Treatment of calcaneal fractures has always been the focus of many clinical researchers.The goals of traditional surgical treatment are not only to restore the integrity of calcaneal articular surface but also to reconstruct the anatomy of the calcaneus.More importantly,we need to reduce postoperative soft tissue swelling and incidence of postoperative complications.In recent years,scholars have reported satisfactory clinical efficacy and prognosis resulting from a sinus tarsal approach for treatment of calcaneal fractures.This paper reviews the latest research progress concerning the sinus tarsal approach for treatment of calcaneal fractures at home and abroad,intending to provide helpful information for the clinical surgeons.

BACKGROUND:Supination maneuver is mainly used for reduction of radial head subluxation in children, but recently, pronation maneuver has also achieved good results in the treatment of radial head subluxation. OBJECTIVE:To objectively evaluate the efficacy of pronationversus supination maneuvers for the reduction of radial head subluxation by using Meta-analysis. METHODS:PubMed, Cochrane Central Register of Controled Trials (CENTRAL), EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from database establishment to December 2014 for colecting the randomized controled trials (RCTs) about pronationversus supination maneuvers for the reduction of radial head subluxation, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction were conducted by two reviewers independently. Meta-analyses were performed by using the RevMan 5.2 software. RESULTS AND CONCLUSION:Five studies involving 436 patients were included. The results of Meta-analyses showed that: compared with the supination maneuvers group the pronation maneuvers group had a higher rate of successful reduction at the first attempt [RR=1.17, 95%CI (1.08, 1.28),P=0.000 3] and lower rate of failed reduction [RR=0.25, 95%CI(0.09, 0.65),P=0.005]. There was no significant difference in the rate of successful reduction at the second attempt [RR=1.39, 95%CI (0.75, 2.58),P=0.30]. Based on the results of systemic assessment, the level of evidence assessed by the GRADE system showed that the outcome indicators of the rate of successful reduction at the first attempt and rate of failed reduction were graded as intermediate level; the outcome indicator of the rate of successful reduction at the second attempt was graded as low level. For the poor quality of the original studies, a prudent choice is suggested; and more highly-quality, large-sample studies are needed.

Objective To explore the clinical effect of posterior pedicle screw internal fixation in the treatment of multiple level noncontiguous thoracolumbar fractures.Methods Thirteen patients with multiple level noncontiguous thoracolumbar fractures were treated by posterior pedicle screw internal fixation.The Frankel score,percentage of vertebral compression and Cobb angle of the injured vertebral segment were analyzed to evaluate the surgery efficacy.Results All patients were followed up from 12 to 24 months ( averaged 15 months ).All cases achieved bone fusion with no implant failure.The Cobb angle of the injured vertebral segment was corrected from preoperative(22.2 ±5.3) degree to postoperative(5.3 ±3.5) degree and(6.2 ±3.6) degree at the last follow up.The percentage of vertebral compression was corrected from preoperative (45.7 ± 14.1 )％ to postoperative ( 6.1 ± 3.8 ) ％ and ( 7.2 ± 3.9 ) ％ at the last follow up.All improvements showed significant differences when compared statistically( t =15.03,t =12.05,Ps ＜0.05 ).The spinal cord function was improved 1 to 2 degree in all patients except 2 patients of grade A.Conclusion The posterior fixation with pedicle screw is a secure,safe and effective method in treating multiple level noncontiguous thoracolumbar fracture.

Objective To investigate the surgical treatment of complex Denis zone Ⅲ sacral fractures.Methods A retrospective study was conducted on the 15 complex Denis zone Ⅲ sacral fractures which had been treated from June 2011 to September 2015 in our hospital.They involved 9 men and 6 women,with an average age of 28.8 years (from 15 to 55 years).There were 8 U-shaped,6 H-shaped and 3 lambda fractures.By the Gibbons grading for the sacral nerve injury,3 cases were rated preoperatively as grade Ⅱ,5 cases as grade Ⅲ and 7 as grade Ⅳ.Of them,10 received π-shaped lumbopelvic fixation and sacral decompression 2 weeks after injury,one had lumbosacral fixation and sacral decompression 6 days after injury,and 4 underwent only sacral decompression 3 months after injury when they presented with symptoms of neural injury after fracture malunion.Their sacral malformation angle,visual analogue scale and EQ-5d scale were compared between preoperation and postoperation.Results The 15 cases were followed up for 9 to 47 months (average,24.9 months).Their full-weight-bearing time ranged from 8 to 14 weeks (average,9.9 months).All the incisions healed well without any infection,pressure sore,implant loosening or breakage.There was no significant difference between the preoperative angle of malformation (35.7° ± 5.0°,from 15° to 90°) and the postoperative value (27.9°±6.0°,from 8° to 90°) (t =1.003,P=0.324).Their VAS pain score decreased significantly from preoperative 7.0 ±0.3 to postoperative 1.9 ±0.2,and their EQ-5D score increased significantly from preoperative 0.20 ± 0.03 to postoperative 0.79 ± 0.04 (P ＜ 0.05).The final follow-ups revealed more or less recovery of neural function in all the patients.Conclusions π-shaped lumbopelivic fixation is an effective treatment for complex Denis zone Ⅲ sacral fractures.Effective decompression and stable fixation are prerequisites for early neurological and functional recovery.Simple sacral decompression can effectively promote nerve recovery in patients with old complex Denis zone Ⅲ sacral fractures.

