ObjectiveTo observe the short-term effectiveness of Endobutton plate in the reconstruction of Lisfranc ligament in tarsometatarsal joint injury.MethodsBetween March 2015 and July 2018, 18 patients with tarsometatarsal joint injuries were treated with Lisfranc ligament reconstruction by Endobutton plate. There were 12 males and 6 females with an average age of 32.5 years (range, 16-55 years). The causes of injury were traffic accident in 8 cases, falling from height in 3 cases, crushing by a heavy objective in 4 cases, and spraining in 3 cases. There were 10 cases of Myerson type A, 4 of type B1, 2 of type B2, 1 of type C1, and 1 of type C2. The interval between injury and operation ranged from 3 to 9 days (mean, 4.9 days). X-ray examination was performed regularly after operation to measure the distance between the first and the second metatarsal joints, and the visual analogue scale (VAS) score was used to evaluate the pain relief. At last follow-up, the reduction of tarsometatarsal joint was evaluated by measuring and comparing the height of the affected and healthy arches. The foot function was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsThe average follow-up time was 15.8 months (range, 10-28 months). All incisions healed by first intention. X-ray reexamination showed that there was no screw loosening or plate fracture. There were significant differences in the distance between the first and the second metatarsal joints and VAS score at 3 months after operation, before removal of the internal fixator, and at last follow-up when compared with preoperative values (P<0.05). There was no significant difference between the time points after operation (P>0.05). At last follow-up, there was no significant difference in the arch height between affected foot [(5.3±0.2) mm] and healthy foot [(5.4± 0.3) mm] (t=1.798, P=0.810). The AOFAS score of foot function was 89.5±7.3 with excellent in 12 cases, good in 4 cases, and fair in 2 cases. The excellent and good rate was 88.9%.ConclusionThe reconstruction of Lisfranc ligament with Endobutton plate can stabilize the tarsometatarsal joint and achieve satisfactory foot function at early stage.
Objective To compare the effectiveness of two single-pin internal fixation techniques—trans-fracture in-out-in Kirschner wire fixation and antegrade elastic stable intramedullary nailing (ESIN) from the radial mid-shaft—in the treatment of distal radial metaphyseal diaphyseal junction (DRMDJ) fractures. Methods A retrospective analysis was conducted on 48 pediatric and adolescent male patients with DRMDJ fractures who met the selection criteria and were treated between January 2022 and December 2024. Among them, 27 patients underwent trans-fracture in-out-in Kirschner wire fixation (group A), and 21 patients underwent antegrade ESIN from the radial mid-shaft (group B). There was no significant difference in baseline data between the two groups (P>0.05), including age, cause of injury, affected side, presence of associated ulnar fracture, time from injury to surgery, or fracture classification. The operation time, intraoperative fluoroscopy frequency, fracture reduction rates on anteroposterior and lateral views, fracture healing time, and postoperative complications were recorded and compared. Clinical efficacy were evaluated at last follow-up using the Gartland-Werley scoring system. Results All surgeries were successfully completed. The operation time was shorter in group A than in group B, with a significant difference (P<0.05). No significant difference was found in the intraoperative fluoroscopy frequency between the two groups (P>0.05). All patients were followed up, with a follow-up time of (11.81±2.09) months in group A and (12.10±2.74) months in group B, showing no significant difference (t=–0.389, P=0.699). In group A, 3 patients experienced Kirschner wire irritation to the skin, which resolved after wound care, adjustment of cast fixation, or early pin removal. No complications such as tendon rupture, osteomyelitis, or nonunion occurred in either group. X-ray films taken on the second postoperative day showed that the fracture reduction rates on both anteroposterior and lateral views reached approximately 90% in each group, with no significant difference between groups (P>0.05). All fractures achieved bony union, and there was no significant difference in healing time between groups (P>0.05). At last follow-up, according to the Gartland-Werley score, 24 cases were rated as excellent and 3 as good in group A, while 19 cases were excellent and 2 good in group B, yielding an excellent-good rate of 100% in both groups. ConclusionBoth fixation techniques achieved satisfactory effectiveness. However, the trans-fracture in-out-in Kirschner wire fixation technique is simpler to perform, requires shorter operation time and eliminates the need for implant removal, making it a potentially preferable option for treating this type of fracture.
Objective To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents. Methods The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed. There were 17 males and 6 females, ranging in age from 4 to 16 years with an average of 8.5 years. The time from injury to operation was 1-4 years. The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient’s upper extremity data at one time, and the preoperative rotation of the distal humerus on the affected side was (33.82±4.39)°. The CT plain scan data were imported into 9yuan3D digital orthopaedic system (V3.34 software) to reconstruct three-dimensional images of both upper extremities. The simulated operation was performed with the healthy upper extremity as the reference, the best osteotomy scheme was planned, overlapped and compared, and the osteotomy guide plate was prepared. The patients were followed up regularly after operation, and the formation of callus in the osteotomy area was observed by X-ray examination. Before and after operation, the carrying angle of both upper extremities (the angle of cubitus valgus was positive, and the angle of cubitus varus was negative) and anteversion angle were measured on X-ray and CT images. At the same time, the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured, and Mayo score was used to evaluate the function of elbow joint. ResultsThe operation time ranged from 34 to 46 minutes, with an average of 39 minutes. All patients were followed up 5-26 months, with a mean of 14.9 months. All the incisions healed by first intention after the operation; 2 patients had nail path irritation symptoms after Kirschner wire fixation, which improved after dressing change; no complication such as breakage and loosening of internal fixators occurred after regular X-ray review. Continuous callus formed at the osteotomy end at 4 weeks after operation, and the osteotomy end healed at 8-12 weeks after operation. At last follow-up, the carrying angle, anteversion angle, external rotation range of motion, and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones (P<0.05). Except for the extension range of motion of the healthy elbow joint (P<0.05), there was no significant difference in other indicators between the two sides (P>0.05). At last follow-up, the Mayo elbow score was 85-100, with an average of 99.3; 22 cases were excellent, 1 case was good, and the excellent and good rate was 100%. ConclusionComputer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy, which has the advantages of short operation time and easy operation, and the short-term effectiveness is satisfactory.