Comparison of Ma-Griffith combined with a minimally invasive small incision to a modified suture technique for the treatment of acute achilles tendon ruptures.

BACKGROUND: The Achilles tendon is the strongest tendon in the human body, although it is also prone to injury and rupture. Currently, the best treatment method for acute Achilles tendon rupture remains controversial. The aim of this study was to compare the efficacy of the Ma-Griffith method combined with a minimally invasive small incision (M-G/MISI) with the modified suture technique (MST). METHODS: We conducted a retrospective review of the medical records of all patients who underwent treatment for acute Achilles tendon rupture between January 2012 and January 2020 at our hospital. Demographic characteristics, operative details, and postoperative complications were recorded, and data were statistically analyzed to compare the treatment efficacy of the two operative methods. RESULTS: A total of 67 patients were enrolled in the study, 34 of whom underwent M-G/MISI treatment, and 33 of whom underwent MST treatment. The intraoperative blood loss in the M-G/MISI group (16.47 ± 13.23 ml) was significantly lower than that in the MST group (34.55 ± 13.01 ml), and the difference was statistically significant (P ˂0.001). The incision in the M-G/MISI group (3.79 ± 1.81 cm) was significantly shorter than that in the MST group (5.79 ± 1.00 cm), and the difference was statistically significant (P˂0.001). The Achilles tendon rupture score and the American Orthopedic Foot and Ankle Society (AOFAS) score were higher than those of the MST group at the sixth month after the operation (P˂0.001). Postoperatively, there was 1 case of traumatic Achilles tendon rupture in the M-G/MISI group and 1 case each of infection and deep vein thrombosis in the modified suture group. CONCLUSIONS: Compared with the MST group, the M-G/MISI group had better Achilles tendon and ankle function scores at 6 months postoperatively, and less bleeding and shorter incisions. M-G/MISI is less invasive than MST.

Treatment of intra-articular calcaneal fractures by plate fixation via lateral transverse incisions and double-window approaches / 中华创伤骨科杂志

Objective@#To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures.@*Methods@#A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures (22 feet) which had been treated at Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016. There were 19 males and 2 females, aged from 20 to 60 years (average, 38.3 years). The fracture affected 13 left feet and 9 right feet. According to the Sanders classification, 10 feet were type Ⅱ, 11 type Ⅲ and one type Ⅳ. They were treated by plate fixation via the lateral transverse incisions and double-window approaches. Early complications within 3 months after operation, the length, width, height, Böhler angle and Gissane angle of the calcaneus one year after operation, functional recovery of the affected feet at the last follow-up, and complications were recorded.@*Results@#The 21 patients were followed up for 21 to 44 months (mean, 36.7 months). Incisions were all healed at the first postoperative stage with no serious skin or soft tissue complications like superficial infection, deep infection or wound dehiscence. At the early stage, one patient suffered epidermal necrosis at the margin of incision, which was cured after dressing change. None of the patients developed subtalar arthritis by the last follow-up. The preoperative length, width, height, Böhler angle and Gissane angle of the calcaneus (respectively, 68.6±1.2 mm, 46.7±0.8 mm, 39.1±2.0 mm, 5.4°±12.1° and 104.3°±10.2°) were significantly improved to 71.7±1.6 mm, 48.8±2.0 mm, 32.8±1.3 mm, 29.2°±6.8°, and 120.8°±6.2° one year after operation(P<0.05). At the last follow-up, their AOFAS ankle-hind foot scores averaged 92.7 points (from 73 to 98 points); 17 feet were rated as excellent, 3 as good and 2 as moderate, giving an excellent and good rate of 90.1%.@*Conclusion@#Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis, leading to good clinical results in the treatment of intra-articular calcaneal fractures.

Treatment of intra-articular calcaneal fractures by plate fixation via lateral transverse incisions and double-window approaches / 中华创伤骨科杂志

