Open calcaneal fractures are relatively rare, but most of them are potentially devastating with severe injury of soft tissue and comminuted bone. Its management is still challenging and controversial. Improper treatment will l ead to wound infection, osteomyelitis and even amputation. Preservation or repai r of soft-tissue to partly cover the hindfoot is the most important factor for the treatment. Another important factor is to restore the alignment and function of the hindfoot. Variables in determining outcomes of different cases include s everity and type of injury, wound location and treatment options. It is suggeste d that different measures should be taken according to different types of injury . This article reviews the current development and progress in the diagnosis and treatment of open calcaneal fractures.

Objective To compare treatments of intra-articular calcaneal fractures with and without bone graft in foot and ankle surgery.Methods A comprehensive search was conducted on line for all English research articles published from January 1990 through December 2010 dealing with open reduction and internal fixation with and without bone graft for intra-articular calcaneal fractures.Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest.Meta-analytic pooling of group results across studies was performed for the 2 treatments.Results The systematic review identified 32 qualified primary studies with 1281 fractures.No significant differences were found in postoperative infection, osteoarthritis or subtalar fusion between the 2 treatments ( P ＞ 0.05) .The average full weight-bearing time in bone graft treatment was significantly lower (5.4 weeks) than in non-graft treatment (10.5 weeks) .The mean B(o)hler angle was significantly larger and long-term loss of collapse significantly lower in bone graft treatment than in non-graft treatment.The bone graft treatment had a lower American Orthopaedic Foot and Ankle Society (AOFAS) score (71.4 points vs.80.5 points) but a higher Creighton score (89.9 points vs.81.0 points) compared with non-graft treatment.Pooled mean results showed no significant differences in the weighted excellent-to-good rate between the 2 treatments (excellent 35%, good 40%, fair 21% and poor 4% for the bone graft treatment versus excellent 34%, good 42%, fair 14%, and poor 10% for the non-graft treatment).Conclusions Open reduction and internal fixation with bone graft for intra-articular calcaneal fractures may lead to better reduction of B(o)hler angle and early return to full weight-bearing without increased risk of postoperative infection.However, since more cases of joint depression and comminuted fracture have been included in the bone graft group in the present study, a prospective controlled comparative study with a large scale of samples is still needed.

[Objective]To discuss the value and methods of severe hindfoot reconstruction in the treatment of hindfoot injures.[Method]Six cases with severe hindfoot injures were treated with hindfoot reconstruction.Among them, 4 patients were males and 2 females. Five cases were fallen from high places and 1 case by traffic accident. All cases associated with talus and calcancus comminuted fractures of type Ⅳ according to Sanders classification and calcaneocuboid, talocalcaneal and talonaviculare joint disorders.Four cases were associated with anterior and medial or plantar skin laceration,2 of anterior and medial skin laceration and 2 of plantar skin laceration. Among them, 1 were of anterior and medial skin avulsion wound and skin necrosis defect.1 were of plantar skin laceration and skin necrosis and bone exposure.[Result]Two cases' incisions without skin laceration were healed up. Among 4 cases incisions with skin laceration, 3 were primarily healed. One was Ⅱ-period healed. Two cases' skin laceration were healed by 1st incisions and 2 skin defects were healed by skin transplantation in 6 and 10 weeks after operation. The postoperative functional evaluation by AOFAS revealed excellent result in 1 foot, good in 3, fair in 2.[Conclusion]Hindfoot reconstruction is an effective method for severe hindfoot injures with the advantages of resoring function and outer aspect hindfoot satisfactorily.

[Objective] To research the plantar pressure distribution of the normal Chinese adult. [Method] The F-scan plantar pressure analysis system was used to collect plantar pressure distribution data of 100 volunteers who stand, walk, jog, go upstairs and downstairs.The plantar pressure distribution data of 5 kinds of physiological states, as well as influence of sex, height, body weight, body mass index and speed was analyzed. [Result] There's different characteristic between 5 kinds of states of the plantar pressure distribution in the Chinese normal adults. There's significant difference between static and dynamic. In four dynamic motions, the gait of walk was stalest, and it became unstable if speed up and go upstairs or downstairs. As for the influential factors of the plantar pressure distribution, there was non-significance of sex. But the speed had the significance. The height, the body weight, the BMI had weak correlation with the plantar pressure distribution. [Conclusion] The plantar pressure distribution of normal Chinese adults has the distinctive quality. The data obtained by this experiment, may provide the reference for the clinical plantar pressure analysis.

[Objective]To explore displacement and plantar pressure distribution of the forefoot before and after the plantar fascia and other plantar ligaments were sectioned.[Method]Seven fresh adult cadaveric feet were tested with the main plantar ligaments exposed,including the plantar fascia,spring ligament,short plantar ligament and long plantar ligament.The displacements of the metatarsals were recorded and calculated with digital speckle correlation measurement(DSCM),also F-scan insoles were put under the plantar aspect of the feet when the speciments were loaded to 700N vertically.The special shifts and plantar pressure data of the metatarsals was collected and stored before and after the main plantar ligaments were sectioned.[Result]The transverse movements of the metatarsals did not change significantly,the same as their vertical displacements except the first metatarsal after the plantar fascia was sectioned,while the peak pressure shifted laterally.When the four major plantar ligaments were all injured,all of the above changed significantly.[Conclusion]The plantar fasciotomy will not consequentially lead to collapse of the forefoot structure.But the redistribution of the plantar pressure and the compensation of other ligaments may result in later complication.

0.05).[Conclusion]Dynamic and static anterior fixation can all provide effective stability for cervical spine.Dynamic anterior fixation can be used in anterior intervertebral decompression and fusion.

