Objective To investigate the diagnosis,operation characteristics and clinical effect of anterior Pilon fracture.Methods A retrospective analysis was carried out to analyze 13 patients who had been treated for anterior pilon fracture from September 2012 to March 2014.All had fresh closed fracture.Mean age was 39.8 years (range,18-61 years).Injury resulted from high falls in 11 patients and falls in 2 patients.According to the preoperative imaging manifestations and four column fracture classification,the fracture type was mainly anterior column fracture.All underwent open reduction and internal fixation with buttress plates,and allograft bone was performed in 8 patients.At the last followup,American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale(VAS) were employed for clinical evaluation.Results Mean period of follow-up was 15.7 months (range,12-30 months).Mean AOFAS score was 91.38 points (range,74-100 points).Excellent results were found in 10 patients,good in 2 and fair in 1,with the excellent-good rate of 92％.Mean VAS score was 1.08 points (range,0-3 points).Traumatic arthritis occurred in 1 patient.Skin necrosis occurred in 1 patient,and was cured by dressing change.There were no complications such as infection,refracture or implant failure.Conclusions Mechanism of injury in anterior pilon fracture is vertical violence when the foot in dorsiflexion position.Imaging findings are mainly characterized by the compression in anterior articular surface of the distal tibia,which is often implicated in the anterior medial malleolus but in part is combined with lateral malleolus fracture.The fracture is the result of high energy injury,and can be diagnosed by mechanism of injury and imaging manifestations.Through anterior approach,open reduction and internal fixation with buttress plates plus allogenic bone grafting obtain satisfactory outcomes.

Objective:To analyze the applicability of Guo's massage system for tendon management in the treatment of chronic lateral ankle instability (CLAI).Methods:Randomized controlled trial design. A total of 82 CLAI patients in our hospital from January 2021 to January 2022 were selected as observation subjects and divided into two groups using a random number table method, with 41 patients in each group. The control group received ankle rehabilitation exercise (3 times for 1 course, 6 courses), while the research group received Guo's massage and tendon manipulation therapy (3 times for 1 course, 6 courses). Before and after treatment, ankle joint range of motion and Y-balance tests were performed. The American Association of Foot and Ankle Surgeons (AOFAS) ankle posterior foot function score was used to evaluate ankle joint function, the VAS scale was used to evaluate patient pain, and the Foot Ankle Energy Scale (FAAM) was used to evaluate the degree of ankle joint function damage and evaluate clinical efficacy.Results:The total effective rate was 95.12%(39/41) in the research group and that in the control group was 78.05%(32/41) ( χ2=5.15, P=0.023). The range of motion of plantar flexion, range of dorsiflexion, varus range of motion, valgus range of motion, anterior extension distance, posterior inward extension distance, and posterior outward extension distance increased in the research group after treatment were significantly higher than those in the control group ( t=11.32, 14.02, 8.70, 18.09, P<0.01). Forward, rear Inner, and rear outer extension distances of the ankle Y-balance test in the research group were significantly higher than those of the control group. The AOFAS score in the research group was significantly higher than that of the control group ( t=5.94, P<0.01), VAS score was significantly lower than that of the control group ( t=13.38, P<0.01). The daily activity score and exercise score in FAAM in the research group were significantly higher than those in the control group ( t=9.14, 14.99, P<0.01). Conclusion:The use of Guo's massage system for tendon management can improve the ankle function of CLAI patients, reduce their pain level, and promote the recovery of the patients.

Objective Based on hemodynamic analysis, to investigate the cause of distal re-entry tear in Stanford type B aortic dissection after thoracic endovascular aortic repair (TEVAR).Methods A patient with type B aortic dissection was reexamined regularly with computed tomography angiography (CTA) at 1st month, 6th month, 12th month and 24th month after TEVAR. Based on the CTA images in each period, three-dimensional (3D) aorta models were reconstructed to perform morphological analysis and hemodynamic simulation.Results Compared with the diameter at 1st month after TEVAR, the diameter of true lumen at 12 months after TEVAR increased by 1.8 times and the global distortion of aorta increased by 16.67%. At postoperative 1st, 6th and 12th month, the maximum blood velocities at the new entry tear in systole were 69.6%, 33.7% and 92.1% higher than the average ones at distal landing zone, and the maximum wall shear stresses (WSSs) were 2.52, 2.32 and 3.52 times of the average WSSs respectively. In addition, the maximum time-averaged WSS (TAWSS) at 1st, 6th and 12th month after TEVAR were 1.88, 2.53 and 3.62 times of the mean TAWSS respectively.ConclusionsThe morphology of the aorta remodeled after TEVAR, and a sudden change in the diameter of true lumen occurred at distal anchoring zone and continued to increase. As a result, the blood flow velocity in this area accelerated, and the intima was continuously exposed to high WSS, leading to the redissection.