Accessory navicular source flatfoot is one of the foot deformity of clinical common disease,its treatment method is more controversial, differences in clinical efficacy of different surgical methods, according to accessory navicular source flatfoot symptoms of surgical treatment,there is no uniform standard, around a pair of accessory navicular excision how to reconstruct the arch produced a series of operation methods, the clinical curative effect of different operative methods produce also different, how to develop the operation strategy, choose operation method, and after acessory navicular excision whether to rebuild posterior tibial tendon, how to rebuild, the problems such as how to rebuild is the research hotspot and difficulty, looking forward to further research.
Flatfoot ; diagnosis ; surgery ; Foot Diseases ; surgery ; Humans ; Reconstructive Surgical Procedures ; methods ; Tarsal Bones ; abnormalities ; surgery

Adult ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Talus ; injuries ; surgery ; Tarsal Bones ; injuries

Fracture dislocation of the navicular bone, fracture of the cuboid, cuneiform, and longitudinal split fracture of the lateral malleolus is a rare combination of fractures. This is a high velocity injury fracture and can be caused by forcible plantar flexion and inversion of the foot at the time of impact onto the ground. Here we reported such a case in a 35-year-old male patient who was treated by open reduction and fixation with a partially threaded screw and two K-wires for the navicular bone, and two interfragmentary screws with a one third tubular plate for the lateral malleolus. K-wires were removed 6 weeks after surgery followed by partial weight bearing. After 6 months, the patient can walk normally with minimal pain and swelling of the foot.
Adult ; Ankle Fractures ; complications ; surgery ; Fractures, Bone ; complications ; surgery ; Humans ; Joint Dislocations ; complications ; surgery ; Male ; Tarsal Bones ; injuries

OBJECTIVE: To analyze radiological characteristics of Muller-Weiss disease, evaluate the clinical value of the imaging examination in diagnosis of Muller-Weiss disease. METHODS: The imaging data of 26 patients with Muller-Weiss disease were collected from September 2015 to August 2020, including 7 males and 19 females, aged 43 to 68 years old with an average of (52.7±4.6) years old. In the X-ray examination observed the shape and position of the navicular bone. The talar-first metatarsal angle(TFM) was measured on the weight-bearing anteroposterior radiograph. The arch angle and angle between mid-axis of talus and mid-axis of the first metatarsal(Meary angle) were measured on the weight-bearing lateral radiographs. The morphology, density, adjacent joint space and position of the navicular bone were evaluated by computed tomography(CT), and magnetic resonance imaging(MRI) was used to observe the shape, signal, cartilage and surrounding soft tissue changes of the navicular bone. RESULTS: Among 26 patients, 21 cases were unilateral and 5 cases were bilateral;X-ray examination showed that the lateral part of navicular bone of foot was compressed and flattened, showing"comma like"or"drop like", navicular moved to the medial side, partial fragmentation of bone, peripheral articular hyperplasia, uneven density and narrowing of relationship gap. According to Meary angle and deformity degree of the affected foot on the lateral X-ray of the load-bearing foot, Maceira staging was performed. There were 0 cases in stageⅠ, 2 cases in stage Ⅱ, 11 cases in stage Ⅲ, 9 cases in stage Ⅳand 4 cases in stage Ⅴ. CT examination showed bone fragmentation, medial displacement of navicular bone and formation of the talocalcaneal joint. MRI examination showed the irregular shape and uneven signal of navicular bone, narrowing of joint space, talocalcaneal joint surface hyperplasia and cartilage destruction, tarsal joint effusion and swelling of surrounding soft tissue. CONCLUSION Muller-Weiss disease has specific imaging manifestation, and an accurate diagnosis can be made based on the patient's age, gender, and clinincal history. Preoperative imaging examination can stage the disease, help clinicians to formulate better surgical plans, and postoperative imaging examination can better evaluate the surgical effect.
Adult ; Aged ; Bone Diseases/diagnostic imaging* ; Cartilage Diseases ; Female ; Foot Diseases/diagnostic imaging* ; Humans ; Hyperplasia/pathology* ; Male ; Middle Aged ; Talus/pathology* ; Tarsal Bones/surgery* ; Tarsal Joints

