Homeopathic Ankle Dislocation for Treatment of Unstable Trimalleolar Fractures Involving Posterior Die-Punch Fragment: A Retrospective Cohort Study.

OBJECTIVES: Unstable trimalleolar fractures are relatively complex and more difficult to manage if die-punch fracture is present. We aimed to evaluate the curative effect of homeopathic ankle dislocation on the unstable trimalleolar fractures involving posterior die-punch fragments. METHODS: A total of 124 patients diagnosed with unstable trimalleolar fractures combined with post-die punch fragment between June 2008 and June 2020 were retrospectively included. Patients who received homeopathic ankle dislocation were named as the experimental group, and patients who accepted conventional treatment were control group. The fracture healing time, wound healing, American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS), visual analogue scale (VAS), the Kellgren-Lawrence arthritis grading scale (KLAGS) and short-form 36 score (SF-36) scores were collected. Student t-test was used for fracture healing time. Wound healing and SF-36 were compared using the Mann-Whitney test. Repeated measurement analysis of variance (ANOVA) was used for AOFAS and VAS. χ2-test was used for KLAGS. RESULTS: AOFAS showed statistically significant differences between the two groups (p = 0.001). In non-weight-bearing and weight-bearing conditions, VAS scores were significant different between the two groups, and there was an interaction between group and time point (p < 0.001). The experimental group was superior to the control group in terms of physical function (p = 0.022), role-physical (p = 0.018), general health (p = 0.001) and social function (p = 0.042).The operation time of experimental group was shorter than that of control group (p < 0.001). CONCLUSION: Homeopathic ankle dislocation is used for the unstable trimalleolar fractures involving posterior die-punch fragment, which can provide better functional outcomes while shortening the operation time and recovery period.

Effects of low-GI biscuits as pre-loads or mid-meal snacks on post-prandial glycemic excursions in women with recent gestational diabetes: A protocol for a randomized crossover trial and an extended tailored intervention.

Background: Increased post-prandial glycemic excursions contribute to the development of diabetes and have been observed in women with recent gestational diabetes mellitus (GDM) and with normal glucose tolerance at post-partum. As a convenient meal replacement, low-GI biscuits are helpful for improving glycemic excursions in patients with type 2 diabetes. However, it is unknown whether low-GI biscuits as pre-loads or mid-meal snacks have a better effect in diminishing post-prandial glycemic excursions from the individual level in women with recent GDM. Therefore, the aim of this trial is to tailor a better dietary strategy utilizing low-GI biscuits (Fitmeal) to improve post-prandial glycemic excursions through within-subject comparison in such a population and observe the long-term effect of a tailored dietary approach in glycemic control. Methods: We have designed a two-phase trial including a randomized, crossover, non-blinded trial in the first phase, followed by a 4-week tailored intervention in the second phase. A total of 52 post-partum women with recent GDM will be allocated into four meal plans: (1) Fitmeal pre-load 30 min before standard lunch meal (P+L), (2) Fitmeal as a mid-meal snack 2 h before standard lunch meal (S+L), (3) isocaloric standard control with co-ingestion of Fitmeal and standard lunch meal (CL) at the same time, and (4) placebo control with 200 ml of water taken 30 min before standard lunch meal (W + L), on four consecutive days. Acute post-prandial glycemic response (PGR) measured by continuous glucose monitoring (CGM) will be compared among the four meals. In the second phase, all participants will receive a 4-week tailored intervention using Fitmeal as pre-loads or mid-meal snacks based on within-subject PGR results from the first phase. Glycemic metrics, dietary behaviors, and psychosocial factors (e.g., quality of life, self-efficacy, perceived stress, and depression) will be examined at baseline and end-point. Discussion: This trial is expected to optimize the use of low-GI biscuits as pre-loads or mid-meal snacks in improving individual post-prandial glycemic excursions among women with recent GDM. Furthermore, the findings of this study will provide novel information on how to deliver an effective dietary intervention at the individual level and guide future clinical practice of medical nutrition therapy for diabetes prevention. Trial registration number: Chinese clinical trial registry, ChiCTR2200060923.