Objective To compare the lateral rectus abdominis approach versus posteromedian sacrum approach in the surgical treatment of unstable sacral fracture complicated with lumbosacral plexus injury.Methods From June 2010 to December 2014,33 unstable sacral fractures complicated with lumbosacral plexus injury were treated at Department of Orthopaedics,Spinal and Pelvic Surgery Center,Zhongnan Hospital.Of them,24 were fresh and 9 obsolete.The lateral rectus abdominis approach was adopted in 17 patients and the posteromedian sacrum approach in 16.All the patients received surgical treatment within 2 to 12 weeks (average,4.5 weeks) after injury.The 2 groups were compared in terms of operation time,bleeding volume,complications,weight-bearing time,visual analogue scale (VAS),European QOL Five Dimensional health scale (EQ-5D) and lumbosacral injury classification and severity scale (LSICS).Results The 2 groups were compatible due to their insignificant differences in baseline data (P ＞ 0.05).Their follow-up time ranged from 17 to 37 months (average,26.8 months).Perioperatively,infection and necrosis of the lumbosacral incision appeared in 2 patients and iatrogenic injury to the lumbosacral plexus in 3 patients.All the other incisions healed well without major complications like infection,pressure ulcer or implant failure.There were no significant differences between the 2 groups in operation time (235.8± 72.0 minutes versus 318.0 ± 64.7 minutes),intraoperative bleeding volume (558.8 ± 125.7 mL versus 734.0 ±98.0 mL),weight-bearing time (9.4 ±2.4 weeks versus 11.3 ±2.3 weeks),postoperative complications,VAS(1.1 ±0.6 points versus 1.0 ±0.6 points),EQ-5D (0.82 ±0.09 points versus 0.78 ±0.06 points) or LSICS (P ＞ 0.05).The final follow-ups revealed significant improvements in VAS,EQ-5D and LSICS in all the patients (P ＜ 0.05).Conclusion The lumbosacral plexus can be well decompressed via both the lateral rectus abdominis approach and the posteromedian sacrum approach,leading to satisfactory clinical outcomes.

Objective:To investigate the clinical effect of lateral rectus abdominis approach combined with presacral decompression for surgical treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.Methods:A retrospective case series study was performed on the clinical data of 9 patients with old Denis type II sacral fractures complicated with upper sacral plexus injury (L 4-S 1) admitted to Zhongnan Hospital of Wuhan University from June 2010 to December 2016. There were 6 males and 3 females, aged (33.1±7.5)years (range, 15-58 years). Embolization of internal iliac artery and preimplantation of abdominal aortic balloon were performed 2 hours before operation under the guidance of digital subtraction angiography (DSA). Surgery was performed using a single lateral rectus abdominis approach combined with presacral decompression. The operation time, intraoperative blood loss and full weight-bearing time were recorded. The visual analogue scale (VAS) and European QOL Five Dimensional health scale (EQ-5D) were compared before and after operation. The Gibbons' impairment scale was used to assess neurological function. X-ray and CT scan were used to observe internal fixation and fracture healing. The complications during and after operation were recorded. Results:The patients were followed up for 24-52 months [(35.2±5.2)months]. The operation time was (2.9±0.6)hours. The intraoperative bleeding was (573±138)ml, and the full weight-bearing time was (11.6±1.2)weeks. X-ray and CT scan showed bone healing in all patients at the latest follow-up. The VAS and EQ-5D scale improved from preoperative (7.8±0.6)points and (0.34±0.07)points to the final follow-up of (0.8±0.3)points and (0.81±0.05)points ( P<0.05). According to Gibbons classification, 8 patients were grade I and 1 patient was grade II one year after operation ( P<0.01). Namely, the radiation pain of lower extremities was significantly improved in all patients, among which 8 patients showed pain disappeared and completely returned to normal and 1 patient showed residual numbness and hypoesthesia of the affected limbs. No major complications (eg, iatrogenic lumbosacral plexus injury, vital blood vessels or pelvic organs injury) occurred during the operation. During the follow-up period, only one patient developed traumatic hip arthritis and underwent total hip arthroplasty 6 months after operation. Fractures of the remaining patients were healed well without complications like infection, pressure ulcer or implant failure. Conclusions:For old Denis type II sacral fractures complicated with upper sacral plexus injury, lateral rectus abdominis approach combined with presacral decompression can fully decompress the upper sacral plexus nerve, relieve pain, and promote functional rehabilitation, with low incidence of complications. It is an alternative surgical method for the treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.