The author observed a new accessory bone of the foot in the distal portion of navicular, which articulated with the medial cuneiform and the intermediate cuneiform, and named it os infranaviculare. A degenerative change was observed between the accessory bone and the navicular; this caused midfoot pain to the patient during weight-bearing. Thus, the patient was treated by excision of the accessory bone. The symptom was relieved at one-year postoperative.
Bone Diseases/complications/*pathology/radiography/surgery ; Humans ; Male ; Middle Aged ; Pain/etiology ; Running ; Tarsal Bones/*pathology/radiography/surgery

OBJECTIVETo explore the diagnosis and treatment of tarsometatarsal joint complex injury (TJC).

METHODSFrom January 2007 to January 2009,16 patients with tarsometatarsal joint complex injury were treated with open reduction and internal fixation. There were 12 males and 4 females, ranging in age from 21 to 45 years with an average of 34.1 years. Seven cases were left and 9 cases were right and all injuries caused by direct violence. Four cases caused by traffic accident 5 by fall from high and 7 by crush injury. Intercuneiform dislocation were in 11 cases, naviculocuneiform joint dislocation in 3 cases and cuboid fracture in 2 cases. All the cases were three column injuries. According to the situation of exploring and the stability, screw fixation was used for intertarsal joint, internal and middle column tarsometatarsal joint, the Kirschner wire fixation for external column and miniature plate fixation for comminuted fracture of metatarsal bones and compressible fracture of cuboid. The criteria of the AOFAS Foot and Ankle Surgery by the United States Association of ankle-rear foot functional scale was used to evaluate the clinical effect.

RESULTSAll the patients were followed up,the duration ranged from 6 to 18 months(averaged 12.6 months). According to the score system of AOFAS,the total score was (74.6+/-10.4 ) points, including pain items of (29.3+/-5.9), the score of functional items of (32.4+/-5.6) points, and power lines of (12.9+/-2.6). All the incisions were primarily healed without infection, skin necrosis,fixture broken or loosen. Three cases received arthrodesis due to osteoarthritis. Four cases were followed up continually because they only had the radiologic osteoarthritis without pain.

CONCLUSIONAnatomical reduction and stable fixation is the key point of the treatment of tarsometatarsal joint complex injury. Open reduction and internal fixation at the first stage is good for secondary arthrodesis.

Adult ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Metatarsal Bones ; injuries ; surgery ; Middle Aged ; Tarsal Joints ; injuries ; surgery

OBJECTIVETo discuss the clinical effects of open reduction and internal fixation (ORIF) for treatment of patients with Lisfranc injury combined the second metatarsal base comminuted fracture.

METHODSFrom March 2007 to June 2012, 7 patients with Lisfranc injury combined the second metatarsal base comminuted fracture were treated including 5 males and 2 female aged from 22 to 51 years old (means 42 years), 4 of sprain and 3 of traffic injury. According Myerson classification, there was 1 case of type A, 3 of type B and 3 of type C. Kirschner wire was used to fix Lisfranc ligament placing from the medial cuneiform bone to the second metatarsal base during the operation. After the operation American Orthopaedic Foot and Ankle Society (AOFAS) criteria system were applied to evaluate the foot and ankle function. Preoperative and postoperative AP, lateral and oblique X-ray and CT scan were collected for radiographic evaluation.

RESULTSAll patients were followed up from 12 to 20 months (16.8 months in average). According to AOFAS criteria system, 3 cases were excellent result,3 good, 1 fair. All the wounds were primary healing without skin necrosis, infection, Kirschner loose,broken, or other complications.

CONCLUSIONKirschner wire had good clinical efficacy for fixing Lisfranc ligament injury with the second metatarsal base comminuted fracture, and could avoid arthrodesis.

Adult ; Bone Wires ; Female ; Humans ; Male ; Metatarsal Bones ; injuries ; surgery ; Middle Aged ; Tarsal Joints ; injuries ; surgery ; Wound Healing

OBJECTIVETo explore the effect of reduction and fixation with multi-Kirschner wires for treatment of Lisfranc fracture-dislocations.