The Effects of Intravenous Dexamethasone on Rebound Pain After Nerve Block in Patients with Ankle Fracture: A Randomized Controlled Trial.

Purpose: A single-injection nerve block provides excellent analgesia in a short time, but rebound pain after the nerve block disappears has attracted researchers' attention. The aim of this study is to evaluate the effect of intravenous dexamethasone on rebound pain after adductor canal block (ACB) and popliteal sciatic nerve block in patients with ankle fracture. Methods: We recruited 130 patients with ankle fractures scheduled for open reduction and internal fixation (ORIF), each of whom received ACB and popliteal sciatic nerve block. Patients were divided into two groups: C (ropivacaine only) and IV (ropivacaine with intravenous dexamethasone). The primary outcome was the incidence of rebound pain. Secondary outcomes included the following: pain scores at 6 h (T1), 12 h (T2), 18 h (T3), 24 h (T4), and 48 h (T5) after operation; duration of the nerve block; number of presses of the analgesia pump and rescue analgesic consumption in the three-day postoperative period; quality of recovery scale (QoR-15 score); postoperative sleep quality; satisfaction of patients; and levels of serum inflammatory markers (IL-1ß, IL-6, and TNF-α) six hours after surgery. Results: Compared with group C, the incidence of rebound pain in group IV was significantly reduced, and the duration of nerve block was extended by approximately nine hours (P<0.05). Moreover, patients in group IV had significantly lower pain scores at T2-T4, lower levels of serum inflammatory markers (IL-1ß, IL-6, and TNF-α), higher QoR-15 score two days after the operation, and satisfactory sleep quality the night after surgery (P<0.05). Conclusion: Intravenous dexamethasone can reduce the rebound pain after adductor block and sciatic popliteal nerve block in patients with ankle fracture surgery, prolong the duration of nerve block, and improve the quality of early postoperative recovery.

Risk factors for deep surgical site infection following surgically treated peri-ankle fractures: a case-control study based on propensity score matching.

AIMS: This study aims to identify the risk factors for deep surgical site infection (DSSI) following surgically treated peri-ankle fractures. METHODS: We performed a retrospective case-control study using the propensity score matching (PSM) method in 1:2 ratio, based on the 6 baseline variables, including age, gender, living area, insurance type, fracture location and surgical date. Data on patients who underwent surgical treatment of peri-ankle fractures were collected by inquiring their hospitalization medical records and operative records, as well as the laboratory reports. Conditional logistic regression analysis was performed to identify the risk factors for DSSI. RESULTS: A total of 2147 patients were eligibly included and 74 had a DSSI, indicating an incidence rate of 3.4%. After PSM, 70 cases of DSSI and 140 controls without DSSI were matched, constituting the study cohort. The univariate analyses showed significant differences between groups in terms of history of any surgery, time to operation, surgical wound classification, smoking, alcohol drinking, RBC count, hemoglobin concentration and hematocrit (%). The conditional logistic regression analysis showed time to operation of < 4 or > 9 (vs 4-9 days); unclean wound, current smoking, high-energy injury mechanism and lower hematocrit were independent risk factors for DSSI. CONCLUSIONS: Timely modification of smoking and hematocrit (%), and limiting operation within a rational time frame for an optimized soft tissue condition, may provide potential clinical benefits for SSI prevention.

Surgeon volume and risk of deep surgical site infection following open reduction and internal fixation of closed ankle fracture.

