Objective： To introduce a posteromedial approach through the medial border of the medial head of gastrocnemius for reduction and reattachment of bony avulsiun of the posterior cruciate ligament （PCL） from the tibia...Objective： To introduce a posteromedial approach through the medial border of the medial head of gastrocnemius for reduction and reattachment of bony avulsiun of the posterior cruciate ligament （PCL） from the tibia. Methods ： Eleven patients with avulsed tibial attachment of the PCL underwent an operative reduction and internal fixation through the posteromedial approach of the gastrocnemius in our department from February 1998 to March 2000. The skin incision was reversed L-shaped along the medial border of the medial head of the gastrocnemius and the posterior capsule was exposed by dissecting the medial border and lateral retraction, avoiding the damage of the popliteal neurovascular structures. After that, the posterior capsule was vertically dissected a little medially to the posterior intercondylar sulcus and just on the posterior medial tibial eminence positioned by finger palpation. Then the PCL and its tibial attachment were easily accessible. In the delayed cases, PCL peripheral releasing was necessary to overcome the ligament retraction and to refresh the fracture bed for optimal reduction and bony healing. At last, one or two biodegradable screws were used to fix the avulsed bone segment and 30° flexion knee plaster cast immobilization was regularly applied after the wound was closed. The evaluation included X-ray, posterior sag sign and posterior drawer test compared with the contralateral side. The functional assessment of the low limbs was not available because of concomitant injuries. Results ： The posteromedial approach of the gastrocnemius used in repair of tibial attachment avulsed injury of the PCL could provide benefit of clear anatomical exposure, few blood loss （20 ml on average）, no need for detachment or reattachment of any structure. The patients were followed up for 11 months on an average （ranging from 6 months to 2 years ）. It demonstrated that bony healing was achieved within 4-6 weeks in cases of fresh injury and 7-9 weeks in cases of delayed injury. Six out of 8 fresh cases showed totally negative posterior sag sign or posterior drawer test but 2 had extra laxity for 1-2 mm. In 3 delayed cases, extra laxity for 3-4 mm was presented compared with the contralateral knee. Conclusions： The posteromedial approach of the gastrocnemius is ideal for internal fixation of avulsed tibial attachment of the PCL. It is fairly easy, safe, time-saving, applicable alternatives, in addition, the morbidity is rare and can also be used in management of posteromedial fracture of the medial femoral condyle and tibial plateau.展开更多
：Objective：To introduce the posterolateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases.Methods：This study consisted of 32 cases,22 males and 10 females with th...：Objective：To introduce the posterolateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases.Methods：This study consisted of 32 cases,22 males and 10 females with the mean age of 48 years（range,21-63years）,suffering from posterior malleolar fracture.All cases were treated with the posterolateral surgical approach to the ankle.The average follow-up period was 28 months （range,24-35 months）.The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle （OMA）score and plain radiographs.Results：All cases showed radiological evidence of bony union at follow-up.The average OMA score was 82 points; 21 cases had excellent scores（90-100 points）,9 good （61-90 points）,and 2 fair（31-60 points）.The excellent-togood rate was 93.8%.Although most cases did not show any wound dehiscence or necrosis,one patient had a superficial infection which healed after using antibiotic dressing and one had sural cutaneous nerve injury that underwent spontaneous remission without any treatment after three months.In addition,one presented with mild symptoms of peroneal tendonitis that disappeared after plateremoval.Conclusion：The posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments.展开更多
Objective： To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis. Methods： Between November 2009 and June 2012, 28 patients with ankle arthritis were treated, among whom 11 had obvio...Objective： To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis. Methods： Between November 2009 and June 2012, 28 patients with ankle arthritis were treated, among whom 11 had obvious foot varus deformity, and 17 were almost normal in appearance. There were 13 males and 15 females with an average age of 49.4 years （range, 23-67 years）. The main symptoms included swelling, pain, and a limited range of motion of the ankles. The ankle joints functions were assessed by American Orthopedic Foot and Ankle Society （AOFAS） ankle and hindfoot score and visual analog scale （VAS） preoperatively and at I year follow-up. Results： Twenty-eight patients were followed up for 19.8 months on average （range, 1-2 years）. Superficial wound infection occurred in 3 cases, and was cured after debridement; the other incisions healed by first intention without complications. All ankles were fused at 1 year follow-up after operation. The symptom was relieved completely in all patients at last follow-up without complication of implant failure, or nonunion. The postoperative AOFAS ankle and hindfoot score was 83.13±3.76, showing significant difference when compared with the preoperative score （45.38±3.21, P〈0.01）. VAS was significantly decreased from 8.01±0.63 to 2.31±1.05 at 1 year follow-up （P〈0.05）. Conclusion： Modified Blair ankle fusion has the advantages of high feasiblity, less cost and rigid fixation. It shows high reliability in pain relief and may obtain a good clinical effectiveness.展开更多
