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Correlation between acute gastrointestinal injury severity and intestinal microenvironment in rabbits with severe multiple trauma

Gang LIU ; Bo WANG ; Xiaoying TANG ; Guoting CHEN

Chinese Journal of Trauma.2017;33(10):929-937. doi:10.3760/cma.j.issn.1001-8050.2017.10.013

Objective To investigate the correlation between acute gastrointestinal injury severity and intestinal microenvironment in rabbits with severe multiple trauma.Methods A total of 60 New Zealand white rabbits were enrolled and randomly assigned into the experimental group (48 rabbits) and control group (12 rabbits).In experimental group,the models of traffic-induced injuries were successful made by using self-made small gravity traction colliders.There were nine rabbits with craniocerebral injury combined with damage of liver and spleen,three with four extremity fractures combined with damage of liver and spleen,12 with rib fractures combined with damage of lungs and pleural effusion,11 with epidural hematoma,contusion and laceration of brain as well as fractures of four extremities and pelvis,and nine with multiple fractures.The injuries had met the criteria of multiple severe traumas according to the injury severity score (ISS).The control group had similar condition with experimental group except for participation in injury model.The parameters at time points of 6,12,24 and 48 h after injury were observed.The parameters were:(1)Enzyme linked immunosorbent assay (ELISA) and high pressure liquid chromatography (HPLC) were used to detect the levels of diamine oxidase (DAO) and the ratio of lactulose to mannitol in urine in order to evaluate the permeability of intestinal mucosal barrier.(2) The small intestinal propulsive rate was detected by carbon pushing mcthod.The interstitial cells of Cajal in the snall intestine wall were observed by transmission electron microscopy.The expression of C-kit was detected by Western blot.By these means,the dynamic function of intestinal mucosal barrier was evaluated.(3) The damage degree of intestinal nucosal barrier was evaluated by pathological observation and Chiu score in the end of small intestine and colon.(4)The intestinal bacterial translocation was evaluated by intestinal microflora culture,mesenteric lymph nodes checking as well as translocation examination of liver and spleen.Results (1) The level of DAO plasma and urine lactulose/mannitol ratio at 6 h after injury increased to varied degrees,and reached the peak during 12-24 h,the correlation analysis of which showed that plasma DAO levels were positively correlated with AGI grade at 6,12 and 24 h (r =0.486 3,0.493 3,0.477 6,P ＜ 0.05).The ratio of urinary lactulose/ mannitol excretion was only positively correlated with AGI grade at 6 and 12 h (r =0.478 5,0.497 2,P ＜ 0.05).(2) The gastrointestinal transmission rate in the experimental group was (48.2 ± 5.2) ％,and that of the control group was (60.3 ± 3.0) ％.The gastrointestinal transmission rate of model group rabbits was significantly longer than that of control group (P ＜ 0.05).(3) The interstitial cells of Cajal decreased dramatically during 12-24 h after the injury,and the expression level of C-kit protein decreased consistently with the increase of AGI grade.(4) The intestinal and colonic mucosa tissues of the experimental group showed obvious necrosis at 12-24 h after injury,and the Chiu score increased gradually with the increase of AGI grade under light microscope.(5) The Enterobacter and Enterococcus in the experimental group increased significantly compared with that in the control group.But the numbers of Bifidobacterium,Lactobacillus,Lactobacillus,Bacteroides as well as the ratio of Bifidobacterium to Enterobacteriaceae significantly decreased(P ＜0.05).(6)The organ bacterial translocation rates were 24％,42％ and 62％ after injury in experimental group (P ＜0.05).Conclusions Acute gastrointestinal injury may occur early after severe multiple trauma,and the injury severity is closely related to the change of intestinal barrier function and bacterial translocation.Early attention and active correction of the change of intestinal microenvironment are of great importance for treatment of multiple trauma.