Increasing evidences have shown that surgeon volume was associated with postoperative complications or outcomes in a variety of orthopaedics surgeries, but few were focused on ankle fractures. This study aimed to investigate the deep surgical site infection (DSSI) in association with the surgeon volume following open reduction and internal fixation (ORIF) of ankle fractures. This was a retrospective analysis of the prospectively collected data on patients who underwent ORIF for acute closed ankle fractures between October 2014 and June 2020. Surgeon volume was defined as the number of ORIF procedures performed within 12 months preceding the index operation. The receiver operating characteristic (ROC) curve was constructed to determine the optimal cut-off value, whereby surgeon volume was dichotomized as high or low. The outcome was DSSI within 1 year postoperatively. Multivariate logistics analysis was performed to examine the DSSI in association with surgeon volume and multiple sensitivity/subgroup analyses were performed to refine the findings. Among 1562 patients, 33 (2.1%) developed a DSSI. The optimal cut-off value was 7/year. Low-volume (<7/year) was significantly associated with a 5.0-fold increased risk of DSSI (95%CI, 2.2-11.3; P < .001). Sensitivity/subgroup analyses restricted to patients aged <65 years, with or without concurrent fractures, with unimalleolar fractures, bi- or trimalleolar fractures, receiving ORIF within 14 days and those operated by ≥10-year experience surgeons showed the consistently significant results (ORs, 2.7-6.8, all P < .05). The surgeon volume of <7 cases/year is associated with an increased risk of DSSI. It is more feasible that patients with complex fractures or conditions (eg, bi- and trimalleolar or presence of concurrent fractures) are preferentially directed to high-volume and experienced surgeons.

Surgeon volume and the risk of deep surgical site infection following open reduction and internal fixation of closed tibial plateau fracture.

BACKGROUND: Emerging evidences supported that the surgeon case volume significantly affected post-operative complications or outcomes following a range of elective or non-elective orthopaedic surgery; no data has been available for surgically treated tibial plateau fractures. We aimed to investigate the relationship between surgeon volume and the risk of deep surgical site infection (DSSI) following open reduction and internal fixation (ORIF) of closed tibial plateau fracture. METHODS: This was a further analysis of the prospectively collected data. Adult patients undergoing ORIF procedure for closed tibial plateau fracture between January 2016 and December 2019 were included. Surgeon volume was defined as the number of surgically treated tibial fractures in the preceding 12 months and dichotomized on the basis of the optimal cut-off value determined by the receiver operating characteristic (ROC) curve. The outcome was DSSI within one year post-operatively. Multiple multivariate logistic models were constructed for "drilling down" adjustment of confounders. Sensitivity and subgroup analyses were performed to assess the robustness of outcome and identify the "optimal" subgroups. RESULTS: Among 742 patients, 20 (2.7%) had a DSSI and 17 experienced re-operations. The optimal cut-off value for case volume was nine, and the low-volume surgeon was independently associated with 2.9-fold (OR, 2.9; 95%CI, 1.1 to 7.5) increased risk of DSSI in the totally adjusted multivariate model. The sensitivity analyses restricted to patients with original BMI data or those operated within 14 days after injury did not alter the outcomes (OR, 2.937, and 95%CI, 1.133 to 7.615; OR, 2.658, and 95%CI, 1.018 to 7.959, respectively). The subgroup analyses showed a trend to higher risk of DSSI for type I-IV fractures (OR, 4.6; 95%CI, 0.9 to 27.8) classified as Schatzker classification and substantially higher risk in patients with concurrent fractures (OR, 6.1; 95%CI, 1.0 to 36.5). CONCLUSION: The surgeon volume is independently associated with the rate of DSSI, and a number of ≥ nine cases/year are necessarily kept for reducing DSSIs; patients with concurrent fractures should be preferentially operated on by high-volume surgeons.

Relationship between surgeon volume and the risk of deep surgical site infection (DSSI) following open reduction and internal fixation of displaced intra-articular calcaneal fracture.

