Common iliac artery ureteral fistula is a rare but potentially life-threatening disease which is difficult to diagnose clinically. This paper reports a case of common iliac artery ureteral fistula. The patient was admitted to our hospital due to ureterostomy bleeding for one day. He underwent radical cystectomy and bilateral ureterostomy for bladder cancer 4 years ago, and also underwent radiotherapy and bilateral ureteral stents indwelling after the operation. Angiography revealed a left common iliac artery pseudoaneurysm, and a left common iliac artery ureteral fistula was considered. The left common iliac artery stent-graft was implanted. The patient recovered well after the operation, and there was no obvious hematuria during follow-up period of 6 months.

Objective To investigate clinical effect of minimally invasive knotless bridge-suture technique for acute achilles tendon rupture.Methods The clinial data of 23 patients with acute achilles tendon rupture treated in Department of Orthopaedics,Shanghai Jiao Tong University Affiliated Sixth People's Hospital from August 2017 to February 2018 were analyzed retrospectively.There were 21 males and 2 females,aged (37.1 ± 5.6) years,with an age range of 29-51 years.Minimally invasive knotless bridge-suture technique was performed in all cases until the soft tissue condition of the patients improved.Patients were followed up by outpatient review at 3 weeks,6 weeks,3rd,and 6th months postoperatively,followed by every 3 months,followed up 12 to 18 months,and the deadline was April 2019.Ratio of perimeter of the affected lower extremity to that of the uninjuried,number of repetitions for one leg calf rise in one minute,American Orthopaedic Foot and Ankle Society (AOFAS) anklehind foot score,the achilles tendon total rupture score(ATRS) and time to return to work were investigated at last follow-up,as well as complications during the follow-up period.Results Twenty-three cases were followed up.At last follow-up,ratio of perimeter of the affected lower extremity to that of the uninjuried was (92.7 ± 1.8) ％,number of repetitions for one leg calf rise in one minute was (25 ± 2) times,AOFAS ankle-hind foot score was (91.5 ±2.2) scores,ATRS was (92.6 ±2.4) scores,time to return to work ranged from 6 to 9 weeks.All patients underwent first-stage healing.No skin necrosis,superficial infection and sural nerve injury occurred.No achilles tendon re-rupture was seen during the follow-up period.Conclusion Minimally invasive knotless bridgesuture technique for acute achilles tendon rupture is applied easily and less invasive,enabling patients to return to work earlier and proved to be a secure and effective treatment.

Objective To evaluate the surgical techniques and clinical outcomes of ankle distraction arthroplasty with platelet-rich plasma(PRP) injection for post-traumatic ankle arthritis.Methods From May 2012 to May 2017,32 patients with post-traumatic ankle arthritis were treated at Department of Orthopaedic Surgery,Shanghai Sixth Peopled Hospital.They were 22 males and 10 females,with an age of 32.6±5.8 years(from 18 to 40 years).Their course of disease was 14.0±2.8 months(from 6 to 24 months).After failure of the conservative management for at least 6 months,they received ankle distraction arthroplasty with PRP injection.American Orthopaedic Foot&Ankle Society(AOFAS) ankle-hindfoot score and visual analogue scale(VAS) were used to evaluate the final overall outcomes.Range of motion(ROM) of the ankle joint and complications were also recorded postoperatively.Results Pin tract infection occurred in 12 patients but responded to alcohol care.All the patients were followed up for an average of 36 months(from 18 to 60 months).The VAS score decreased significantly from preoperative 6.8±1.2 to postoperative 8±1.4;the AOFAS ankle-hindfoot score increased significantly from preoperative 38.5±6.2 to 80.3±8.1 at the final follow-up;dorsal expansion and plantar flexion of the ankle increased significantly from preoperative 8.3°±7.0° and 24.7°±6.4° to 12.8°±6.5° and 31.4°±5.3° at the final follow-up,respectively(all P<0.05).Two patients had to receive salvage arthrodesis after conservative management failed to relieve their symptoms or delay the progression of their post-traumatic arthritis.Conclusion Ankle distraction arthroplasty with PRP injection is an effective ankle preserving surgery which can relieve symptoms,improve functions and delay progression of post-traumatic ankle arthritis.

Objective: To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis. Methods: A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics, Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018. They were divided into 2 groups by their treatment methods. In the 9 patients treated by instrumentation with 3D-printed patient-specific guides, there were 6 males and 3 females with an age of 54.6±8.6 years, 4 left and 5 right sides involved, and one case of Takakura stage 1, 3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a. In the 12 patients treated by conventional techniques, there were 7 males and 5 females with an age of 53.0±6.5 years, 7 left and 5 right sides involved, and one case of Takakura stage 1, 5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a. The 3D printed guide group and the conventional group were compared in terms of operation time, intraoperative blood loss and frequency of intraoperative fluoroscopy, tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS). The differences in TAS, TT and TLS between pre- and post-operation in the 3D printed guide group were also evaluated. Results: There were no significant differences in the preoperative general data between the 2 groups (P>0.05), indicating they were comparable. All the patients were available for follow-up for an average of 7.8 months (from 3 to 15 months). The 3D printed guide group incurred significantly shorter operation time (106.2±10.6 min), less intraoperative blood loss (207.2±16.0 mL) and lower fluoroscopy frequency (2±0) than the conventional osteotomy group (all P<0.01). The post-operative TAS (94.3°±3.2°) and TT (3.8°±0.8°) angles in the 3D guide group were significantly different from their preoperative values (84.6°±3.5° and 7.6°±1.6°) (P<0.01). The 3D printed guide group was not significantly different from the conventional group in postoperative TAS (94.3°±3.2° versus 92.4°±5.9°), TT (3.8°±0.8° versus 4.2°±1.1°) or TLS (83.7°±3.4° versus 84.2°±2.2°) angles (P>0.05). Conclusions Compared with conventional techniques, instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency. The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity, leading to similar efficacy compared with conventional osteotomy.