Objective To introduce calcaneal osteotomy without subtalar fusion for calcaneal malunion and to discuss its indications, advantages and disadvantages. Methods From November 1998 to May 2003, 24 cases with 26 calcaneal malunion for 1 to 9 months were treated by calcaneal osteotomy without subtalar fusion. The average age was 32.6 years (range, 28 to 42 years). All patients underwent radiography including plain, axial and lateral views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, 13 cases were of type Ⅱ(9Ⅱb, 4Ⅱc), 13 of type Ⅲ(8 Ⅲac, 5 Ⅲbc). Through the modified lateral L-shaped approach, the protruding lateral wall of calcaneus was resected and the posterior subtalar facet was reduced by elevating the fragment of the posterior subtalar facet upwards and backwards. The defect of calcaneus was filled with bone autografts. Iliac crest bone graft was used in 19 feet and the bone graft resected from the extruding lateral wall of calcaneus in 7 feet. The calcaneus was fixed with plate and screw. Results 21 feet were followed up for an average of 14.5 months (range, 9 to 22 months). No complications such as wound infection, screw breakage and calcaneum varus were found postoperatively. The average time for bone healing was 11.2 weeks (range, 10.5 to 13.3 weeks). The postoperative functional evaluation by Maryland foot score system revealed excellent result in 8 feet, good in 10, fair in 3. The rate of excellent to good results was 86%. Plain radiographs showed the nearly complete restoration of Bhler angle, Gissane angle, talus inclining angle, calcaneal width and height of the calcaneal thalamus. Conclusion Calcaneal osteotomy without subtalar fusion is an effective method for calcaneal malunion with advantages of correcting deformity markedly, restoring the function and the outer aspect of hindfoot satisfactorily.

Objective To investigate the properties of hind foot motion and it's changes in ankle or subtalar joint arthrodesis. Methods Eight fresh frozen adult leg-foot specimens were mounted in a coordinated system, a Steinmann pin was perforated across the calcaneus as a marker. The displacements of the marked points in the coordinated system were recorded when subtalar or ankle joint was fixed respectively. Through matrix translation and Euler equation, the angle of the calcaneus rotation were calculated, representing the motion of the subtalar and ankle joints in different condition, Statistical analysis were also taken between different conditions. Results Three dimensional (3-D) motion was observed in hind foot motion. The range of motion with ankle joint fixation was: inversion 15.99??2.81?, eversion 8.62??1.90?, dorsiflexion 3.70??1.00?, plantar flexion 5.87??1.39?, adduction 7.64??2.04?, and abduction 3.99??1.78?. When subtalar joint was fixed, they were: 7.13??1.07?, 5.52??0.85?, 17.09??2.87?, 30.75??5.04?, 10.77??1.56?, and 6.54??1.88? respectively. While they were 22.62??3.21?, 40.88??5.77?, 18.87??3.89?, 9.12??2.05?, 17.48??2.26? and 11.47??2.29?, when no joint was fixed. Arthrodeses of ankle or subtalar joint would affect the hindfoot motion significantly (P

Objective To introduce the method of arthroscopically assisted closed reduction and percutaneous screw fixation for intra-articular calcaneal fractures and to discuss its clinical indications, advantages and disadvantages. Methods From February 2003 to December 2004, 12 unilateral intra-articular calcaneal fractures were treated with the method of arthroscopically assisted closed reduction and percutaneous screw fixation. 7 cases were males and 5 cases were females. The average age was 36.8 years (range, 23-61 years). 8 feet were on right side and 4 feet were on left side. The mechanism of injury was fall from a height in 11 cases and vehicle accident in 1 case. According to Sanders classification, 8 cases were type Ⅱ fractures(1 type ⅡA, 5 type ⅡB, 2 type ⅡC) and 4 cases were type Ⅲ fractures(2 type ⅢAB,1 type ⅢAC,1 type ⅢBC). Results Arthroscopy in the operation showed the fracture space and step were less than 1 mm. The preoperative X-ray film showed that B?觟hler angle was 18.4??5.8?, Gissane angle was 109.1??10.2?, calcaneal width was (35.9?2.2) mm. The postoperative X-ray film demonstrated that B?觟hler angle was 25.4??3.5?, Gissane angle was 118.1??6.4?, calcaneal width was (32.3?1.1) mm. The average follow-up of nine patients was 17.4 months (range, 10-25 months). According to Maryland foot score, all patients had satisfactory results with the mean score of 92.5 score (range, 82-100 score), 6 were excellent and 3 were good. None of the patients had re-displacement of fracture, significant lame or other late complications. They regained normal shape of foot and wore normal footwear. Conclusion Arthroscopically assisted closed reduction and percutaneous screw fixation is an effective and applicable minimal-invasive treatment for Sanders type Ⅱ and selected type Ⅲ intra-articular calcaneus fractures. It can significantly reduce the risk of soft tissue injury and other complications while ensuring satisfactory reduction of the posterior calcaneal facet of the subtalar joint and reliable fixation.

[Objective]To investigate the curative effect and methods of distal tibial fracture by operation.[Method]From May 2004 to Feb.2005,30 cases of distal tibial fracture were treated in the department.All cases were treated with open reduction,internal fixation with medial anatomic plates,and with bone-grafting prophylacticly in all cases.The operation would be done on 10~14 days after fracture.They were followed up and analyzed retrospectively.[Result]All cases were followed up for 8～17 months(average 13.9 months).All wounds were primary healing and all fractures obtained bone-union.Twenty-two cases were the excellent,6 cases were the good according to Mazur's criteria.The excellent and good rate was 93.3%.All cases had no severe complication,such as wound infection,cutaneous necrosis and bone non-union.[Conclusion]Anatomic plate of distal tibia is a perfect choice for treatment of distal tibial fracture.Operative juncture and prophylactic bone grafting were very important to obtain satisfactory effect.