Objective To explore a suitable repairing method for skin defects of the foot and ankle, and to evaluate the therapeutic effects of the different repairing methods. Methods From January 2000 to October 2005, 36 patients with skin defects of the foot and ankle underwentthe repairing treatment, of whom 35 were males and 1 was female, aged 5-62 years, averaged 38 years. Of the 36 patients, 12 had an injury by a machine, 22 had a traffic accident, 1 had an infection, and 1 had a cold injury. And the injuries involved the dorsum of the foot, heel, forefoot, and medial or lateral malleolus. The injuries were respectively treated by 2 different repairing methods, the repair with the coverage by the lateral supramalleolar flaps and the repair with the coverage by the reverse sural neurocutaneous flaps. The skin defectsranged in area from 5 cm×4 cm to 20 cm×10 cm. The lateral supramalleolar flapwas used in 15 patients (15 flaps) with a flap area of 5 cm×4 cm-15 cm×8 cm,and the reverse sural neurocutaneous flap was used in 21 patients (22 flaps) with a flap area of 6 cm×4 cm20 cm×10 cm. We retrospectively observed the therapeutic results and compared the success rates of the two methods. Results Of the 36 patients, 15 underwent the repair with the coverage by 15 lateral supramalleolar flaps; 10 achieved a complete survival of the flaps, 2 developed an epidermal necrosis over the distal part, and 3 developed a complete necrosis.The other 21 patients underwent the repair with the coverage by 22 reverse sural neurocutaneous flaps. Of the 22 flaps, 21 had a complete survival, and only 1 failed to survive. The comparison revealed that there was no difference in the color, texture, and contour of the flaps between the 2 repaired groups. And the patients in the 2 groups were equally satisfied with the repairing treatments. The sensation of the flaps recovered to S0-S1. Conclusion The repairing of the foot and ankle skin defects with the coverage by the lateral supramalleolar flaps or by the reverse sural neurocutaneous flaps can achieve a similar good therapeutic result. However, the repair with the lateral supramalleolarflaps is more suitable for the skin defect of a smaller area over the medial orlateral malleolus, or the proximal dorsum of the foot; the repair with the reverse sural neurocutaneous flaps is more suitable for the skin defect of a larger area over the foot and ankle without serious destruction of the malleolar arterial rete.
Objective To summarize the surgical technique of ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation, and to evaluate the cl inical effectiveness. Methods Between March 2009 and June 2010, 18 patients with ankle joint disease were treated, including 8 cases of post-traumatic arthritis, 3 casesof rheumatoid arthritis, 5 cases of osteoarthritis, and 2 cases of post-traumatic necrosis of talus. There were 10 males and 8 females with an average age of 48 years (range, 36-67 years). The average disease duration was 3 years (range, 1-6 years). The main symptoms included swell ing, pain, and a l imited range of motion of the ankle. Four patients accompanied with ankle varus deformity and 2 patients with valgus deformity. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system, the preoperative score was 43.5 ± 10.2. An ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation was performed in all patients. Results Superficial wound infection and partial skin necrosis occurred in 1 case respectively, and were cured after symptomatic treatment; the other incisions healed by first intention without compl ications. Sixteen patients were followed up 16 months on average (range, 1-2 years). The X-ray films showed that bone fusion was obtained at 8-16 weeks (mean, 12 weeks) after operation. The symptom was rel ieved completely in all patients at last follow-up without compl ication of implant failure, nonunion, and malunion. The postoperative AOFAS ankle and hindfoot score was 83.0 ± 6.3, showing significant difference when compared with the preoperative score (t=26.20, P=0.00). Conclusion Ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation has the advantages of feasible technique, the rigid fixation, and high fusion rate, soit may obtain a good cl inical effectiveness.
Objective To investigate the rehabilitation treatment methods for distal tibiofibular syndesmosis injury triad after the second surgery. Methods We reported the postsurgical rehabilitation treatment for a 16-year-old male who received second surgery for internal fixation screw rupture on August 20th 2014, due to weight bearing too early after his first surgery in March 2014 for distal tibiofibular syndesmosis diastasis combined with lateral malleolus fracture, ligamenta talofibulare anterius and deltoid ligament rupture. The patient was treated in the Rehabilitation Center of National Sports Training Center on September 25th, 2014. By analyzing the rehabilitation assessment results, a secondary ankle impingement syndrome was detected and following modified treatments were implemented. Results At the end of the first course of treatment, right ankle muscle strength, range of motion and Y balance tests were all weaker than the left. At the end of the second course of treatment, all data were better than the first course. At the end of the third course, all data were close to normal value except the right leg forward squat. Conclusions Through comprehensive rehabilitation, assessment feedback and further treatment improvement, complex cases like distal tibiofibular syndesmosis injury triad after second injury can be well handled. However, more cases should be collected and investigated.
Objective To study the method and effect of transferring the pedicled second metatarsal base for repairing bone defect of lateral malleolus. Methods Thirty lower limb specimens were anatomized to observe the morphology, structure and blood supply of the second metatarsal bone . Then transferring of thepedicled second metatarsal base was designed and used in 6 patients clinically.All cases were male, aged from 24 to 48 years old, and the area of bone defect was 3-4 cm. Results Followed up for 3-11 months, all patients healed primarily both in donor and recipient sites. There were excellent results in 4 cases and good results in 2 cases . The morphology and function of the malleoli were satisfactory. Conclusion Transferring of the pedicled second metatarsal base for repairing bone defect of lateral malleolus is an effective and reliable operative method.
