PTT thickness of[(4.1±1.2) mm vs (5.5±0.6) mm, P＜0.001], despite of the fact that no significant difference in PTT thickness between the two groups in othersubgroups was noted (P＞0.05). As results of ROC analysis PTT thickness of type II AN subgroup predicting whether abnormality, the bestcut-off point was of 4.7 mm, sensitivity of 87.5%, specificity of 85.7%, with area under curve (AUC) of 0.875. [Conclusion] In PTTD, thepresence of type II AN can increase the thickness of PTT and aggravate the lesion.

Abstract:[Objective] To evaluate the clinical outcome of accessory navicular fusion and posterior tibial tendon reattachment for adulttype II painful accessory navicular syndrome. [Methods] A retrospective study was done on 10 adult patients who had type II painful acces-sory navicular syndrome treated with abovesaid surgical procedures in the our department from March 2021 to June 2023, including 3males and 7 females with an average age of (40.2±4.4) years. The clinical and imaging data were evaluated. [Results] All patients were oper-ated on successfully completed, with operation time of (54.2±4.4) min, incision length of (5.1±0.9) cm, intraoperative blood loss of (17.0±8.2) mL, intraoperative fluoroscopy times of (1.9±0.8) times, ambulation time of (5.2±0.9) weeks, and the full weight-bearing activity time of(8.5±1.1) weeks. All patients were followed up for an average of (13.5±1.9) months. With time preoperatively, 3 months after surgery and atthe last follow-up, the VAS score [(6.1±1.0), (1.3±0.7), (1.4±0.8), P＜0.001] and AOFAS score [(55.6±7.1), (87.5±4.6), (90.0±0.5), P＜0.001]improved significantly. In term of imaging, there was no significant change in calcaneal inclination angle after operation. Fusion betweenthe navicular and accessory navicular was radiographically noted in a mean of (16.2±3.5) weeks. [Conclusion] The modified navicular fu-sion and posterior tibial tendon reattachment are an effective surgical method for the treatment of adult type II painful accessory navicularsyndrome.