SUMMARY Anklejointfractureisoneofthemostcommontypesoffracture.Therearemanyresearches on the injury mechanism,treatment principles and surgical techniques.A type of injury which combines posterior dislocation of fibula,known as the Bosworth injury,is relatively rare.In 1947,Bosworth first described this type of injury as an unusual ankle fracture dislocation with fixed posterior fracture disloca-tion of the distal part of the fibula.In this type of fracture,the proximal fibular shaft fragment locks be-hind the tibialis posterior tubercle.This rare ankle fracture variant is often not recognized in initial radio-graphs and requires a computed tomographic (CT)scan for verification.But there are already many re-ports,discussing the injury mechanism,treatment principles and surgical techniques.However,there are few reports of anterior dislocation of the fibula,caused by either injury or surgery.The mechanism of the injury is still not clear.This article reports a case of anterior dislocation of the fibula.We report a patient with left ankle open fracture (Lauge-Hansen pronation-external rotation stage Ⅲ,Gustilo ⅢA).Open reduction and internal fixation was done in the initial surgery,but ended up with poor reduction,resulting in fibula anterior dislocation,anterior dislocation of talus and tibia fibular dislocation.The fibula was dis-located anteriorly of the tibia,which rarely happened.The patient suffered severe ankle joint dysfunc-tion.The second operation took out the original internal fixation,reduced the fracture,and reset the in-ternal fixation.The function of ankle joint was improved obviously after operation.But because of the ini-tial injury and the two operations,the soft tissue around the fracture was greatly damaged.6 months after the second operation,and the fracture still not healed,so the bone graft was carried out in the third sur-gery.Two months after the third surgery,the function of the ankle was significantly better than before, but the fracture healing was poor,which needed further review.Through this case,we understand the rare type of ankle fracture with anterior dislocation of the fibula,and recognize that the timing and quality of initial surgery has a great impact on the patient’s prognosis and rehabilitation period.

Objective:To investigate the differences between emergency surgery and selective surgery treatment of ankle fractures with dislocation .Methods:In the study , 40 patients with ankle fracture and dislocation were treated and followed up from May 2013 to May 2014, and all the data were collected and analyzed .The subjects involved 29 male patients and 11 female patients .The patients were randomly separated into two groups , and the patients in group A were given surgical intervention within 6 hours af-ter injury , while those in group B were initially given close reduction and given selective operation when the soft tissue condition got better .Group A contained 13 male patients and 7 female patients with average age of 37.10;Group B consisted of 15 male and 5 female, with average age of 37.85.Results:The Baird-Jackson score was applied for assessment of the patients ’ outcomes.According to the score , the outcomes were classified into excellent , good, fair, and poor.In group A (emergency group), the outcomes were 13 (65.0%), 4 (20.0%), 3 (15.0%), and 0, respectively.In group B ( selective group), they were 11 (55.0%), 7 (35.0%), 2 (10.0%), and 0, respectively.The numbers of the patients from excellent to poor were 24 (55.0%), 11 (27.5%), 5 (12.5%), and 0, respectively. Conclusion: There is no significant difference in postoperative function between the two groups , however , early surgical intervention can benefit in accomplishing anatomical reduction much easier and shortening the time of hospitalization , which is cost-saving for the patients .

There has still been controversy on selection of approapreate treatments for elderly patients with acetabular fracture who are rapidly increasing in number. Although the treatment principle for them is anatomical reduction, effective fixation and early mobilization, choice of a proper treatment has turned to be a new hot spot for clinical research because the physical status, bone quality and fracture type of the elderly population are special. With unceasing achievements in medicine, surgical techniques and implants, the management ideas and strategies for elderly acetabular fractures have become gradually mature and diversified. The current major protocols include conserverative treatment, open reduction and internal fixation and total hip arthroplasty. In order to enhance the surgeons'knowledge of elderly acetabular fractures and summarize the cilinical experiences in management of them, we present this review to illustrate the current achievements and new development trends.

