Objective To explore the operative methods for the first metatarsal fractures. Methods From January 2003 to January 2006, surgical operation was done on 17 patients with the first metatarsal fractures including 15 males and two females at average age of 40.5 years (11-65 years). There were four patients with the first metatarsal base fractures, seven with the first metatarsal shift frac-tures and six with the first metatarsal neck or head fractures, of whom four were with open fractures. The surgical treatment included open reduction, plate internal fixation and screw or K-wire fixation. Results Of all, 14 patients were followed up for average 14 months ( 12-24 months), which showed wound healing at one stage, without any complications. The bone union time was 8-16 weeks (mean 10.5 weeks). All patients could walk with weight loading after mean 13 weeks (9-18 weeks), without obvious pain or com-plaints. According to the midfoot and forefoot scale of American Orthopedic Foot and Ankle Society (AOFAS), the mean score was 86.3 points (78-100 points). Conclusion Anatomic reduction and stable internal fixation is the best solution for the first metatarsal fracture and plays important role in recovery of foot form and foot arch function.

ObjectiveThe purpose of this study was to analyze the outcomes of surgical treatment of displaced intra-articular calcaneal fractures (ICFs) in children and its characteristics.MethodsBetween January 2004 and October 2008,we review the results of 9 displaced,intra-articular fractures in 8 skeletally immature patients,who were treated with open reduction and internal fixation in our hospital.There were 7 males and 1 female,with the mean age of 13.1 years(range:10 to 15 years).Preoperative radiographs and computed tomographic scans were used to classify fractures.Clinical and radiographic evaluation were performed in postoperative follow-up visits.The functional outcomes were assessed with use of the modified American Orthopaedic Foot and Ankle Society(AOFAS) ankle and hindfoot score.The published literatures of child ICFs treated with ORIF were reviewed.ResultsIn the series,there were 4 tongue-type and 5 joint depression-type fractures according to Essex-Lopresti classification,and according to Sanders classification,we found 5 type-Ⅱ fractures,3 type-Ⅲ and 1 type-Ⅳ fractures.The mean follow-up time was 47.4 months (range:21 to 72 months).All fractures healed within 2 to 4 months.The average preoperative and postoperative Bohler angles were 5.7 and 33.1 degrees respectively,and the mean Gissane angles were 106.5 and 128.0 degrees respectively.The mean modified-AOFAS score was 65.2 points(range:53 to 68 points).Skin necrosis was found in one foot.After the review of literatures,78.6％ (48/61) of displaced ICFs were male in children.Based on the Sanders classification,36 of 67 (53.7％) were type-Ⅱ fractures,25 of 67 (37.3％) were type-Ⅲ and 6 of 67 (9.0％) were type-Ⅳ; And 15 of 37 (40.5％) were tongue-type,22 of 37 (59.5％) were joint depression-type fractures according to Essex-Lopresti classification.ConclusionMost children with displaced ICFs treated with ORIF had a good clinical outcome with few complications.The children and adolescents that were exposed to high-energy trauma suffer calcaneal fractures that were similar to adult fracture patterns.

Objective To measure stress distribution of the main bone architecture of the normal adult cadaveric foot and discuss the effect of plantar ligament injury on stress distribution. Methods Seven fresh adult cadaveric feet were used and 10 strain gauges attached to the bones of the longitudinal foot arch,including the calcaneus,navicular,medial cuneiform,1-5 metatarsal trunk,the distal part of the tibia and fibular,respectively.After the loading Was added to 700 N by almighty test machine,resistance strainmeter was used to measure surface strain of these bones.The results were processed statistically. Results The strain was varied based on different bone segments attached and increased with loading.Tensile force was always found at the medial part of the navicular,the distal part of the tibia and fibular,while the others showed compression all the time.Peak strain was found at calcaneus.followed by the second and third metatarsal.Strain on the surface of the bone segments changed greatly with different ligament injury(P＜0.05).Conclusion The bone surface stress of the longitudinal foot arch changes significantly when the plantar ligament is injured.

