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To explore the therapy of ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis and improve surgical results.Patients who had dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis were retrospectively analyzed and 30 patients were enrolled the study. They were all treated by ankle joint dislocation and the surgical results were evaluated by the Baird–Jackson ankle scoring system. Longitudinal curved incision in medial malleolus was made in ankle joint dislocation and subluxation was automatically formed by appropriate traction of ankle joint. The talus and the distal end of internal and external malleolus were pushed the outside to form the lateral dislocation of the ankle joint. After fully revealed the posterior malleolus and distal articular surface of the tibia, the anatomical reduction of comminuted bones with joint cartilage and posterior malleolus was achieved by fixed with absorbable screw or Kirschner wire. Internal and external malleolus fracture was fixed by the conventional approach.The average follow-up period was 13 months. According to the Baird–Jackson ankle scoring system, the excellent and good result was 28 cases, fair was 2 cases which the excellent and good rate was 93.3% without talar necrosis in any cases.Ankle joint dislocation can achieve the satisfactory results in treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. Ankle joint dislocation can make joint cartilage restore accurately with excellent results.

The findings suggest that minimally invasive knee arthrolysis is a much better option for the treatment of post-traumatic knee stiffness due to its advantages such as shorter operative time, little trauma, less blood loss and better postoperative final joint activity. Further studies with a long term of follow-up are wanted.

BackgroundDistal femur fractures are difficult to manage, and the selection of implant approach for internal fixation remains controversial. This study explores the clinical outcome of treating distal femoral fractures with a locking compression plate using a posteriolateral novel approach.MethodsTwenty patients with distal femoral fractures were included in our study, and all patients underwent fixation of the fracture using a locking compression plate through a posterolateral approach. The postoperative fracture healing time, complications, and functional recovery were observed and recorded. The joint function was categorized according to the Kolmert functional criteria.ResultsAll patients were followed up for an average of 12 months, and all incisions healed by first intention. Among the all patients, 19 patients achieved fracture healing 3 to 4 months after surgery. The remaining 1 patient with distal femoral C3 comminuted fracture achieved partial fracture healing 15 months after surgery, and bone grafting was needed. All knees can reach the state of straightening, and the postoperative excellent rate was 90%. Among them, 8 patients had maximal flexion of more than 120°, 10 patients had flexion between 90° and 120°, and 2 other patients had flexion of 70° and 40°.ConclusionsFixation of the fracture using a locking compression plate through a posterolateral approach seemed to be an acceptable surgical option for treatment of distal femoral fractures.

Femoral shaft fracture is one of the most common types of fracture encountered in the clinic. For certain complex femoral shaft fractures, the traditional intramedullary nail may not provide sufficient stability. Therefore, novel intramedullary nail systems are required. The femur 3D model and the internal fixation model were designed using Mimics 17.0 (Materialise), Geomagic Studio 2012 (Raindrop) and Solidwork 2016 (Dassault) software. The validity of the models was verified through comparison with previous data in silico. To further simulate the comminuted femoral shaft fracture, the novel and traditional type of intramedullary nail system were included in the finite element analysis with the software. The displacement and stress distribution of the two internal fixations were compared using Abaqus 6.14 (Dassault) software. The effectiveness of the model was verified. The stress at the fixed end of the novel intramedullary nail system was greater than that at the fixed end of the traditional intramedullary nail system. However, the displacement of the novel intramedullary nail method was smaller than that of the traditional intramedullary nail. The novel intramedullary nail system features good stability and stress stimulation at the broken end, which is beneficial for bone healing. The present study may provide a theoretical basis for the selection of a means of internal fixation in the clinic.