The Hippocratic oath commands doctors to be the patients supreme advocate. Coupling this command with a well trained physician is the sine qua non of orthopaedic risk management. A favorable doctor and patient relationship is also essential. The occurrence of a malpractice lawsuit is more often the result of the failure to practice the art of medicine by the orthopaedist rather than a failure to apply the science of orthopaedics. The ER (emergency room) is a dangerous area. The risk of litigation in the emergency room is not directly proportional to the severity of injury. In fact, the risk of initiation of legal action is greater in cases of relatively modest disability.

We review the literature about Heterotopic Ossification (HO) and introduce its pathophysiology, classification, incidence, clinical presentation, diagnosis, prophylaxis and treatment in this article. HO is the presence of bone in soft tissue where bone normally does not exist. Mature HO has the same morphology as callus. It is considered that 3 conditions are necessary for HO: osteogenic precursor cells, inducing agents, and a permissive environment. Fever, swelling, erythema, and occasional joint tenderness appear in the early stage of HO. The most sensitive imaging modality for early detection of HO is three-phase bone scintigraphy which can also monitor the metabolic activity and degree of maturity of HO. Non-steroidal antiinflammatory drugs (NSAIDs) are the most effective for the prophylaxis of HO after the operation of hip replacement or acetabulum fracture. Surgical resection is the only treatment for patients with severe joint tenderness following HO.

Objective:To investigate the management of pelvic injury associated with complete anterior sacroiliac joint dislocation.Methods:In the study, 6 cases of pelvic injury associated with complete an-terior sacroiliac joint dislocation treated in Beijing Jishuitan Hospital from February 2008 to June 2014 were analyzed.We described the history and severity of injury, emergency treatment, and fracture radio-logy.In all the cases, the surgical treatment and postoperative functional exercise were performed.We followed up all the cases on an average of 1.6 years, assessed the postoperative recovery and summed up the treatment experience.Results:All the 6 patients with fractures recovered without infection and nerve symptoms after surgery.Their X-rays showed good reduction of sacroiliac joints.All the cases were followed up on an average of 1.6 years.Six months after surgery, the Majeed scores were perfect in 2 cases, good in 2, fair in 1, and poor in 1.The patients with poor scores suffered persistent pain, and decreased physical activity, and when walking long distances, they needed a walking stick.The 2 patients with low scores could not resume the original work.Conclusion:Pelvic injury associated with complete anterior sacroiliac joint dislocation is a special type of the pelvic injury since the managements during the emergency phase are difficult.The surgery should be done as early as possible, and the anterior approach is available for the reduction and fixation.

Objective To evaluate the results of operative treatment of comp ou nd acetabular fractures through single ilioinguinal approach. Methods 46 cases o f compound acetabular fractures were treated through single ilioinguinal approac h from June 1994 to October 2003 in our department. Their functional recovery an d complications were followed up. Results On the average, 40 cases were followed up for 40.4 months. All the fractures healed and no infection was found. Clinic al results were excellent and good in 33 patients, and only one patient showed s light ectopic ossification after the operation. Conclusions Acetabular fractures associated with anterior and posterior hemi-transverse fractures, most both co lumn fractures and some T shape fractures can be treated through the single ilio inguinal approach which can result in good reduction, satisfactory functional re covery, less invasive incision, and low rate of postoperative complications.

Objective To evaluate the secondary internal fixation plus bone grafting for salvage of failed internal fixation for intertrochanteric hip fractures. Methods Between January 2001 and March 2008, 25 patients with intertrochanteric fractures who had suffered from failed initial internal fixation were treated with secondary open reduction and internal fixation and bone auto grafting. They were 15 men and 10 women, with a mean age of 50 (17 to 72) years. The mean interval between the initial operation and the revision was 12 (4 to 27) months. The failure of original internal implants involved the dynamic hip screw (DHS) in 12 patients, the dynamic condylar screw (DCS) in 3, the angular blade plate (ABP) in 1, the cephalomedullary nail in 3 and the cannulated screw in 6. The replacement of internal implants included PFN in 12 eases, DCS in 7, DHS in 4 and ABP (95°) in 2. Results The mean follow-up was 24 (6 to 84) months. The revisions were uneventful. Of the 25 nonunions, 24 healed (96.0%). The postoperative mean hip rating (Harris score) for the hip joint was 87(35 to 100) points. The X-ray films at the last follow-up revealed the coLlodiaphyseal angle averaged 120° ( 110° to 140°). No avascular necrosis of the femoral head or hip degeneration was found. Conclusion In properly selected patients, secondary internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.

