Objective To investigate the guidance of a new intraoperative classification of distal tibiofibular syndesmosis injury in the selection of internal fixation for ankle fractures.Methods Between January 2010 and January 2015 our department treated 116 patients with displaced closed ankle fracture (Weber type B or C).They were 60 men and 56 women,aged from 18 to 78 years (average,45.6 years).After reduction and fixation of the fibular fracture,we assessed the syndesmosis stability using the fibular hook traction test and radiological findings.We classified the distal tibiofibular syndesmosis injury into 3 grades (grade Ⅰ:＜ 4 mm displacement;grade Ⅱ:4-7 mm displacement;grade Ⅲ:＞ 7 mm displacement).Selection of proper screwing was determined by our new classification.Results Of the 116 cases,82 (70.7％) demonstrated distal tibiofibular syndesmosis injury.Screwing of the distal tibiofibular syndesmosis was not conducted for 30 (25.9％) of them who were of stable grade Ⅰ.52 (44.8％) cases were of unstable grades Ⅱ and Ⅲ.Of the 48 cases of grade Ⅱ,44 were fixated with one screw and the rest 4 became stable grade Ⅰ after Volkmann block fixation and received no screwing.Fixation of the distal tibiofibular syndesmosis with 2 screws was conducted for the 4 cases of unstable grade Ⅲ.All the patients were followed up for 12 to 60 months.No non-union,screw breakage,or syndesmosis separation after screw removal occurred.The American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring showed a good/excellent rate of 93.1％ (108/116).Conclusion Our new intraoperative classification can provide correct judgment of the severity of distal tibiofibular syndesmosis injury,thus guiding the selection of proper screw fixation to enhance the outcomes of ankle fractures.

BACKGROUND: Femoral intertrochanteric fracture is a common fracture type in elderly patients, and which kind of internal fixation system is better remains controversial.OBJECTIVE: To investigate the short-term efficacy of proximal femoral nail antirotation (PFNA) system versus intertrochanteric antegrade nail (InterTan) system in the treatment of femoral intertrochanteric fracture.METHODS: Forty-five patients with femoral intertrochanteric fracture were divided into PFNA (n=19) and InterTan (n=26) groups. The operation time, intraoperative blood loss hospitalization time, incidence of complications and Harris hip scores at postoperative 3 months were compared between two groups.RESULTS AND CONCLUSION: (1) Patients with PFNAs enjoyed a significantly shorter operation time at (125.8±21.5) minutes compared those with InterTans who needed (156.2±54.5) minutes (P < 0.05). (2) The intraoperative blood loss in the PFNA and InterTan groups was (226.3±107.2) mL and (300.0±150.3) mL, respectively, but the difference was not significant (P > 0.05). (3) No significant difference was identified in the hospitalization time, incidence of complications and Harris hip scores at postoperative 3 months between two groups (P > 0.05). (5) Our findings indicate that except for short operation time in PFNA system, there are no significant differences in the intraoperative blood loss, hospitalization time, incidence of complications and Harris hip scores at postoperative 3 months between two internal fixation systems,and both possess good safety and efficacy in postoperative short period.

Objective To analyze the safety and effectiveness of robot-assisted laparoscopic partial nephrectomy(RLPN) for cT2 renal tumors in international multi-centers.Methods This study was conducted to collect information on surgical procedures performed by RLPN and robot assisted laparoscopic radical nephrectomy (RRN) in nineteen international urological centers from January 2012 to December 2017.RLPN were performed in 159 patients (118 males and 41 females),with the average age of (59.3 ± 13.2) years,body mass index(BMI) of (28.7 ± 5.4)kg/m2,preoperative GFR of (77.3 ± 22.1) ml/min.RRN were performed in 219 patients,with the average age of (62.0 ± 12.9) years,BMI of (28.7 ±6.1) kg/m2,preoperative GFR of (71.4 ± 20.3) ml/min.There was no statistical difference between the two groups in gender and BMI.The age of the patients in RLPN group was younger than that in RRN group,and the preoperative GFR was better.The patient's baseline demographics,perioperative data,tumor pathology,oncologic outcomes,and renal function (GFR) were recorded.Results All 378 cases underwent successful surgery.The operation time of RLPN was 150 min(65-353 min),which was shorter than that of RRN [180 min(85-361 min),P ＜ 0.001].The intra-operative blood loss of RLPN was more than that of RRN [150 ml (40-3 000 ml) vs.100 ml (10-1 100 ml),P ＜ 0.001].The incidence of intra-operative complications were not statistically different between the two groups [5.7％ (9/159) vs.3.2％ (7/219),P =0.240].The incidence of postoperative complications was higher in the RLPN group than that in RRN group [19.5％ (31/159) vs.10.5％ (23/219),P =0.014],but there was no significant difference in the incidence of complications of grade 3 or above [4.4％ (7/159) vs.2.3％ (5/219),P =0.246].The recurrence-free survival rate of RLPN group was higher than that of RRN group [91.4％ (117/128) vs.81.9％ (167/204),P =0.013],and RLPN group was more conducive to renal function protection (P ＜ 0.001).Conclusions RLPN for cT2 tumors can obtain effective tumor control rate and better renal function preservation.It could be an acceptable alternative for surgical management of cT2 tumors.