To evaluate the biomechanical action of lateral malleolar’s anatomical hook-plate in treatingWeber A-type ankle fracture. Methods Forty-eight cadaveric specimens of adult’s inferior extremities from June 2005to October 2006 were observed, consisting of 26 males and 22 females and aged 18-55 years. The external malleolus of the specimens were transected by using a wire saw at the ankle joint level, and then were divided into 4 groups randomly (groups A, B, C and D). Four distinct internal fixation instruments were used: lateral malleolar’s anatomical hook-plate in group A, general screws in group B , 1/3 tubular plate in group C and standard tension band in group D. Each group was further divided into 2 subgroups, A1-D1 and A2-D2. A1-D1 groups underwent anti-pressure and A2-D2 groups underwent anti-torsion biomechanically comparative analysis. Results The peak values of anti-pressure experiments in groups A1-D1 were (799.83 ± 105.47), (699.17 ± 63.81), (598.83 ± 123.14) and (453.00 ± 111.67) N respectively, group A1 was significantly higher than groups B1, C1 and D1 (P lt; 0.01); meanwhile, the peak values of anti-torsion experiments in groups A2-D2 were (37.17 ± 1.81), (30.33 ± 2.22), (20.50 ± 2.92), (24.83 ± 3.47) Nm respectively, group A2 was significantly higher than groups B2, C2 and D2 (P lt; 0.01). Conclusion The lateral malleolar’s anatomical hook-plate represents a definite biomechanical superiority, when compared with other 3 internal fixation instruments in treating fracture of external mlleolus.
Objective To investigate the effectiveness of a new hook-shaped anatomical locking plate in the treatment of Danis-Weber type A lateral malleolus fractures. Methods A retrospective analysis was performed on the clinical data of 45 patients with Danis-Weber type A lateral malleolus fractures who met the selection criteria between November 2020 and November 2022. According to the surgical methods, they were divided into the observation group (treated with the new hook-shaped anatomical locking plate, 23 cases) and the control group (treated with the conventional lateral malleolus anatomical locking plate, 22 cases). There was no significant difference in baseline data such as gender, age, cause of injury, Danis-Weber type of fracture, time from injury to operation, and combined ligament injury between the two groups (P>0.05). The operation time, partial weight-bearing time, return to work time, and postoperative complications were recorded and compared between the two groups. The function and pain of ankle joint were evaluated by the range of motion of ankle dorsiflexion, plantarflexion, varus, valgus, and visual analogue scale (VAS) score at 1 and 3 months after operation, and at last follow-up, and the American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 months after operation and at last follow-up. Results All patients were followed up 10-18 months (mean, 15.1 months). There was no significant difference in operation time between the two groups (P>0.05); the postoperative partial weight-bearing time and return to work time of the observation group were significantly earlier than those of the control group (P<0.05). During the follow-up, there was 1 case of joint stiffness in the observation group, and 1 case of joint surface displacement, 1 case of joint stiffness, and 1 case of traumatic arthritis in the control group. There was no significant difference in the incidences of complications between the two groups (P>0.05). With the extension of time after operation, the range of motion of ankle dorsiflexion, plantarflexion, varus, valgus, and VAS score of the two groups gradually improved, and there were significant differences between different time points (P<0.05); At 1 and 3 months after operation, the above indexes in the observation group were significantly better than those in the control group (P<0.05), and there was no significant difference between the two groups at last follow-up (P>0.05). The difference of AOFAS score between the last follow-up and 3 months after operation in the observation group was significantly better than that in the control group (P<0.05). ConclusionCompared with the conventional lateral malleolus anatomical locking plate, the new hook-shaped anatomical locking plate has a more reliable fixation effect in the treatment of Danis-Weber type A lateral malleolus fracture, which is conducive to early functional exercise of the ankle joint, so that patients can bear weight earlier and return to work earlier, and the operation time is not significantly prolonged, and the effectiveness is satisfactory.
Objective To investigate the method and effect of compound grafting of vascularized fibular head and flaps to repair compl icated lateral malleolus defects. Methods From July 2000 to April 2006, 6 patients with lateral malleolus bone defect underwent the repairing treatment. There were 5 males and 1 female, aged 9-47 years. The causes of injuries was traffic accident in 4 cases and crash in 2 cases. And 5 cases were in the left side and 1 in right side. The bone defect ranged 3.5-8.5 cm in size and the skin defect ranged 14 cm × 4 cm-18 cm × 7 cm in size. The time from injury to surgery rangedfrom 15 to 30 days. The compl icated lateral malleolus defects were repaired by transplanting the fibular head pedicled with the lateral inferior genicular artery 5-10 cm, and the peroneal perforator flaps or latissimus dorsi flaps 16 cm × 5 cm-20 cm × 8 cm. The raw surfaces of donor site were inflated and packaged with intermediate spl it thickness skin graft. Results One flap with 1 cm distal edge dry necrosis healed after change of dressing and others all survived. The free skin grafts survived and the incision healed by the first intention. All the cases were followed up for 4 to 15 months, and all patients achieved the bony heal ing within 8-16 weeks and the transplanted fibular head grew well. The shape of reconstructed lateral ankles was similar to the normal one and the ankle mortise moved well. The texture of flaps was soft without diabrosis and abrasion. According to Baird-Jackson criterion, the results were excellent in 3 cases, good in 2 cases and fair in 1 case and the excellent and good rate was 83.3%. Conclusion The fibular head pedicled with the lateral inferior genicular artery has good blood supply and the reconstructed lateral malleolus is similar to the normal. The peroneal perforator flaps and latissimus dorsi flaps have adequate blood supply and big dermatomic area. So this operation is an effective method to repair lateral malleolus defect.