Arthroscopy-Assisted Reduction in the Management of Isolated Medial Malleolar Fracture.

PURPOSE: To evaluate the feasibility of arthroscopic reduction percutaneous fixation (ARPF) in the treatment of isolated medial malleolar fracture and compare the results with those of conventional open reduction internal fixation (ORIF). METHODS: This prospective study enrolled 77 patients with isolated medial malleolar fracture between November 2011 and February 2016. The patients were assigned to the ARPF (n = 34) and ORIF (n = 43) groups. The Olerud-Molander ankle score (OMAS), ankle range of motion (ROM), visual analog scale, and radiographic evaluation were determined at the scheduled follow-up. RESULTS: In the ARPF group, 11 of 34 patients (32.4%) had chondral lesions. Tears of the deltoid ligament and anterior inferior tibiofibular ligament were noted in 3 (8.8%) and 15 (44.1%) patients, respectively. The mean follow-up was 5 years. The mean OMAS was higher in the ARPF group than in the ORIF group. The differences were statistically significant at 6 months (mean ± standard deviation, 80.2 ± 4.0 for ARPF vs 77.2 ± 4.1 for ORIF, P = .005) and 1 year (92.9 ± 4.9 vs 88.1 ± 4.6, P < .001), but not at the latest follow-up (P = .081). Ankle ROM was markedly improved in the ARPF group, unlike in the ORIF group at 6 months (dorsiflexion, P = .025; plantarflexion, P < .001) and 1 year (dorsiflexion and plantarflexion, P < .001). The improvement remained at the latest follow-up in plantarflexion (P = .001) but not in dorsiflexion (P = .354). CONCLUSIONS: Arthroscopy-assisted reduction is a feasible alternative modality with superior short-term outcomes for treating isolated medial malleolar fracture, but its superiority may be attenuated in the intermediate term. LEVEL OF EVIDENCE: Level III, comparative study.

[Efficacy analysis of antibiotic bone cement in treating infectious wound of lower extremity].

OBJECTIVE: To discuss the clinical effect of antibiotic bone cement in the treatment of infectious wound of lower extremity. METHODS: From January 2016 to January 2019, 28 patients who had infection wounds of lower extremity were treated by antibiotic bone cement, including 21 males and 7 females with age of 34 to 76 (53.8±16.5) years old. The wound area after the initial debridement was 4 cm×3 cm to 12 cm×8 cm. All patients were treated with the antibiotic bone cement, when infection was controlled and fresh granulation tissue grew on the wound surface, local sutures or skin grafts were performed. The changes of white blood cell (WBC), erythrocyte sedimentation rate(ESR), C reactive protein(CRP) and positive rate of bacterial culture of wound secretions were recorded andcompared before and after 2 weeks of the operation. The healing time, recurrence rate and complications of fresh granulation on wound surface were calculated. RESULTS: All patients were followed up for 3 to 6(4.3±1.2) months. After the recurrence of diabetic foot wound infection, 3 patients presented different degree of rupture, and the remaining patients had good wound healing. No serious complications such as aggravation of infection and amputation occurred. The WBC, ESR and CRP of the patients were decreased significantly after operation compared with that before operation (9.1±1.2)×109/L vs. (11.4±2.2)×109/L, (23.5±7.6) mm/ h vs. (57.1±14.9) mg/L, (44.2±13.1) mg/L vs. (89.2±26.7) mg/L (P<0.05). The formation time of fresh granulation on the wound surface was 12 to 21(15.6±3.2) days. CONCLUSION: The antibiotic bone cement can control infection of lower extremity wound effectively, promote the growth of fresh granulation tissue and wound healing.

Effect of Induced Membrane Formation Followed by Polymethylmethacrylate Implantation on Diabetic Foot Ulcer Healing When Revascularization Is Not Feasible.

No study has investigated the role of induced membrane (IM) formation in treating diabetic foot ulcer (DFU). This retrospective study was aimed (1) at evaluating the potential role of a two-staged surgical approach, comprising polymethylmethacrylate (PMMA) implantation and IM formation, in the treatment of DFU and (2) at comparing the results of those with routine wound debridement in patients with DFUs and nonrevascularized peripheral arterial disease (PAD). Fifty patients with infected DFUs who were not candidates for vascular interventions were enrolled between February 2016 and April 2018 and assigned to the PMMA group (n = 28) and conventional group (n = 22). The healing rate, major amputation rate, duration of healing, frequency of debridement procedures, patient survival rate, and reulceration of DFUs were determined. The Mann-Whitney U test, independent sample t-test, and χ 2 or Fisher exact test were used in statistical analysis. Overall clinical outcomes were statistically different between the groups (Z = -2.495, P = 0.013). In the PMMA group, 16 patients (57.1%) with intact IM formation achieved ulceration healing at 13.1 ± 3.7 weeks with a mean number of debridements of 1.3 ± 0.4, which were significantly different compared to those values in 5 patients of the conventional group (22.7%, P = 0.014; healing duration: 26.4 ± 7.8 weeks, P = 0.016; mean number of debridements: 3.6 ± 0.5, P ≤ 0.001). At a mean 16.8 ± 4.3-month follow-up, patient survival rates were 92.9% and 68.2% in the PMMA and conventional groups, respectively (P = 0.032). The major amputation rate and reulceration of DFUs were similar between the groups. The two-staged surgical approach is an available, effective modality for improving healing of DFUs. This study provides preliminary information of IM formation followed by PMMA implantation in the management of DFUs in PAD when revascularization is not feasible.