Objective To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures.Methods A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures (22 feet) which had been treated at Department of Orthopaedics,The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016.There were 19 males and 2 females,aged from 20 to 60 years (average,38.3 years).The fracture affected 13 left feet and 9 right feet.According to the Sanders classification,10 feet were type Ⅱ,11 type Ⅲ and one type Ⅳ.They were treated by plate fixation via the lateral transverse incisions and double-window approaches.Early complications within 3 months after operation,the length,width,height,B(o)hler angle and Gissane angle of the calcaneus one year after operation,functional recovery of the affected feet at the last follow-up,and complications were recorded.Results The 21 patients were followed up for 21 to 44 months (mean,36.7 months).Incisions were all healed at the first postoperative stage with no serious skin or sofi tissue complications like superficial infection,deep infection or wound dehiscence.At the early stage,one patient suffered epidermal necrosis at the margin of incision,which was cured after dressing change.None of the patients developed subtalar arthritis by the last follow-up.The preoperative length,width,height,B(o)hler angle and Gissane angle of the calcaneus (respectively,68.6 ± 1.2 mm,46.7 ± 0.8 mm,39.1 ± 2.0 mm,5.4° ± 12.1° and 104.3°± 10.2°) were significantly improved to 71.7 ± 1.6 mm,48.8 ±2.0 mm,32.8 ± 1.3 mm,29.2° ± 6.8°,and 120.8° ± 6.2° one year after operation(P ＜ 0.05).At the last follow-up,their AOFAS ankle-hind foot scores averaged 92.7 points (from 73 to 98 points);17 feet were rated as excellent,3 as good and 2 as moderate,giving an excellent and good rate of 90.1％.Conclusion Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis,leading to good clinical results in the treatment of intra-articular calcaneal fractures.

Advances in the treatment of acute closed Achilles tendon rupture / 中华骨科杂志

Acute closed Achilles tendon rupture is a common sport injury.Rupture of the Achilles tendon may limit the ability of physical exercises and activities of daily life.Conservative treatment has long recovery time and high risk of re-rupture of Achilles tendon.In recent years,with the early functional rehabilitation exercise,including early weight bearing and ankle joint flexion and extension exercise under the protection of orthopaedic braces,re-rupture risk of Achilles tendon has been significantly reduced,thus conservative treatment is becoming more and more popular.The surgical treatment mainly includes traditional open surgery and minimally invasive surgery.Minimally invasive treatment has less trauma,low re-rupture rate like open surgery,low risk of wound infection and is helpful for early rehabilitation.However,the risk of the sural nerve injury is higher.Open surgery has clear operating field and low re-rupture rate and low risk of the sural nerve injury.However,it still has some problems such as superficial and deep infection of the incision,suture reaction,tissue adhesion and so on.Both of them can achieve satisfactory results in the treatment of acute closed Achilles tendon rupture.Although the mechanism of injury of acute closed rupture of the Achilles tendon and epidemic characteristics have a deeper understanding,including degenerative tendon rupture and mechanical rupture of Achilles tendon,the incidence rate showed a rising trend,and affected by the geographical,gender,age and other factors,due to the existence of a variety of patient groups,there is still controversy over the optimal treatment modalities resulting from the diversity of the patient population.According to the individual differences of different groups of patients,the combination of early rehabilitation exercise can achieve satisfactory clinical effects as long as the treatment methods are appropriate.At present,the effect of biological therapy on the healing of Achilles tendon and the prevention of deep vein thrombosis are still controversial.There is no definitive evidence for the effectiveness of biological therapy and the need for prophylactic anticoagulation.The purpose of this study is to summarize the treatment of acute closed Achilles tendon rupture,and to discuss the importance of early functional exercise for acute closed Achilles tendon rupture and its effect on prognosis.

A new navigation system for distal locking of tibial intramedullary nail / 中国组织工程研究

BACKGROUND:Positioning of the distal locking screws of a tibial intramedulary nail is often chalenging and time consuming. The traditional free-hand technique under fluoroscopic control involves considerable radiation exposure.OBJECTIVE: To evaluate the results of a new electromagnetic navigation system (TRIGEN-SURESHOT navigation system) for distal locking of tibial intramedullary nail in tibial diaphyseal fracture and to compare the effects with the free-hand method.METHODS: Forty-five cases of tibial diaphyseal fracture in the Second Hospital of Anhui Medical University from May 2014 to August 2015 were analyzed retrospectively, and were divided into two groups. Patients in navigation group (n=23) were treated with intramedullary nail using the TRIGEN-SURESHOT navigation system for distal locking, and the remainings in free-hand group (n=22) were given the free-hand method.RESULTS AND CONCLUSION: All cases were followed up for 17-32 months. The one-time success rate of distal locking nail operation was 100％ in the navigation group, which was significantly higher than that in the free-hand group (P 0.05). To conclude, the effect of the TRIGEN-SURESHOT navigation system for distal locking of tibial intramedullary nail is satisfactory, exhibiting the advantages of short operation time, high success rate, and no radiation.

Effectiveness of modified suture technique in treatment of acute closed Achilles tendon rupture / 中国修复重建外科杂志

Objective: To investigate the effectiveness of modified suture technique in the treatment of acute closed Achilles tendon rupture.