[Clinical study of staging operation for large gouty stone on the first metatarsophalangeal joint].

OBJECTIVE: To explore short-term curative effect of staging operation for large gouty stone on the first metatarsophalangeal joint. METHODS: From January 2015 to December 2016, 12 patients with giant gout stone on the first metatarsophalangeal joint were treated with staging operation, including 12 males, aged from 45 to 73 years old, 6 cases on the right side and 6 cases on the left side. After conservative treatment for more than 2 years, the size and location of ventilator stone were detected by dual energy CT. The bone destruction of the first metatarsophalangeal joint was observed on X-ray examination. All patients underwent stageⅠgout radical removal and temporary fixation with Kirschner wire, and metatarsophalangeal joint fusion and internal fixation were performed after local soft tissue conditions were stabilized. The level of blood uric acid before and after hand were compared, and correction and complications of limb deformity were observed, VAS score was applied to evaluate pain relieved degree. RESULTS: All patients were successfully completed two stages ' operation. Twelve patients were followed up for 9 to 13 months. VAS sco re and uric acid content at different time points were observed and recorded. VAS score before operation ranged from 6 to 9, and decreased to 0 to 1 at 7 weeks after operation; the level of blood uric acid ranged from 443 to 501 µmol/L before operation, and decreased to 307 to 330 µmol/L at 7 weeks after operation. The first metatarsophalangeal joint deformity of foot was corrected and the shape was recovered at 5 to 7 months after operation. One patient occurred incision infection and flap edgenecrosis, and the wound healed by debridement and dressing change. CONCLUSION: Staged operation for the treatment of giant gout stone on the first metatarsophalangeal joint of foot could correct joint deformity, restore shape of the first metatarsophalangeal joint, relieve pain of the affected foot, and beneficial for control content of serum uric acid, and has less complications.

[Four kinds of operative methods for subtalar arthrodesis in treating old calcaneal fracture].

OBJECTIVE: To explore clinical efficacy of four surgical methods for subtalar joint fusion and internal fixation in treating old calcaneal fractures. METHODS: From March 2014 to November 2017, 25 patients (26 feet) with old calcaneal fractures treated with four surgical methods of subtalar arthrodesis were retrospectively analyzed, including subtalar joint fusion in situ for 2 patients (2 feet), subtalar articular strut bone graft fusion for 6 patients (6 feet), subtalar joint fusion with calcaneus V-shaped osteotomy for 6 patients(6 feet), and subtalar bone graft fusion with calcaneus cuneiform osteotomy for 11 patients (11 feet). They aged from 23 to 70 years old with an average of (36.7±5.8) years old, and the courses of disease ranged from 3 to 35 months with an average of (9.5±5.1) months. Postoperative complications were observed, talar tilt angle, calcaneus Böhler angle, Gissane angle, and the heel height were compared before and after surgery at 12 months. VAS score and American Orthopaedic Foot and Ankle Society(AOFAS) score were employed to evaluate clinical efficacy at 12 months after surgery. RESULTS: Twenty-one patients (21 feet) were followed up for 13 to 34 months with an average of (20.1±3.7) months, four patients(5 feet) were lost to follow-up. Two patients were underwent surgical incision rupture, 1 patient occurred fracture nonunion, and no complications such as fracture nonunion, loosening or fracture of internal fixation occurred in the other patients. There were significant differences between preoperative and postoperative in talar tilt angle[(5.3±2.4)° vs (11.2±4.6)°, t=7.24, P<0.05], calcaneus Böhler angle[(5.4±2.7)° vs(25.5±5.3)°, t=11.2, P<0.05], Gissane angle[(89.4±9.6)° vs (122.0±5.2)°, t=8.13, P<0.05], and heel height[(28.5±5.1) mm vs(47.1±3.7) mm, t=6.45, P<0.05]. VAS score was decreased from 5.2±1.0 before operation to 1.6±0.7 at 12 months after operation(t=5.12, P<0.05); AOFAS score was improved from 52.4±6.4 to 86.2±5.2 at 12 months after operation(t=6.41, P<0.05); 14 feet got excellent results, 4 good , 2 moderate and 1 poor. CONCLUSIONS: Subtalar joint fusion in situ, subtalar articular strut bone graft fusion, subtalar joint fusion with calcaneus V-shaped osteotomy, and subtalar bone graft fusion with calcaneus cuneiform osteotomy are effective operation methods for old calcaneal fractures, which have advantages of relieving pain, correcting deformity of calcaneal, improving foot function. Reasonable selection and treatment is the key to ensure the efficacy.