It is well established that the postoperative results were affected by the surgeon volume in a variety of elective and emergent orthopaedic surgeries; however, by far, no evidences have been available as for surgically treated displaced intra-articular calcaneal fractures (DIACFs). We aimed at investigating the relationship between surgeon volume and deep surgical site infection (DSSI) following open reduction and internal fixation (ORIF) of DIACFs. This was a further analysis of prospectively collected data from a validated database. Patients with DIACFs stabilised by ORIF between 2016 and 2019 were identified. Surgeon volume was defined as the number of surgically treated calcaneal fractures within one calendar year and was dichotomised based on the optimal cut-off value. The outcome measure was DSSI within 1 year postoperatively. Multivariate logistics regression analyses were performed to examine the relationship, adjusting for confounders. Among 883 patients, 19 (2.2%) were found to have a DSSI. The DSSI incidence was 6.5% in surgeons with a low volume (<6/year), 5.5 times as that in those with a high volume (≥6/year) (incidence rate, 1.2%; P < 0.001). The multivariate analyses showed a low volume <6/year was associated with a 5.8-fold increased risk of DSSI (95% confidence interval, 2.2-16.5, P < 0.001). This value slightly increased after multiple sensitivity analyses, with statistical significances still unchanged (OR range, 6.6-6.9; P ≤ 0.001). The inverse relationship indicates a need for at least six cases/year for a surgeon to substantially reduce the DSSIs following the ORIF of DIACFs.

Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate the postoperative analgesia effect of ultrasound-guided single popliteal sciatic nerve block for calcaneal fracture. METHODS: A total of 120 patients scheduled for unilateral open reduction and internal fixation of calcaneal fracture were enrolled in this prospective randomized study. Patients in group B received ultrasound-guided single popliteal sciatic nerve block after operation, but Patients in group A did not. All patients received patient-controlled intravenous analgesia (PCIA) after operation. The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use and the total number of times the patient pressed the analgesia pump were recorded. The time of rescue analgesia and the adverse reactions were recorded. Pain magnitude of the patients immediately after discharge from operating room (T1), and at 4th (T2), 8th (T3), 12th (T4), 16th (T5), 24th (T6) and 48th (T7) h after the operation were assessed with visual analog scale (VAS). In addition, patient, surgeon and nurse satisfaction were recorded. RESULTS: The VAS scores at T2 ~ T5, the time of rescue analgesia and the adverse reactions, the total number of times the patient pressed the analgesia pump were significantly declined in group B (p < 0.001). The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use were prolonged and patient surgeon and nurse satisfaction were improved in group B (p < 0.05). CONCLUSION: Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture. TRIAL REGISTRATION: ChiCTR, ChiCTR2100042340. Registered 19 January 2021, URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=66526 .

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study.

BACKGROUND: This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors. METHODS: This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI. RESULTS: A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showed Pseudomonas aeruginosa in 7 cases, methicillin-resistant Staphylococcus aureus (MRSA) in 6, methicillin-susceptible Staphylococcus aureus (MSSA) in 5, methicillin-resistant coagulase-negative Staphylococci (MRCNS) in 2, Escherichia coli in 2, and Proteus mirabilis in 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12). CONCLUSIONS: SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.

The plantarward oblique Chevron osteotomy: an optional method to treat hallux valgus with painful plantar callosities.

Hallux valgus (HV) is a foot deformity that can be treated with Chevron osteotomy, and a modified plantarward oblique osteotomy has been proposed in recent years. However, no research has focused on the correctional power of the osteotomy. The aim of this study was to examine the character of this plantarward oblique Chevron osteotomy (POCO) and to determine the rationale of this method.Radiographs and clinical data from 65 HV patients (77 feet) with painful callosities were evaluated. The intermetatarsal angle, hallux valgus angle, and relative height of the second metatarsal were measured, and a valid width of the first metatarsal was proposed. A visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society hallux-metatarsophalangeal interphalangeal scale (AOFAS) were used to evaluate the patients' clinical results.There were significant differences in the HVA and IMA. The decline in the height of the second metatarsal was positively related to the decline in the height of the first metatarsal, but the changes were smaller for the first metatarsal. Painful callosities disappeared in 77 feet, 4 (5.1%) patients had no pain but a remaining plantar callosity, and 2 (2.6%) patient had relieved pain with a plantar callosity after follow-up. The VAS scores improved from 8.58 ± 0.50 to 1.96 ± 0.75 points after the operation (p < 0.001). Significant differences were demonstrated in the AOFAS scores (65.81 ± 4.05 vs 87.88 ± 3.41, p < 0.001). The modified POCO prevents the dorsal migration of the metatarsal head, preserves other lesser metatarsals and provides an opportunity for patients who may possibly need additional future deformity correction. Therefore, POCO is a safe and effective method to treat hallux valgus and offers the superior potential benefits of correction and transfer metatarsalgia.

