Objective To evaluate the clinical efficacy of external biplanar mini-fixator and limited internal fixation in treatment of severe midfoot fracture-dislocation.Methods Eight patients with severe midfoot fracture-dislocation were admitted from May 2009 to August 2012.They were 6 men and 2 women,28 to 57 years of age (average,35.4 years).According to the Gustilo classification,there were one type Ⅱand 7 cases of type Ⅲ.Two cases of midfoot fracture were complicated with dislocation of the transverse tarsal joint,4 with dislocation of the tarsometatarsal joint,and 2 with dislocation of both the transverse tarsal joint and the tarsometatarsal joint.The external biplanar mini-fixator was applied to stabilize and maintain lengths of the medial and lateral columns and normal geometry of the foot arch after reduction of the fracture-dislocation.K-wires were used if limited internal fixation was necessary.The external fixator was removed at 12 to 16 weeks postoperatively.The clinical treatment efficacy was assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale and the visual analogue scale (VAS).Results The patients were followed up for an average of 13.4 months (from 10 to 24 months).Postoperative radiological films showed fine reduction of the fractures and dislocations.No reduction was lost after removal of external and internal fixations.They were able to walk independently and had good functional recovery of the injured feet without traumatic arthritis during the follow-up period.Their average AOFAS scores were 65.8 at 3 months after operation,71.3 at 6 months and 80.6 at 12 months; the average VAS scores were 7.5 at 3 months,4.3 at 6 months,and 1.2 at 12 months,respectively.Conclusion In treatment of severe midfoot fracture-dislocation,external biplanar mini-fixator combined with limited internal fixation can perfectly reconstruct and maintain the medial and lateral columns and normal geometry of the foot arch,preventing functional disability caused by foot malformation.

Objective To observe the short-term clinical outcomes of arthroscopic single-tibial tunnel Pushlock fixation in the treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL).Methods From December 2015 to January 2018,15 patients with tibial avulsion fracture of PCL were treated at Department of Articular Surgery,The Third Affiliated Hospital to Hebei Medical University.They were treated with arthroscopic single-tibial tunnel Pushlock fixation.All the fractures were fresh.They were 9 males and 6 females,aged from 14 to 64 years (average,33.6 years).The short-term outcomes were evaluated by comparing their preoperative and postoperative flexion of the knee,International Knee Documentation Committee (IKDC) and Lysholm scores.Results The operation lasted from 40 to 70 minutes (average,53 minutes).The 15 patients were successfully followed up for 10 to 18 months (average,12.2 months).All the fractures united well within 3 months after operation.All the posterior drawer tests were negative,showing no displacements or no complications like lesions of popliteal fossa,nerves and vessels,or impaired knee extension.At 6 months after surgery,the knee flexion (123.4°± 6.5°),the Lysholm scores (91.8 ± 3.5) and the IKDC scores (95.5 ± 1.6) were all significantly improved compared with the preoperative values (77.5°±13.1°,46.8 ±8.9 and 37.0±8.9) (P ＜0.05).Conclusion The tibial avulsion fracture of PCL can be treated by arthroscopic single-tibial tunnel Pushlock fixation with satisfactory early outcomes.