[Bone and soft tissue combined with surgery for the treatment soft flatfoot combined with painful navicular bone].

OBJECTIVE: To explore short-term clinical effects of bone and soft tissue combined with surgery for the treatment of soft flatfoot accompanied with painful navicular bone. METHODS: From May 2015 to August 2017, 16 patients (16 feet) with navicular bone soft flatfoot accompanied with painful navicular bone were treated with bone and soft tissues operation (gastrocnemius release, medial displacement calcaneal osteotomy, and excision of accessory navicular with reconstruction of posterior tibial tendon). Among them, there were 9 males (9 feet) and 7 females (7 feet), aged from 22 to 48 years old with an average of (32.0±3.4) years old. The duration of diseases ranged from 6 months to 5 years with an average of (2.4±1.7) years. The postoperative complications were observed, talocalcaneal angle, the first metatarsal horn of the talus, arch height, angle of inclination and calcaneal valgus before and after operation at 12 months were compared. VAS score and AOFAS score after operation at 12 months were applied to evaluate pain relief and function. RESULTS: All patients were followed up for an average of (18.4±3.5) months(13~25 months). The incisions of patients were healed at grade A without wound infection, nonunion or delayed union, internal fixation fracture or loosening and other complications. Medial pain of foot was disappeared and motor ability was restored at 12 months after operation. Arch height, angle of inclination and the first metatarsal horn of the talus of lateral X-ray before operation and after operation at 12 months on weight-bearing foot were(21.51±1.20)°vs(31.01±1.62)°, (10.71±1.52)°vs(22.12±2.11)°, (15.61±1.41)°vs(5.10±1.20)°; talocalcaneal angle, the first metatarsal horn of the talus of AP X-ray before operation and after operation at 12 months on weight-bearing foot were (36.12±2.21) ° vs (22.12±2.61)°, (13.41±1.51)°vs(4.30±0.91)°; calcaneal valgus of axial X-ray before operation and after operation at 12 months on weight-bearing foot were (10.80±1.21)°vs(3.92±1.81)°; there were statistical difference in imaging indicators between preoperation and 12 months after operation. VAS score was significantly decreased from (6.21±2.31) before operation to (1.82±0.56) at 12 months after operation (t=2.64, P<0.05). AOFAS score was obviously increased from (51.2±5.6)before operation to (87.1±4.7)at 12 months after operation (t=3.43, P<0.05). CONCLUSIONS: Bone and soft tissue operation (namely, gastrocnemius release, medial displacement calcaneal osteotomy, and excision of accessory navicular with reconstruction of posterior tibial tendon) could obviously relieve foot pain, improve foot appearance and function in patients with navicular bone soft flatfoot complicated with painful navicular bone, and has certain clinical efficacy.

[Treatment of old calcaneal fractures with calcaneus V-shape osteotomy for the subtalar joint preservation].

OBJECTIVE: To observe the clinical effect of calcaneus V-shape osteotomy for the subtalar joint preservation in the treatment of old calcaneal fractures. METHODS: A retrospective study was conducted on 18 patients (18 feet) with old calcaneal fractures treated by calcaneus V-shape osteotomy from March 2014 to November 2017. Included 13 males and 5 females, aged from 23 to 48 years old with an average of (34.3±4.5) years and the course of disease was from 2 to 9 months with an average of (4.5±4.1) months. According to the classification of Sanders, 14 cases of type II and 4 cases of type III. The postoperative complications were observed. The changes of Böhler angle, Gissane angle, heel height and the tilt angle of talus were compared between before operation and 12 months after operation. Maryland foot score was used to evaluate the curative effect. RESULTS: Fourteen patients were followed up, 4 patients were loss to follow-up. And the follow-up time was 13 to 35 months, with an average of (21.2±4.1) months. The fracture healing time was 10 to 12 weeks with an average of (12.4±2.1) weeks. One patient had skin necrosis of incision after operation, and no complications such as nonunion of fracture and loosening or rupture of internal fixation were found. The tilt angle of talus, Böhler angle, Gissane angle, heel height at 12 months after operation were (11.4±5.1)°, (24.7±4.3)°, (124±3.1)°, (46.1±2. 8) mm, respectively, while before operation were (9.1±2.9)°, (6.8±3.1)°, (93.4±11.7)°, (34.5±5.3) mm, there were significant difference between before and after operation. Maryland score was significantly increased from 59.21±7.21 preoperatively to 86.34 ±4.14 postoperatively 12 months(t=43.1, P<0.05), and 8 cases got excellent results, 4 good, 1 fair, 1 poor. CONCLUSIONS: Calcaneus V-shape osteotomy for subtalar joint preservation is one of the effective methods in the treatment of old calcaneal fractures, which has the advantages of preserving subtalar joint, correcting calcaneal deformity, inproving foot appearance, alleviating foot pain and raising foot function.