Objective To explore the operative methods of open reduction and fixation for the cuboid fractures. Methods The study involved 12 patients with cuboid fractures treated from October 2006 to October 2008. There were seven males and five females, at average age of 38.5 years (range 18-70 years). All patients had closed fractures, including 10 with compression fracture and two with sagittal fractures. The surgical treatments included open reduction, internal fixation by plate, screw or K-wire.Results Ten patients were followed up for 15 months on average ( range 12-24 months), which showed one stage wound healing, with mean time of bone union for 10 weeks ( range 8-15 weeks). No infection was found in any patient. The weight load walk began at 12 weeks ( range 8-18 weeks), with no obvious pain. According to American orthopaedic foot and ankle society (AOFAS) midfoot scale, the mean score was 88.6 (range 73-100). Conclusion Anatomic reduction and stable internal fixation of the cuboid fractures is the key point for recovery of foot form, stabilization and function of the feet.

ObjectiveTo evaluate the strain of the weight-bearing metatarsal bone. Methods6 fresh-frozen cadaveric lower extremities were dissected to expose the dorsal aspect of metatarsal. Bone segments were clarified for adherence of strain-gauges while feet kept intact. Then vertical downward axial load was exerted to distal tibia at a 2 mm/min velocity, from 0 N to 1200 N with one minute interval of 200 N leveled loading augment each for sampling. Superficial strain of the metatarsal was measured by resistance strainmeter methods. ResultsThe strain increased gradually with axial loading, and compress force was always found at every marked bone. The strain of every marked bone was significantly different at the same loading (P<0.05). As to the strain of the middle of the metatarsal, the sequence was the second metatarsal＞the third metatarsal＞the fourth metatarsal＞the first metatarsal＞the fifth metatarsal. As to the strain of the second metatarsal, the sequence was the middle＞the neck＞the base. ConclusionThe peak strain was found at the middle of the second and third metatarsal with axial loading, which prompts the stress fractures of the second and third metatarsal are most common, especially the middle of the second metatarsal.

Objective:To study the coronal bone structure matching of distal radius in normal population and some patients with postoperative distal radius fracture, and to explore the clinical significance of coronal bone structure reduction of distal radius fracture.Methods:CT scans of 80 asymptomatic wrists were performed. Mimics 20.0 and 3-Matic research software were used to measure the matching data of coronal bone structure of the distal radius. Total of 44 patients with distal radius fractures treated with open reduction and volar plate fixation were collected. According to the data coronal bone structure of the distal radius, the matching group was in the normal range, and the mismatching group was less than the normal range. X-ray films were used to evaluate fracture healing, humeral height, ulnar angle and palm tilt angle at 3 months and 12 months after operation. The clinical indexes of wrist pain, wrist function, grip strength and activity were recorded in 2 groups. The DASH score was used for evaluation, and statistical comparisons was made between the two groups of related indicators.Results:The coronal bone structure matching value of the distal radius in 80 normal adults was 45.0%±16.2%. All the 44 patients with distal radius fracture were followed up for an average of 16 months. The postoperative wound healing was good, and the bone healing standard was reached 3 months after the operation. 3 months after surgery, radius height, ulnar deviation angle and palmar inclination angle of the mismatched group were all smaller than those of the matched group, but the differences had no statistical significance. The pronation angle in the mismatched group (68.82°±11.62°) was lower than that in the matched group (76.91°±9.14°), and the difference was statistically significant ( t=2.567, P=0.014). The DASH score in the mismatched group (15.53±2.36) was higher than that in the matched group (13.62±2.52), and the difference was statistically significant ( t=2.591, P=0.013). 12 months after surgery, the VAS score of the matched group (2.08±2.95) was less than that of the mismatched group (2.95±1.24), and the difference was statistically significant ( t=2.348, P=0.024). There was no significant difference in wrist range of motion, grip strength and DASH score between the two groups. Conclusion:The coronal bone structure matching of distal radius is about 45.0% in normal population. Early wrist dysfunction, limited pronation, and wrist pain may occur when the postoperative matching degree of the distal radius fracture is not within the normal range.

