Objective The distal tibiofibular syndesmosis (DTS) is a fretting joint and it is still a hot issue how to satisfy strong internal fixation while allowing fretting. This study described and evaluated a new method for elastic fixation of DTS injury with Nice Knot. Methods The study was designed as a retrospective study. Between June 2020 and June 2021, 31 patients who were diagnosed with ankle fracture and DTS injury without additional orthopedic injuries were enrolled in this case series. The study included 22 males and nine females, with an average age of 34.71 ± 14.66 years. All patients were treated with Nice Knot binding for DTS. Surgical time, length of stay, time of DTS fixation, total weight‐bearing time, complications, imaging parameters, and functional scores at follow‐up were recorded. Paired sample t‐tests or single factor analyses of variance were used at intra‐group comparison. Results All patients completed surgery with normal syndesmotic parameters. The recovery of DTS injury was verified by Hook and lateral malleolus rotation tests. The average follow‐up time was 15.97 ± 3.30 months. Only one case showed superficial infection after surgery, and the wound healed after symptomatic treatment. In terms of imaging, there were no significant differences in tibiofibular clear space (TFCS), tibiofibular overlap distance (TFOS), medial clear space (MCS), and superior clear space (SCS) immediately and at different follow‐up points after surgery. All obtained excellent and good outcomes according to the AOFAS score at least follow‐up after surgery. Conclusions Nice Knot elastic fixation of DTS injury is firm and stable while maintaining the physiological micromotion of the ankle joint.

Background Thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) are widely used in video-assisted thoracic surgery (VATS). However, they have corresponding adverse effects, including hypotension for TPVB and unpredictable injectate spread in ESPB. An optimal perioperative analgesic strategy remains controversial. We investigated the effect of ultrasound-guided combined TPVB and ESPB (CTEB) for VATS. Material/Methods A total of 120 patients scheduled for thoracic surgery were randomized to receive either ultrasound-guided TPVB, ESPB, or CTEB preoperatively. Postoperative analgesia was achieved with sufentanil patient-controlled intravenous analgesia. The primary outcome was the static pain score at 2 h after surgery. Results The static pain score 2 h postoperatively was significantly different among the 3 groups. This difference was statistically significant for Group ESPB vs Group TPVB ( P =0.004), but not for Group ESPB vs Group CTEB ( P =0.767), or Group TPVB vs Group CTEB ( P =0.117). Group TPVB exhibited the highest incidence of hypotension among the 3 groups. More patients experienced a sensory loss in Groups TPVB and CTEB 30 min after the block performance. Patients receiving CTEB exhibited a lower incidence of chronic pain 6 months postoperatively than those in Group ESPB. Conclusions CTEB does not enhance the analgesic effect of ESPB in patients undergoing VATS; however, it may induce a faster sensory loss after nerve block and reduce the incidence of postoperative chronic pain compared with ESPB. CTEB may also help to reduce the incidence of intraoperative hypotension compared with TPVB.

Background: The routine perioperative use of opioids has recently been questioned due to opioid-related side effects, which can be potentially harmful in geriatric patients. This study aimed to evaluate the effects of opioid-free anesthesia in geriatric patients undergoing hip surgery. Methods: A total of 121 patients, aged 60 years or older, undergoing elective hip surgery were randomized to receive either opioid-free anesthesia with dexmedetomidine and esketamine (OFA group) or balanced anesthesia with opioids (CON group). All patients received a preoperative fascia iliaca block and postoperative patient-controlled analgesia using tramadol. The primary outcome was the incidence of a composite of anesthetic-related complications (nausea and vomiting, hypoxemia, ileus, urinary retention and delirium) within 48 hours postoperatively. The hemodynamics, postoperative pain and quality of life were also assessed. Results: The incidence of composite adverse events was significantly reduced in the OFA group compared with the CON group (35.0% vs. 62.3%, estimated difference: 27.3%, 95% confidence interval: 10.2%–44.4%, P = 0.003). Notably, patients in the OFA group experienced less postoperative nausea and vomiting (P = 0.040), and hypoxemia (P = 0.025) compared with those in the CON group. However, the incidences of postoperative ileus, urinary retention and delirium were comparable between the two groups. Also, patients in the OFA group had less pain in motion at 24 h postoperatively, as well as less risks of intraoperative hypotension and bradycardia (P <0.05). No significant differences in the postoperative quality of life were observed between the two groups. Conclusions: Opioid-free anesthesia with dexmedetomidine and esketamine reduced postoperative anesthetic-related complications and provided improved hemodynamic stability in geriatric patients undergoing hip surgery. Trial registration: Chinese Clinical Trial Registry, retrospectively registered on 05/02/2022 (www.chictr.org.cn; ChiCTR2200056421)