Objective To classify tibial plateau fractures based on the analysis of the morphology and injury mechanisms of 200 cases of tibial plateau feature.Methods We collected the X-ray and CT images of 200 consecutive cases of tibial plateau fracture in i99 patients who had been treated at our department from January 2010 to April 2011.They were 134 males and 65 females,from 15 to 77 years of age (average,45.7 years).According to the Schatzker classification,9 cases were type Ⅰ (4.5％),105 type Ⅱ (52.5％),19type Ⅳ (9.5％),37type Ⅴ (18.5％),30type Ⅵ (15.0％),and none type m.The fracture morphology and injury mechanism of each case were analyzed to propose a new classification system.Results Fractures of tibial plateau can be classified into the following five types:(a) Lateral condylar fracture and valgus injury (100 cases,50％).The injury mechanism is the axial force on the valgus and extended knee joint.(b) Fracture-dislocation injury (24 cases,12.0％).This type includes typical Schatzker type Ⅳ,and some cases of Schatzker type Ⅵ associated with lateral subluxation.Its mechanism is a compound force of valgus,varus,rotational and axial stresses.The rotational force is the key factor leading to subluxation of the knee joint.(c) Double-condylar fracture (40 cases,20.0％).This type is caused by an axial force on the extended knee,including Schatzker type Ⅴ and some cases of Schatzker type Ⅵ not associated with knee subluxation.(d) Posterior condylar fracture and flexion injury (32 cases,16.0％).This type only involves the posterior condylar plateau,and is caused by an axial force on the flexed knee.Based on the morphology,posterior condylar fractures can be further divided into three subtypes:simple split of posteromedial condyle,simple collapse of posterolateral condyle,and a combination of the two.(e) Frontal plateau compression fracture and hyperextension injury (4 cases,2.0％).This type is caused by an axial force on the hyper-extended knee.It is characterized by significant compression of the anterior plateau and intact posterior plateau.Conclusion Based on the morphological features and injury mechanisms,tibial plateau fractures can be classified into 5 types:lateral condylar fracture,fracture-dislocation injury,double-condylar fracture,posterior condylar fracture,and frontal plateau compression fracture.

Objective To evaluate the clinical effect of early total care (ETC) for treatment of unstable pelvic fractures.Methods This retrospective case series study included eighteen patients with unstable pelvic fractures treated surgically from May 2013 to May 2015.There were 11 male and 7 female patients,aged (45.1 ± 13.1)years.Eleven patients were injured due to road traffic accidents and 7 due to fall from height.Tile B type pelvic fractures were seen in 8 patients and Tile C type in 10 patients.All patients were treated with ETC method and received open reduction and internal fixation within 24 to 48 hours after the primary treatment.Data were collected,such as operation time,intraoperative blood loss,hospital length of stay and perioperative complications.Majeed score and EuroQol 5 dimension (EQ-5D) were used for evaluation of clinical outcome and quality of life respectively.Excellent and good rate of operation was assessed using the Matta clinical evaluation standard.Results Three patients died and fifteen patients survived.Operation time was (120.1 ± 22.2)minutes,amount of intraoperative blood loss was (355.9 ± 56.4) ml,and hospitalization was (8.5 ± 1.6) days.Incidence of perioperative complications was 56％,including 3 patients with acute respiratory distress syndrome,1 pneumonia,2 acute lung injury,1 incisional wound infection,2 multiple organ failure and 1 diffuse intravascular coagulation.All patients were followed up for (15.1 ±2.4)months (range,12-21 months).Majeed score was decreased from preoperative (93.7 ± 6.1) points to final follow-up of (74.1 ± 9.2) points,and the EQ-5D index was decreased from preoperative 0.96 ± 0.04 to final follow-up of 0.74 ± 0.19 (both P ＜ 0.05).Excellent and good rate of operation was 80％.Conclusions ECT provides satisfactory short-term outcome for treatment of unstable pelvic fractures,but the incidence of complications is high.Doctors should choose reasonable treatment plan according to the surgical indications.