文摘Objective： To introduce a posteromedial approach through the medial border of the medial head of gastrocnemius for reduction and reattachment of bony avulsiun of the posterior cruciate ligament （PCL） from the tibia. Methods ： Eleven patients with avulsed tibial attachment of the PCL underwent an operative reduction and internal fixation through the posteromedial approach of the gastrocnemius in our department from February 1998 to March 2000. The skin incision was reversed L-shaped along the medial border of the medial head of the gastrocnemius and the posterior capsule was exposed by dissecting the medial border and lateral retraction, avoiding the damage of the popliteal neurovascular structures. After that, the posterior capsule was vertically dissected a little medially to the posterior intercondylar sulcus and just on the posterior medial tibial eminence positioned by finger palpation. Then the PCL and its tibial attachment were easily accessible. In the delayed cases, PCL peripheral releasing was necessary to overcome the ligament retraction and to refresh the fracture bed for optimal reduction and bony healing. At last, one or two biodegradable screws were used to fix the avulsed bone segment and 30° flexion knee plaster cast immobilization was regularly applied after the wound was closed. The evaluation included X-ray, posterior sag sign and posterior drawer test compared with the contralateral side. The functional assessment of the low limbs was not available because of concomitant injuries. Results ： The posteromedial approach of the gastrocnemius used in repair of tibial attachment avulsed injury of the PCL could provide benefit of clear anatomical exposure, few blood loss （20 ml on average）, no need for detachment or reattachment of any structure. The patients were followed up for 11 months on an average （ranging from 6 months to 2 years ）. It demonstrated that bony healing was achieved within 4-6 weeks in cases of fresh injury and 7-9 weeks in cases of delayed injury. Six out of 8 fresh cases showed totally negative posterior sag sign or posterior drawer test but 2 had extra laxity for 1-2 mm. In 3 delayed cases, extra laxity for 3-4 mm was presented compared with the contralateral knee. Conclusions： The posteromedial approach of the gastrocnemius is ideal for internal fixation of avulsed tibial attachment of the PCL. It is fairly easy, safe, time-saving, applicable alternatives, in addition, the morbidity is rare and can also be used in management of posteromedial fracture of the medial femoral condyle and tibial plateau.
文摘：Objective：To introduce the posterolateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases.Methods：This study consisted of 32 cases,22 males and 10 females with the mean age of 48 years（range,21-63years）,suffering from posterior malleolar fracture.All cases were treated with the posterolateral surgical approach to the ankle.The average follow-up period was 28 months （range,24-35 months）.The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle （OMA）score and plain radiographs.Results：All cases showed radiological evidence of bony union at follow-up.The average OMA score was 82 points; 21 cases had excellent scores（90-100 points）,9 good （61-90 points）,and 2 fair（31-60 points）.The excellent-togood rate was 93.8%.Although most cases did not show any wound dehiscence or necrosis,one patient had a superficial infection which healed after using antibiotic dressing and one had sural cutaneous nerve injury that underwent spontaneous remission without any treatment after three months.In addition,one presented with mild symptoms of peroneal tendonitis that disappeared after plateremoval.Conclusion：The posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments.
文摘Objective： To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis. Methods： Between November 2009 and June 2012, 28 patients with ankle arthritis were treated, among whom 11 had obvious foot varus deformity, and 17 were almost normal in appearance. There were 13 males and 15 females with an average age of 49.4 years （range, 23-67 years）. The main symptoms included swelling, pain, and a limited range of motion of the ankles. The ankle joints functions were assessed by American Orthopedic Foot and Ankle Society （AOFAS） ankle and hindfoot score and visual analog scale （VAS） preoperatively and at I year follow-up. Results： Twenty-eight patients were followed up for 19.8 months on average （range, 1-2 years）. Superficial wound infection occurred in 3 cases, and was cured after debridement; the other incisions healed by first intention without complications. All ankles were fused at 1 year follow-up after operation. The symptom was relieved completely in all patients at last follow-up without complication of implant failure, or nonunion. The postoperative AOFAS ankle and hindfoot score was 83.13±3.76, showing significant difference when compared with the preoperative score （45.38±3.21, P〈0.01）. VAS was significantly decreased from 8.01±0.63 to 2.31±1.05 at 1 year follow-up （P〈0.05）. Conclusion： Modified Blair ankle fusion has the advantages of high feasiblity, less cost and rigid fixation. It shows high reliability in pain relief and may obtain a good clinical effectiveness.
