Unilateral External Fixator Combined with Lateral Auxiliary Frame for Ultimate Treatment of Tibia and Fibula Shaft Fractures with Poor Soft Tissue Conditions.

Background: For severe soft tissue damage or open fracture, unilateral external fixation is one of the treatment choices. In the current study, a unilateral external fixator combined with a lateral auxiliary frame was used to treat tibia and fibula shaft fractures with poor soft tissue conditions to verify its feasibility for the ultimate treatment. Methods: We retrospectively analyzed the patients with tibia and fibula shaft fractures who underwent unilateral external fixator combined with lateral auxiliary frame between December 2018 and October 2020. The clinical outcomes were recorded. Results: 31 patients with tibia and fibula shaft fractures who received unilateral external fixator combined with lateral auxiliary frame were included in the current study. Among them, 23 cases had closed fractures with poor soft tissue and 8 cases had Gastilo type I open fractures. The average duration of hospital stay was 7.3 ± 2.3 days. The causes of injury were traffic accidents in 15 cases (48.4%), fall from height in 7 cases (22.6%), crush injury in 5 cases (16.1%), and other causes in 4 cases (12.9%). During follow-up, the clinical healing time was 3.0 ± 0.85 months. Additionally, the infection rate of pin-tract and reoperation rate was 12.9% and 3.2%. Fortunately, all patients achieved fracture healing and recovered well without joint dysfunction and obvious claudication. The Johner-Wruh scores showed that 27 cases (87.1%) were "excellent" and 4 cases (12.9%) were "good." Conclusions: The unilateral external fixator combined with lateral auxiliary frame is an effective option for ultimate treatment of the tibia and fibula shaft fractures with poor soft tissue conditions.

Distal tibial tubercle-high tibial osteotomy with assistance of modifiable spreader in the treatment of varus knee osteoarthritis: A retrospective observational study.

As one of the knee preservation surgical approaches, good clinical outcomes of high tibial osteotomy were reported. Aims of this study were to analyze the clinical outcome and pre- and postoperative radiographical parameter and knee functional score between distal tibial tubercle high tibial osteotomy (DTTHTO) and open wedge- high tibial osteotomy (OWHTO) in patients with varus knee osteoarthritis after more than 1 year following-up. A total of 194 consecutive patients in our joint center from March 2016 to October 2021 were enrolled, according to the surgical method, patients were divided into DDTHTO and OWHTO groups. Radiographic parameters of Kellgren-Lawrence grading, hip-knee-ankle angle, weight bearing line ratio and medial tibial plateau angle, knee functional score of American knee society (AKS) score, western Ontario and McMaster universities arthritis index (WOMAC) score, visual analogue score (VAS) were introduced to evaluate clinical outcome for patients who received DDTHTO and OWHTO. There were 103 knees and 89 knees in the OWHTO and DTTHTO group, respectively. Mean weight bearing line ratio for OWHTO and DTTHTO were 25.1 ±â€…11.7 and 25.2 ±â€…12.0% respectively, medial tibial plateau angle and hip-knee-ankle angle angle demonstrated that all patients in the present study inherited a varus angle ranges from 3.4° to 9.5°. Preoperative AKS, WOMAC and VAS were 68.4 ±â€…5.7 versus 69.0 ±â€…5.9, 109.3 ±â€…15.0 versus 107.7 ±â€…14.0 and 6.8 ±â€…1.0 versus 6.9 ±â€…0.8, and there was no significant difference between 2 groups (P > .05). Mean postoperative AKS and WOMAC score for patients in both OWHTO and DTTHTO group were significantly improved, moreover, postoperative VAS of DTTHTO patients was lower than that in OWHTO group (P < .05). When comparing the operation time, intraoperative blood loss and bone union time, DHHTO group shows a superiority in these variables over patients in OWHTO (121 ±â€…29.6 vs 145.7 ±â€…35.2 minutes, 115.0 ±â€…20.8 vs 103.3 ±â€…17.3 mL, 13.7 ±â€…4.1 vs 12.0 ±â€…2.8 weeks; P < .005) and incidence of complication was lower for DTTHTO group. DTTHTO in patients with varus knee osteoarthritis has good clinical outcomes, and it can achieve a better postoperative alignment. Operation time and surgical trauma were also less in patients who underwent DTTHTO.

Application of unilateral external fixation by the "joystick technique" in the treatment of pediatric tibia shaft fractures: technical note.

BACKGROUND: The aims of current study were to present the clinical outcomes in patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction and describe the details of our technique. METHODS: We retrospectively analyzed the patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction between July 2018 and March 2020. The clinical outcomes were evaluated. RESULTS: A total of 23 patients were included in the current study with the average age of 8.0 years (ranged 4-14 years). The average duration of hospital and follow-up were 5.9 days (ranged 4-8 days) and 17.4 months (ranged 8-27 months), respectively. At postoperative 3 days, the visual analog scale (VAS) score was 3.1 ± 1.43, which was significantly lower than the preoperative score of 7.3 ± 1.5. Of these, 2 cases showed redness and swelling of pin-tract and exudation at postoperative 1 month, who improved after oral antibiotics without causing fixation failure. The average time to full weight-bearing without crutches was 5.1 weeks (ranged 3-8 weeks). All patients achieved fracture healing and good functional recovery. No complications including fixation failure, reoperation, epiphyseal injury occurred, infection around implants, vessel damage, nerve damage, and limitation of joint movement were observed. The Johner-Wruh scores showed that 21 cases (91.3%) were "excellent" and 2 cases (8.7%) were "good." CONCLUSIONS: This procedure had advantages of simple operation, minimum trauma, early recovery of lower limb function, and no risk of complications. It may provide a new choice for children with tibia shaft fractures who require surgical treatment.

Ossification timeline of sesamoid bones at metatarsophalangeal joints.

Ossification timeline is a critical issue in studies regarding sesamoid bones at metatarsophalangeal (MTP) joints, but actual knowledge is still incomplete. The present study determines the cutoff age of sesamoids ossification at MTP joints. We conducted a retrospective review of radiographs of the feet from 5553 males and 3225 females between November 2005 and September 2012 to identify presence of sesamoids at 5 MTP joints and 3 variations of hallucal sesamoids. Age-specific prevalence of each presence and variations was calculated and clustered to produce latent age groups corresponding to the sesamoid ossification process in males and females, respectively. Males older than 7 years of age were divided into 5 age groups (8-11, 12-15, 16-29, 30-76, and 77-92 years), while females were classified into 4 age groups (8-11, 12-26, 27-76, and 77-92 years). According to the characteristics of sesamoid prevalence in each age group, the pre-ossification stage was defined at age 1-7 years in both genders and the ossifying stage was defined at age 8-29 years in males and 8-26 years in females. We also defined ossified stage as age 30-92 years in male and 27-92 years in females. The ossifying and ossified stages include 2 or 3 substages in both genders. A clustering analysis provided novel cutoff age points as ossification timelines for the sesamoid bones at MTP joints in males and females, which may have an impact on future sesamoid and skeletal development research.