[Treatment of distal radius fracture with manual reduction and external fixation with small splint steel support external fixation].

OBJECTIVE: To evaluate the short-term result for the treatment of distal radius fracture with manual resetting and fixing with small splint. METHODS: From January 2015 to December 2016, 60 cases of distal radial fractures were treated by manual resetting and small splint fixation including 39 males and 21 females with an average age of (43.50±10.56) years old ranging from 18 to 65 years old. According to AO classification, 38 cases were type A, 19 cases were type B, 3 cases were type C. The anteroposterior and lateral X-ray of the wrist joint was performed before reduction, 1, 2, 4 weeks after reduction, and the removal of the small splint, the palm inclination angle, ulnar deviation angle and radius height were measured. At 8, 24 and 48 weeks after reduction, the wrist extensor, palmar flexion, pronation, supination, ulnar deviation and radial deviation were measured. Wrist strength was measured at 4, 8, 24 and 48 weeks after fracture reduction. After the distal radius fracture healed, the splint support was removed. After dismantling small splint steel support, Mayo score of wrist joint was performed. RESULTS: All cases of distal radius fractures were followed up, the healing time of fracture was 6 to 8 (7.1±0.9) weeks. The difference of palmar obliquity, ulnar deviation angle and radius shortening between before reduction and 2 weeks after reduction was statistically significant. There was no significant difference in palmar inclination, ulnar deviation and radius shortening between 2 and 4 weeks after reduction. After 24 weeks and 8 weeks, 48 weeks and 24 weeks after reduction, there was significant difference in wrist extensor, palmar flexion, pronation, supination, ulnar deviation and radial deviation. The grip strength was statistically significant between after reduction and 4 weeks after reduction, 8 weeks and 4 weeks after reduction, 16 weeks and 8 weeks after reduction, 24 and 16 weeks after reduction. There was no significant difference in grip strength between 48 weeks and 24 weeks after reduction. The Mayo wrist function scoring system was used to evaluate the curative effect, the results were excellent in 50 cases, good in 8 cases, fair in 1 case and poor in 1 case. CONCLUSIONS: The treatment of distal radius fracture with the method of manual resetting and fixing with plywood is simple and the clinical efficacy is accurate.

[Case-control study on tibetan Baimai ointment (see symbol in text) for the treatment of wrist-dysfunction after distal radius fracture].

OBJECTIVE: To evaluate efficacy and safety of Baimai ointment (see symbol in text) in the treatment of wrist-dysfunction after distal radius fracture. METHODS: From April, 2011 to June, 2012, 43 patients with distal radius fracture were treated with plaster fixation. All the patients were divided into two group: test group and control group. Twenty-one patients in test group and 22 in control group, and the baseline was balance (P > 0.05). The 21 patients in test group were treated with Baimai ointment (see symbol in text), fomentation, functional exercises. The 22 patients in control group were treated with placebo, fomentation, functional exercises. Foment affected side wrist with wet towel in 20 min before medication, with the temperature between 50 degrees C and 60 degrees C. Smear drugs uniformly in range of 3 cm in the vicinity of palm stripes after drying (about 3 g) and take functional exercises for the activities of wrist and hand. Continuous follow the program per 8 hours once and follow-up for 8 weeks. The Wrist's pain was assessed with VAS. The wrist's activities were measured with the protractor of orthopedic. Measure The grip strength was measured with dynamometer. The wrist's function were assessed with the table of Cooney. RESULTS: The test group had a significantly better results than those of control group in the extent of wrist's pain throughout the treatment (P < 0.001), and grip strength on the 28th day and the 56th day (P < 0.05), and Cooney functional assessment on the 56th day (P < 0.05). Wrist's activities had no significane difference throughout the 8 weeks (P > 0.05). There were no drug adverse reactions occurred. CONCLUSION: Tibetan Baimai ointment (see symbol in text) has the treatment of wrist-dysfunction after distal radius fracture for external use, which can reduce the extent of wrist's pain, promote grip strength recovery in the middle and late of process, promote wrist's function recovery latterly, and safety for external use.