METHODSThere were 49 patients (37 male and 12 female aged from 20 to 28 years old) involved in the study. According to the Myserson damage typing, type A in 12 cases, B1 in 3, B2 in 28, C1 in 4 and C2 in 2. Kirschner wires were applied to fix and reconstruct the three-column in three directions according to the structural characteristic of midfoot. Reconstruction of three-column needed not only to reduce and to fix every single column, but also to establish union of the columns.

RESULTSAccording to the evaluation of AOFAS for midfoot, 14 cases were excellent (90 to100), 22 cases good (80 to 89), 8 cases fair (70 to 79) and 5 cases poor (60 to 69), with an average score of 84.200+/-9.663.

CONCLUSIONThe diagnosis and treatment of Lisfranc fracture-dislocations should comply with the theory of three-column reconstruction of foot arch, which can achieve the static balance of biomechanics and provide a stable environment for healing of fracture and soft tissue. Reduction and fixation with multi-Kirschner wires is an effective treatment method for Lisfranc fracture-dislocations.

Adult ; Bone Wires ; Female ; Fracture Fixation ; methods ; Fractures, Bone ; surgery ; Humans ; Joint Dislocations ; surgery ; Joints ; injuries ; Male ; Metatarsal Bones ; injuries ; Middle Aged ; Tarsal Bones ; injuries

OBJECTIVETo summmarize the clinical experience of open reduction and internal fixation for the treatment of tarsometatarsal joint injury ane evaluate the effects of operative treatment to tarsometatarsal joint injury.

METHODSFrom March to July in 2009,9 patients with tarsometatarsal joint injury were treated by open reduction and internal fixation included 7 males and 2 females with an average age of 33.5 years old ranging from 20 to 47 years. According to Quenu-Kuss classification, there were 5 cases of type A, 3 of type B, 1 of type C. All patients were treated by cannulated screws and Kirschner wires through 1 to 2 microtubule straight incision on dorsum of foot. The foot function were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score.

RESULTSAll patients were followed up for 5 to 12 months with an average of 8 months. Complications concluded 1 case with infection, 1 case with post-traumatic arthritis. The failure of Kirschner wires was not discovered in 9 cases. According to AOFAS system,the total scores increased from preoperative (15.5 +/- 4.2) to postoperative (92.0 +/- 5.2) (t = -45.95, P < 0.01). The results were excellent in 7 cases, good in 1, and poor in 1.

CONCLUSIONOpen reduction and internal fixation for the reatment of tarsometatarsal joint injury should have satisfying results.

Adult ; Bone Screws ; Bone Wires ; Female ; Foot Injuries ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Metatarsal Bones ; injuries ; surgery ; Middle Aged ; Tarsal Joints ; injuries ; surgery

OBJECTIVETo explore clinical outcomes of posterior malleolar fractures with medial-extension type through posterioromedial and posteriorlateral incision.

METHODSFrom January 2008 to January 2011,25 patients with posterior malleolar fractures with medial-extension type were treated by hollow lag screw. Among them, 15 patients were treated through posteromedial incision,including 9 males and 6 females,aged from 21 to 67 years old with an average of 48.1 +/- 1.3; there were 5 cases with type A, 6 cases with type B and 4 cases with type C,according to Denis-Weber classification. Ten patients were treated by through posterior-lateral incision,including 6 males and 4 females, aged from 23 to 64 years old with an average of 46.9 +/- 1.5; there were 3 cases with type A, 5 cases with type B and 2 cases with type C,according to Denis-Weber classification. Operation time, blood loss, length of incision, times of X-ray exposure and complications of two groups were recorded and compared, Baird-Jackson effective evaluation were applied for evaluate clinical outcomes.

RESULTSAll patients were followed up from 12 to 49 months with an average of 20.6 months. There were significant differences in operation time, blood loss, times of X-ray exposure and complications between two group (P < 0.05). While there was no obvious meaning in clinical outcomes between two groups (P > 0.05).

CONCLUSIONTreating posterior malleolar fractures with medial-extension type through posteromedial approach can expose and fix fracture under direct vision, has advantages of shorter operation time, less X-ray exposure and blood loss, is a good choice of surgical approach.

Adult ; Aged ; Ankle Fractures ; Bone Screws ; Female ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Tarsal Bones ; injuries ; surgery