Purpose Double-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation, is undergoing constant improvement. This study aims to assess the clinical effect of a modified single-endobutton combined with the nice knot in the fixation of Rockwood type III or V acromioclavicular joint dislocation. Methods From January 2016 to June 2019, 16 adult patients (13 males and 3 females) with Rockwood type III or V acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with the nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow-up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated. Results Sixteen patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50–90 min with an average of (62.5 ± 3.10) min. The intraoperative blood loss was 30–100 ml, with an average of (55.0 ± 4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow-up. The mean VAS score of the patients was 5.88 ± 0.26 preoperatively, compared with 0.19 ± 0.14 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). The mean Constant score was 45.5 ± 2.0 preoperatively, compared to 94.0 ± 0.73 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). Patients had statistically significant preoperative and postoperative AC (acromioclavicular distance) and CC (coracoclavicular distance) distances (P < 0.05); 6 months postoperatively the AC(P = 0.412) and CC(P = 0.324) distances were not statistically significant compared to the healthy side. Conclusion Nice knot provides a reliable fixation for the single-endobutton technique in the treatment of acromioclavicular dislocations. The modified single-endobutton technique combined with the nice knot can achieve good clinical outcomes in the treatment of Rockwood type III or V acromioclavicular joint dislocation.

Percutaneous minimally invasive surgery involving Achilles tendon (AT) repair has the advantages of a low rerupture rate and fewer postoperative complications. However, due to the inability to operate under direct vision, the injury of the small saphenous vein (SSV) and sural nerve (SN) remains largely a high risk involving many challenges. We propose to introduce the preoperative application and advantages of ultrasonography in percutaneous minimally invasive surgery for acute AT rupture. Our results indicated that ultrasonography could locate the position of the SN more accurately and reduce the risk of iatrogenic nerve injury. Compared with the traditional surface markers, the preoperative localization and marking of AT, SSV, and SN in ultrasonography significantly reduced the risk of intraoperative accidental injury to blood vessels and nerves, which could reduce postoperative complications and promote early rehabilitation of patients. We ultimately exploit the properties of ultrasonography in percutaneous minimally invasive surgery to treat Achilles tendon rupture.

Purpose: Wire tension band technique, as a widely accepted strategy for the treatment of patellar fractures, is undergoing constant improvement. This study aims to assess the clinical effect of a modified wire tension band technique for treatment of comminuted displaced patellar fractures. Methods: From January 2015 to December 2021, 97 adult patients (52 males and 45 females) with comminuted displaced patellar fractures were treated with wire tension band technique in our department. The age ranged from 18 to 68 years old with an average of 39 years old. All patients had single closed comminuted displaced patellar fractures and all were treated with open reduction internal fixation. There were 58 patients in the modified wire tension band group (The MW group) and 39 patients included in the Kirschner wire tension band group (The KW group). Operating time, intraoperative bleeding, length of hospital stay, postoperative follow-up, fracture healing time, and knee motion and function scores were recorded and compared between the two groups. The incidence of postoperative complications such as non-union of the fracture, infection, failure of the internal fixation, re-fracture, and broken of the internal fixation were recorded and evaluated. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. VAS (Preoperative and last follow-up scores in the Visual Analogue Scale) and Böstman scale were recorded and evaluated. Results: There were no significant differences in basic information such as age, gender, BMI, mechanism of injury, history of smoking and alcohol, injured limb and follow-up time in the MW group compared to the KW group. Intraoperative time (49.91±3.88, min ) in the MW group was significantly lower than intraoperative time (67.64±4.27, min) in the KW group and the difference was statistically significant (P＜0.05). In the MW group (102.59±10.01, ml), intraoperative blood loss was significantly lower than in the KW group (126.41±13.86, ml), and the difference between the two groups was statistically significant(P＜0.05). The intraoperative time of fluoroscopy in the MW group was (8.14±1.82, s), which was lower than the intraoperative time of fluoroscopy in the KW group (10.41±1.67, s), and the difference between the two groups was statistically significant(P＜0.05). The hospital days were also significantly shorter in the MW group (6.07±1.23, d) than in the KW group (6.79±1.42, d). The difference was statistically significant(P＜0.05). There was no significant difference between the two groups in terms of fracture healing time, mobility, VAS score and Böstman score after surgery. There were no complications such as infection or non-healing fractures. However, there were 2 cases of wire fracture complications in both the MW and KW groups when the internal fixation was removed. Conclusion: The modified wire tension band technique for fixation of patellar fractures is an effective new technique for the safe and reliable management of patellar fractures and offers an alternative strategy for the treatment of patellar fractures.