ObjectiveTo evaluate the clinical outcome of new proximal femoral nail antirotation (PFNA) in treatment of subtrochanteric fractures. MethodsThere were 31 patients with traumatic subtrochanteric fractures intramedullarily fixed with PFNA. The patients included 14 males and 17 fe-males at a mean age of 54.6 years (range 34-90 years). According to Seinsheimer classification of sub-trochanteric fractures, 14 patients were with type Ⅱ fractures (including four patients with type ⅡA,seven with type ⅡB and three with type ⅡC), 12 with type Ⅲ fractures (including eight with type ⅢA and four with type ⅢB), two with type Ⅳ fractures and three with type Ⅴ fractures. Close reduction was performed under traction and C-arm fluoroscopy in 26 patients and open reduction through a mini-incision before inserting the nail in five patients due to difficult close reduction. ResultsThe operation lasted for a mean time of 72.5 minutes (range 45-120 minutes), with mean blood loss of 127.5 ml (range 100-350 ml). Of all, 27 patients (87.1%, 27/31) were followed up for a mean duration of 14.3 months (range 8-24 months), which showed fracture union in all patients, with a mean union period of 17.4 weeks (range 10-21 weeks). According to Harris Hip Rate Scale, the results were. excellent in 21 pa-tients, good in two and fair in four, with excellence rate of 85.2% (23/27). ConclusionsPFNA is an effective device for treatment of subtrochanteric fracture, with a high union rate and a low complication rate, for it has advantages of easy use and minor trauma, low bleeding and stable fixation in operation.

Objective To discuss the effect of the calcaneocuboid joint arthrodesis on the weight- bearing area of subtalar joint and its clinical significance.Methods Twelve fresh-frozen cadaver foot specimens were used for determination of weight-bearing area of the subtalar joint on foot and ankle neutral position,dorsiflexion,plantoflexion,adduction,abduction,inversion and eversion motion by means of pressure sensitive film before and after calcaneocuboid joint arthrodesis under weight loading.Results Weight-bearing area of the subtalar joint averagely increased for (32.54?7.45)% in all positions after calcaneocuboid joint arthrodesis,with statistical significance (P＜0.05).Conclusion Weight-bear- ing area of the subtalar joint increases after calcaneocuboid joint arthrodesis,which contributes to decrea- sing the pressure and increasing the stability of the subtalar joint.

Objective:To understand the current state of financial toxicity and suicide risk in head and neck cancer patients, to investigate the correlation between the level of financial toxicity and suicide risk in head and neck cancer patients, and to provide a basis for reducing the level of financial toxicity and the risk of suicide in head and neck cancer patients.Methods:A cross-sectional survey was conducted, from March 1 to July 31, 2022, 150 head and neck cancer patients were selected from Oncology Department of East Hospital Affiliated to Tongji Universityby by convenient sampling method. The survey was carried out by means of the general questionnaire, Comprehensive Score for Financial Toxicity based on the Patient-Reported Outcome Measures (COST-PROM), Cancer Suicide Risk Scale (CSRS), and then analysis the datum.Results:The score of COST-PROM of 150 head and neck cancer patients was (18.00 ± 6.12) points, and the score of CSRS of head and neck cancer patients was (36.31 ± 8.51) points. The total score of economic toxicity was significantly negatively correlated with the total score of suicide risk and its dimensions ( r values were -0.446 to 0.235, all P<0.05). The total score of suicide risk was negatively correlated with the total score of economic toxicity and the scores of each dimension ( r values were -0.446 to -0.251, all P<0.05). Conclusions:Patients with head and neck cancer were at higher risk of suicide, and financial toxicity was a significant contributing factor to suicide risk, with higher levels of financial toxicity associated with a higher risk of suicide. Reducing the level of financial toxicity in patients with head and neck cancer has important implications for reducing their risk of suicide.

Objective:To conduct a scoping review on the application of family resilience intervention in adults with chronic disease.Methods:Related studies published from database establishment to October 30, 2023 were systematically searched on PubMed, Web of Science, Cochrane Library, PsycINFO, CINAHL, Scopus, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biomedical Database. The included literature was summarized and analyzed.Results:A total of 9 articles were included. The intervention elements for family resilience included increasing awareness of diseases and family characteristics, solving and responding to family problems, engaging in family interaction and communication, integrating internal and external resources, and providing psychological and technical support. The outcome indicators were the level of family resilience and effectiveness.Conclusions:The intervention of family resilience in adults with chronic disease has certain effectiveness and clinical significance, but research is still in the exploratory stage. Further high-quality research is needed to verify the long-term intervention effect and feasibility, and to construct a diversified family resilience intervention program suitable for China.