Rationale: Open total dislocation of ankle joint is rare and often caused by high-energy injury. The present study describes a patient with open total lateral dislocation of ankle joint without fractures and obtained a satisfactory clinical result following early debridement and irrigation, one-stage repairment of ligaments, and plaster external fixation. Patient concerns: The patient, a 45-year-old male, complained of right foot pain with bleeding and limited motion. Physical examination showed a 15-cm open wound at the medial ankle region, with soft tissues impaired and ankle bones exposed. The 3 dimensional reconstruction computed tomography (CT) examination showed an open total dislocation of ankle joint without concomitant fractures. Diagnoses: open total lateral dislocation of ankle joint without fractures Interventions: Early modern wound care including thorough debridement and irrigation on the wound was performed to remove contaminated soft tissues. Subsequently, the dislocated ankle joint was reduced by hand and the medial and lateral collateral ligaments were repaired using wire anchors. Outcomes: The medial wound healed at 2 weeks after surgery, and several common complications such as infection and skin necrosis did not occur. The last follow-up showed a good range of metatarsal flexion and extension of the injured foot, and obvious signs of traumatic arthritis were not observed. According to Kaikkonen ankle function score, the patient was assessed with 90 points. Lessons: For open total dislocation of ankle joint, early treatment should focus on debridement and irrigation, reduction and fixation of the dislocated ankle, protection of the weak soft tissues, and stable external fixation to promote wound healing and reduce the incidence of related complications.

Background: To compare the efficacy of three-point locating versus routine locating techniques for implanting helical blades for proximal femoral nail anti-rotation-II in the treatment of trochanteric fractures. Methods: From January 2010 to June 2013, 90 patients with intertrochanteric fractures were surgically treated, including 48 males and 42 females with an average age of 70.5 ± 7.2 years. According to the AO classification, there were 45 cases of A2.1, 35 cases of A2.2, and 10 cases of A2.3. Based on locating techniques, the 90 patients were divided into two groups: the three-point group and the routine group, with 45 patients in each group. All operations were performed by the same group of surgeons using proximal femoral nail anti-rotation (PFNA); the helical blade was inserted into the femoral neck with the three-point locating technique or by the usual method according to treatment group. Several figures including total operation time, elapsed time for implanting the helical blade, intraoperative blood loss, X-ray exposure time, and tip-apex distance (TAD) were measured and compared. Results: The three-point group was significantly superior as compared to the routine group in terms of total operation time [(59.34 ± 9.42) min vs (67.61 ± 12.63) min, P < 0.01], elapsed time for implanting the helical blade [(4.58 ± 1.25) min vs (7.82 ± 2.19) min, P < 0.01], intraoperative blood loss [(92.78 ± 34.09) ml vs (154.01 ± 39.10) ml, P < 0.01], X-ray exposure time [(8.84 ± 1.45) vs (14.62 ± 2.91), P < 0.01], and tip-apex distance [(16.78 ± 1.55) mm vs (21.91 ± 3.01) mm, P < 0.01]. Among the 90 patients, 80 were followed up for an average time of 12 months (10-15 months), including 42 patients who were part of three-point group and 38 patients who were part of the routine group. No spiral blade cut was found on the femoral head in any patient in the three-point group, whereas it occurred in 2 patients in the routine group 1 month after surgery. However, there was no significant difference in the Harris score between the two groups 6 months after the operation. Conclusion: The three-point locating method is faster and more accurate than the routine locating method.

Background:To explore a new classification of femoral shaft fracture combined with femoral artery injury and to summarize and analyse the characteristics of various types of injury to formulate a correct early diagnosis and treatment strategy.Methods: The data of 21 patients with femoral shaft fracture combined with femoral vascular injury from December 2009 to March 2019 were analysed retrospectively, including 20 males and 1 female aged (40 ±15.5) years. The causes of injury were traffic injury (n = 16), heavy object injury (n = 3), fall injury (n = 1), crush injury (n = 1), open fracture (n = 12) and closed fracture (n = 9). The patients were classified according to whether the femoral shaft fracture was open, the location of femoral artery injury and whether it was combined with a severe multiple injury. The open femoral shaft fracture with femoral artery injury was type I, in which a similar location of fracture and vascular injury comprised type Ia, while different locations comprised type Ib. The closed femoral shaft fracture with femoral artery injury was type II, in which fracture and vascular injury at same level comprised type IIa and different levels comprised type IIb. Patients with severe multiple injuries had a type III fracture. The location of femoral shaft fracture, femoral artery injury and injury; main signs; diagnosis time; waiting time before operation; operation time; times of operations; hospitalization time; and Enneking lower limb function score were recorded.Results: According to our classification, there were 7 cases of type Ia, 4 cases of type Ib, 6 cases of type IIa, 3 cases of type IIb and 1 case of type III. The location of femoral fracture (lower segment in 7 cases, middle segment in 9 cases, proximal segment in 5 cases) and feoral artery injury (adductor tendon fissure in 12 cases, superior popliteal fossa in 7 cases, proximal deep femoral artery bifurcation in 2 cases) and the type of femoral artery injury (contusion and embolization in 3 cases, complete rupture in 18 cases) were compared. The diagnosis time for type I patients were 2.0 (1.0, 2.0) h, the preoperative waiting time was 3.5 (3.0, 5.0) h, the first operation time was 405.0 (335.0, 540.0) min, the number of operations was 2.0 (2.0, 4.0) times, the length of hospital stay was 49.0 (21.0, 71.0) days, the fracture healing time was 7.0 (5.0, 9.0) months, and the Enneking lower extremity function score was 20.0 (19.0, 22.0) points. The diagnosis time for type II patients was 7.0 (6.0, 18.5) h, the waiting time before surgery was 9.0 (8.3,20.5) hours, the first operation time was 385.0 (319.5, 490.0) min, the number of operations was 3.0 (2.0, 3.5) times, the length of hospital stay was 57.0 (29.0, 111.5) days, the fracture healing time was 6.00 (5.50, 7.50) months, and the Enneking lower limb function score was 14.0 (13.0, 15.5) points. All patients had signs of obvious weakening or disappearance of dorsal pedis artery pulsation, all type II patients had blue ecchymosis signs at the site of vascular injury, 6 patients had normal muscle strength and sensation of lower limbs, 12 patients had dorsal extension dysfunction, and 1 patient underwent thigh amputation.Conclusion: The new classification of femoral shaft combined with femoral artery injury is helpful in the diagnosis, treatment and prognosis of the injury. Generally speaking, the diagnosis time of type I injury is faster than that of type II injury, the waiting time before operation is shorter, and the prognosis of lower limb function is better. Sufficient attention should be paid to the type II injury.Weakening or disappearance of dorsal pedis artery pulsation and blue ecchymosis signs are typical signs .