Objective To summarize the methods of ankle hinge position design in the correction of clubfoot deformity by Ilizarov method, and to explore its application value in the prevention of ankle dislocation. Methods A retrospective study was conducted including 28 patients with rigid clubfoot deformity (34 feet) who met the selection criteria and admitted between September 2021 and December 2024. There were 19 males and 9 females with an average age of 31.8 years (range, 19-47 years). According to Dimeglio classification, there were 21 feet of degree Ⅲ and 13 feet of degree Ⅳ. The causes were traumatic sequelae in 9 cases, congenital foot deformity in 15 cases, spina bifida sequelae in 1 case, peripheral neuropathy in 1 case, and cerebral palsy sequelae in 2 cases. The malformation lasted from 6 to 46 years, with an average of 29.3 years. All patients were treated with Ilizarov circular external fixator, and the hinge position of ankle joint was planned according to the standard lateral X-ray film of foot and ankle and the principle of Ilizarov limb deformity correction center of rotation angulation (CORA) before operation. The 2008 International Clubfoot Study Group (ICFSG) scoring system was used to evaluate the efficacy. ResultsThe deformity of rigid clubfoot was completely corrected in all patients, and the patients could walk with plantar weight-bearing, and the ankle weight-bearing walking significantly improved when compared with that before operation. There was no complication such as ankle dislocation, talus impact or extrusion, local skin necrosis, needle tract infection, or numbness of extremities during the correction process. All patients were followed up 5-39 months, with an average of 18.1 months. At last follow-up, according to the ICFSG scoring system, 23 feet were excellent, 10 feet were good, and 1 foot was fair, and the excellent and good rate was 97%. Conclusion Designing the position of the ankle hinge according to the principle of CORA can effectively avoid ankle dislocation, talus impingement, tibiotalar joint extrusion, and other ankle adverse events in the process of correcting clubfoot deformity, which has good application value in clinical practice.
ObjectiveTo investigate the preoperative application effect of reverse traction technique in trimalleolar fracture-dislocation of the ankle. Methods A retrospective analysis was conducted on the clinical data of 37 patients with trimalleolar fracture-dislocation of the ankle, who were admitted between January 2020 and June 2024 and met the selection criteria. Upon admission, 18 patients underwent reverse traction (reverse traction group) and 19 patients underwent calcaneal traction (calcaneal traction group); open reduction and plate fixation were performed after the soft tissue condition improved. There was no significant difference (P>0.05) in the baseline data between groups, including age, gender, body mass index, and cause, affected side, and Lauge-Hansen classification of fracture. Outcome indicators were evaluated and compared between groups, including visual analogue scale (VAS) scores before traction, immediately after traction, and before internal fixation, preoperative waiting time, total hospital stay, duration of internal fixation surgery, preoperative Internal Fixation Comfort Questionnaire (ICQ) scores, the incidence of external fixation-related complications during traction, and the American Orthopedic Foot and Ankle Society (AOFAS) score. Results The ICQ scores, as well as the VAS scores at immediate after traction and before internal fixation, were all significantly better in the reverse traction group than in the calcaneal traction group (P<0.05). The incidence of external fixation-related complications was significantly lower in the reverse traction group (0) than in the calcaneal traction group (31.6%) (P<0.05). There was no significant difference between groups (P>0.05) in terms of preoperative waiting time, duration of internal fixation surgery, or total hospital stay. Imaging examination showed that the ankle dislocation was reduced following reverse traction. Patients in both groups successfully underwent internal fixation surgery and were followed up (16.1±1.8) months. All fractures of the two groups achieved bony union with no significant difference in fracture healing time and AOFAS scores at last follow-up (P>0.05). Conclusion For patients with trimalleolar fracture-dislocation of the ankle, the use of reverse traction upon admission can significantly alleviate pain and improve quality of life, with fewer traction-related complications.