Definition of ideal configuration for femoral neck screw fixation in older people.

Femoral neck fractures are the most common injuries encountered by older individuals, and they are associated with high mortality and morbidity. Internal fixation to femoral neck fracture with cannulated screws placed with a configuration of an inverted triangle remain a feasible and effective treatment for femoral neck fractures. The objection of this research was to evaluate the femoral neck morphology, especially the shape of the femoral neck in Chinese people to find the optimal screw position and interval between the screws. 96 consecutive normal subjects without any previous proximal femur operation were reviewed. The patients' information were collected from our database. The minimum of neck canal height (NCHM), neck canal width (NCWM) and inclination angle (AIA and PIA) were measured in different level. There was a significant difference between the AIA and PIA, neck canal height at inferior and superior 1/3 on posterior wall (NCHIP and NCHSP). Although there was a significant difference between the neck canal height at inferior and superior 1/3 on anterior wall (NCHIA and NCHSA, p < 0.001), but the changes were small. The shape of the anterior wall was perpendicular to the horizon and almost parallel with the FNA. In contrast, the shape of the posterior wall resembled a reverse question mark. The inverse triangular fixation was in accordance with the morphology of the femoral neck, and triangular fixation had a high risk of perforation, which may lead to nonunion and avascular necrosis. The anterior screw can be inserted easily with the help of a C-ARM, and the posterior screw positioned mildly posterior to the femoral shaft axis is recommended.

How international are the editorial boards of leading spine journals? A STROBE-compliant study.

Low- and middle-income countries contribute to only a small percentage of publications in multiple medical fields. Editorial bias was reported to be an important reason for this. However, whether this trend exists in leading spine journals remains unclear. This study determined the composition of the editorial boards of leading spine journals and analyzed the international representation of editorial boards.The editorial board members of four leading subspecialty spine journals, including The Spine Journal, Journal of Neurosurgery: Spine, European Spine Journal, and Spine were identified from the journals' websites. The countries of editorial board members were identified and analyzed according to the continent and country income categories classified by the World Bank.A total of 608 editorial board members were identified from the four leading spine journals. The majority (91.4%) of editorial board members were from high-income countries, followed by upper-middle income countries (7.2%), and lower-middle income countries (1.3%). No editorial board members were from low-income countries. Regarding the continent of residence, 46.5% of the editorial board members were from North America, followed by Europe (38.5%), Asia (9.9%), South America (2.8%), Oceania (1.6%), and Africa (0.7%). The editorial board members came from 40 different countries, which were concentrated in North America, Western Europe, and East Asia. The largest number of editorial board members came from the United States (42.3%), followed by Germany (6.9%), the United Kingdom (6.7%), Switzerland (5.8%), and Italy (5.1%).A lack of international representation on editorial boards exists in leading spine journals. Editorial board members from high-income countries are substantially overrepresented, while editorial board members from low- and middle-income countries are severely underrepresented. The United States is the most represented country on the editorial boards of leading spine journals.

Reconstruction of the lateral ankle ligaments using the anterior half of peroneus longus tendon graft.

