PurposeTo investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice.MethodsFrom February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20–65 years). The causes of the fractures included traffic accidents (13 cases), falls from a height (four cases), heavy lifting injuries (three cases), and sport injury (one case). All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction.ResultsThe incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36–76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%.ConclusionThe mid-term curative effects of a reconstruction plate and bioabsorbable screws in the treatment of Pipkin type IV femoral head fractures is significant, and such the treatment can significantly improve the patient's joint function and quality of life.

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PurposeTo investigate the early and mid-term results of open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no deltoid ligament repair (DLR) in the treatment of supination-external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B 3.1) and provide evidence for clinical practice.MethodsThis study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014. There were 13 males and 9 females, mean age 38.9 years (range, 17–73 years). Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents (11 cases), falling from height (6 cases) and sports injuries (5 cases). The mean period of hospitalization was 9.8 days (range, 6–14 days). For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8–10 weeks. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 56.86 ± 4.400, the Medical Outcomes Short Form 36-item (SF-36) questionnaire score was 57.41 ± 4.102 and the visual analog score (VAS) was 5.50 ± 1.058. Patients' main complaints about inconvenience of daily life were also recorded.ResultsAll the 22 patients were followed up for 24–63 months (mean, 33.6 months). None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 ± 5.096, 79.59 ± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data (t = 26.221, p < 0.001; t = 11.910, p < 0.001; t = 11.571, p < 0.001). The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients' main complaints were inconvenience of clothing (17 cases) and extremity cleaning (5 cases).ConclusionIn the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satisfactory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.

Objective To evaluate the clinical effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.Methods From June 2015 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution, 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). Conventional double-feet loading positive and lateral X ray films were taken before operation. Angle between the tibia anatomic axis and the line segment of inside and outside of talus vertex was measured to evaluate the degree of talipes varus and valgus. Functional assessments were performed using Foot and Ankle pain score of American Orthopedics Foot and Ankle Society(AOFAS) and Visual Analogue Scale(VAS) .Results All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All ankles achieved bony fusion, the clinical healing time was 12.7 weeks on average(11~18 weeks).The AOFAS score was 45.36±6.43 preoperatively and 80.25±9.16 at 12 months post operation, with a statistically significant difference(P<0.0001). The VAS score was 8.56±1.85 on average preoperatively and 2.72±0.83 at 12 months post operation, with a statistically significant difference ( P<0.0001). The angle of anatomical tibial shaft and the line segment of inside and outside of talus vertex on X-ray image was 101.93°±4.12° preoperatively and 94.45°±2.37° at 12 months post operation, with a statistically significant difference(P<0.0001). The results of functional evaluation indicated that 44 patients(61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.Conclusion Satisfactory curative effect can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.

Objective To evaluate the clinical effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.Methods From June 2015 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution, 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). Conventional double-feet loading positive and lateral X ray films were taken before operation. Angle between the tibia anatomic axis and the line segment of inside and outside of talus vertex was measured to evaluate the degree of talipes varus and valgus. Functional assessments were performed using Foot and Ankle pain score of American Orthopedics Foot and Ankle Society(AOFAS) and Visual Analogue Scale(VAS) .Results All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All ankles achieved bony fusion, the clinical healing time was 12.7 weeks on average(11~18 weeks).The AOFAS score was 45.36±6.43 preoperatively and 80.25±9.16 at 12 months post operation, with a statistically significant difference(P<0.0001). The VAS score was 8.56±1.85 on average preoperatively and 2.72±0.83 at 12 months post operation, with a statistically significant difference ( P<0.0001). The angle of anatomical tibial shaft and the line segment of inside and outside of talus vertex on X-ray image was 101.93°±4.12° preoperatively and 94.45°±2.37° at 12 months post operation, with a statistically significant difference(P<0.0001). The results of functional evaluation indicated that 44 patients(61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.Conclusion Satisfactory curative effect can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis, while large sample randomized controlled trials are still needed.