BACKGROUND: This study aimed to report our institution's experience in the treatment of chronic lateral ankle instability using the anterior half of the peroneus longus tendon (AHPLT) to reconstruct the lateral ligament. METHODS: This retrospective study included 32 consecutive patients with chronic lateral ankle instability who underwent surgery from January 2013 to December 2014. All patients had failed to resolve with conservative treatment. A total of 32 ankles underwent AHPLT transfer. Patients returned for a clinical and radiologic follow-up evaluation at an average of 28 (range, 24-35) months postoperatively. Outcomes were assessed by comparison of pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale pain scores, and Karlsson scores, and the radiographic assessment including talar tilt and anterior talar translation. RESULTS: Thirty-two patients (32 ankles) (100%) returned for final evaluation. All patients had an excellent or good outcome on patient subjective self-assessment, pain scores, AOFAS scores, and Karlsson scores at final follow-up. Ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was significantly reduced from a preoperative mean of 14.1±4.2° to 3.4±1.3° postoperatively (P<.001), and the anterior drawer was significantly reduced from a preoperative mean of 13.8±3.4mm to 3.6±1.5mm after lateral ankle ligamentous reconstruction (P<.001). CONCLUSIONS: AHPLT transfer to reconstruct the lateral ligament resulted in a high percentage of successful results, with excellent ankle stability and not affected of ankle motion. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

Deep surgical site infection after ankle fractures treated by open reduction and internal fixation in adults: A retrospective case-control study.

Information on ankle fractures is limited. The purpose of this study was to investigate the incidence and risk factors for deep surgical site infection (DSSI) after open reduction and internal fixation (ORIF). Adult patients who underwent ORIF for an ankle fractures at 3 level-I centres between January 2013 and June 2017 were included. Data on demographic, injury-related, and surgery-related variables and biochemical indexes from the laboratory were collected from patients' electronic medical records. Univariate analysis and multivariate logistic regression analysis model were used to perform the data analysis through SPSS 19.0. Within 1-year postoperatively, 2.83% (74/2617) of cases developed DSSI, with the earliest occurring at the 4th and latest at 147th day. Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and methicillin-susceptible Staphylococcus aureus were the top 3 bacteria, causing 73% (37/51) of all the cases. Age (45-64 and ≥65 years), current smoking status, chronic heart disease, lower preoperative albumin level, open injury, and prolonged surgical duration were identified to be independently associated with DSSI occurrence. Preoperative active supplementation of nutrition, immediate smoking cessation, and optimisation of an operative plan for the reduction of surgical duration were feasible measures for DSSI prevention following ORIF of ankle fractures.

Diagnosis and treatment of chronic lateral ankle instability with ligamentum bifurcatum injury: An observational study.

This study aimed to report our institution's experience in the diagnosis and treatment of chronic lateral ankle instability (CLAI) with ligamentum bifurcatum (LB) injury.This retrospective study included 218 consecutive patients with CLAI who underwent surgery from January 2012 to December 2015. The 218 patients received tendon allograft reconstruction of the lateral ligament. CLAI was combined with LB injury in 51.4% (112/218) of patients. The 112 patients with concurrent LB injury had this treated simultaneously; 36 patients underwent excision of the anterior process of the calcaneus, 68 underwent LB repair, and 8 underwent LB reconstruction. Patients returned for a clinical and radiologic follow-up evaluation at an average of 31 (range, 24-35) months postoperatively. Outcomes were assessed by comparison of pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale pain scores, Karlsson scores, and radiographic assessment.Of the patients with concurrent LB injury, 82.1% (92/112) returned for final evaluation. Postoperatively, most patients recovered very well. However, the outcome was not ideal in those who underwent excision of the anterior process of the calcaneus; there were significant postoperative decreases in talar tilt (P < .05) and anterior drawer (P < .05), but there was no significant postoperative improvement in visual analog scale pain score and AOFAS score. Patients who underwent LB repair or reconstruction had an excellent or good outcome regarding patient subjective self-assessment, pain scores, Karlsson scores, and AOFAS scores at final follow-up.Patients with CLAI often have concurrent LB injury. The diagnosis of LB injury can be missed or delayed. Clinicians should closely examine the LB in cases of CLAI, and should surgically repair or reconstruct the LB when necessary.

Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: A retrospective multicenter study.

Information on surgical site infection (SSI) after surgical treatment of ankle fracture is limited and remains controversial. The purpose of the present study was to determine the incidence and risk factors for SSI after open reduction and internal fixation (ORIF) of ankle fracture. Patients who underwent ORIF for ankle fracture at 3 centers between January 2015 and December 2016 were included. The potential risk factors for SSI included demographic variables, including age, sex, body mass index (BMI), hypertension, diabetes mellitus, heart disease, smoking, and excessive alcohol intake; blood test variables including preoperative white blood cell count, neutrophil count, red blood cell count, hemoglobin, total protein, albumin and globulin; injury- and surgery-related variables, including duration of operation (minutes), intraoperative blood loss, surgeon level, fracture site, accompanied dislocation, use of a drainage tube, and antibiotic use. Factors related with SSI occurrence were investigated by univariate analysis, and then by multivariate analysis. During hospitalization, 4.37% (66/1511) of patients developed SSI, which was deep in 1.32% (20/1510) and superficial in 3.05% (46/1510). The most common causative agent was polymicrobial (causing approximately half of all SSIs), followed by methicillin-resistant Staphylococcus aureus (MRSA). Multivariate analysis revealed that the significant risk factors for SSI occurrence were open injury, advanced age, incision cleanliness II - IV, high-energy injury, more experienced surgeon level, greater BMI, chronic heart disease, history of allergy, and preoperative neutrophil count > 75%. Preoperative preventative measures should be taken in patients with these conditions to lower the incidence of SSI after ORIF of ankle fracture. LEVEL OF EVIDENCE: Level III - Retrospective Comparative Study.

Imageological measurement of the sternoclavicular joint and its clinical application.

BACKGROUND: Dislocation of the sternoclavicular joint is rare. However, posterior dislocation compressing important structures in the mediastinum may be fatal. Early diagnosis and prompt therapy of sternoclavicular joint dislocation are important. Computed tomography (CT) is an optimal means to investigate sternoclavicular joint anatomy; however, there are few reports on the imageological anatomical features of the sternoclavicular joint. The study investigated imageological anatomical features, and a new plate was devised according to these data to treat sternoclavicular joint dislocation. METHODS: Fifty-three healthy Chinese volunteers examined with chest CT were included in the study. The coronal, sagittal, and axial images of the sternoclavicular region were reconstructed. The sternal head diameter in the inferolateral-to-superomedial direction, length of the clavicular notch, and angle between the clavicular notch and sternum were measured on coronal images. The angle between the presternum and trunk was measured on sagittal images. The following dimensions were measured on axial images: anteroposterior dimensions of the sternal head, clavicular notch, and presternum; width of the sternoclavicular joint; distance between bilateral clavicles; and minimal distance from the presternum to the underlying structures in the thoracic cavity. A new plate was designed according to the above data and was used to repair six sternoclavicular joint dislocations. All cases were followed up with a range of 9 to 12 months. RESULTS: The proximal clavicle is higher than the presternum in a horizontal position. On axial images, the anteroposterior dimension of the sternal head was longer than the presternum, and the center region of the presternum was thinner than the edges. The left sternoclavicular joint space was (0.82 ± 0.21) cm, and the right was (0.87 ± 0.22) cm. Among the structures behind the sternum, the left bilateral innominate vein ran nearest to the presternum. The distance from the anterior cortex of the sterna to the left bilateral innominate vein was (2.38 ± 0.61) cm. The dislocated joints were reduced anatomically and fixed with the new plate. All cases obtained satisfactory outcomes in follow-up visits. CONCLUSIONS: Normal sternoclavicular joint parameters were measured on CT images, which can facilitate treatment of sternoclavicular joint dislocation or subluxation. This newly designed plate can be used to treat sternoclavicular joint dislocation effectively and safely.