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Biomechanical comparisons of two sacroiliac screws with different lengths in the treatment of central sacral fractures in a finite element model

Yong ZHAO ; Yupeng MA ; Gong CHENG ; Dexin ZOU ; Wei LIAN ; Tao SUN ; Dan WANG ; Shudong ZHANG ; Shengqiang FU

Chinese Journal of Trauma.2017;33(10):896-903. doi:10.3760/cma.j.issn.1001-8050.2017.10.008

Objective To compare the biomechanical characteristics of lengthened sacroiliac screw and long sacroiliac screw fixated in different ways for the treatment of central vertical sacral fractures to provide reference for clinical practice.Methods A finite element model with three dimensions of Tile type C pelvic ring injury (central type Denis Ⅲ fracture of sacrum) was produced.The central sacral fractures were fixated with lengthened sacroiliac screw or long sacroiliac screw in 7 types of models respectively as follows.(1) One long sacroiliac screw was fixated in S1 segment from the right (C1);(2) One long sacroiliac screw was fixated in S2 segment from the right (C2);(3)Two long sacroiliac screws were fixated in S1 and S2 segments respectively from the right (C12);(4) One long sacroiliac screw was fixated in S1 segment from the right and one long sacroiliac screw was fixated in S2 segment from the left (C12hybrid);(5) One lengthened sacroiliac screw was fixated in S1 segment from the right (J1);(6) One lengthened sacroiliac screw was fixated in S2 segment from the right (J2);(7)Two lengthened sacroiliac screws were fixated in S1 and S2 segments respectively from the right (J12).The shift and angle displacement of the central superior surface of sacrum in the case of standing on both feet were measured and compared.The maximum Von Mises stresses in different positions were measured.And various mechanical indices (including stresses of various parts and stress distribution of screws and pelvis,etc) were also quantified and compared.Results The stability of the posterior ring-screw complex was optimal when the sacrum was fixated with S1 & S2 lengthened sacroiliac screws.The maximum Von Mises stresses of screw were affected by sacral segments,namely,S1 ＞ S2 ＞ S1& S2.The maximum Von Mises stress of screws in S1 and S2 segments were similar.The maximum stress of the lengthened sacroiliac screw was lower than that of the long sacroiliac screw.The maximum Von Mises stress of bilateral sacroiliac joints in the lengthened sacroiliac screw fixation model was similar to that of normal pelvis.The maximum stress in the left sacroiliac joint of the long sacroiliac screw fixation model was larger than that of the normal pelvis.The maximum Von Mises stress of screw-bone interface of the long sacroiliac screw fixation model was larger than that of the lengthened sacroiliac screw fixation model.The screw stress distribution of the lengthened sacroiliac screw was superior to that of the long sacroiliac screw,and the screw stress distribution of the double segment fixation was superior to that of the single segment fixation.There was relatively less difference between the pelvic stress distribution of double segment fixation model and that of the normal pelvic model.Conclusion The fixation of S1 & S2 lengthened sacroiliac screws utilized in central sacral fractures of Tile C pelvic ring injury results in a more stable posterior pelvic ringscrew complex,more dispersed screw stress and better pelvic stress distribution which is closed to normal,and can also reduce the risk of internal fixation failure as well as lower back pain.

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Effects of simple posterior decompression and fusion fixation as treatment strategy for complete thoracic fracture dislocation

Yingjie ZHOU ; Xuke WANG ; Shaochun WANG ; Huailiang ZHENG ; Xiangqin SHI ; Xubin CHAI ; Xianjie MENG

Chinese Journal of Trauma.2017;33(10):890-895. doi:10.3760/cma.j.issn.1001-8050.2017.10.007

Objective to investigate the clinical efficacy of decompression and pedicle screw fixation through posterior approach for complete thoracic spine fracture dislocation.Methods The clinical data of six patients with complete thoracic spine fracture and dislocation treated from September 2002 to June 2016 were analyzed retrospectively by case series study.There were five males and one female,aged 21-67 years old (mean,47.2 years).The injury segments were T3～4 dislocation in one case,T5～6 dislocation in two cases,T6 ～7 dislocation in two cases and T8 ～9 dislocation in one case.There was one case of ASIA grade E and five cases of Grade A,and all of six cases were associated with multiple rib fractures and hemopneumothorax.The companied status was one case of sternal fracture,one case of atlantoaxial complex fractures and three cases of pulmonary contusion.The posterior median incision decompression and pedicle screw system fixation were performed,and the intervertebral bone grafting was conducted after restoration.The surgery time,bleeding volume during surgery,fracture restoration,bone grafting fusion,failure of internal fixation and other complications were recorded.The Visual Analogue Scale (VAS) and American Spinal Injury Association (ASIA) classification were used to assess the pain and neurological function improvement between the preoperative visit and final follow-up visit.Results The surgery time was 150-240 minutes (mean,205 minutes).The bleeding volume during the surgery was 700-2 100 ml (mean,1167 ml).One case was died of pulmonary infection at one week after surgery,the others were followed up for 3-14 months (mean,7.4 months).After operation,five patients were satisfied with the reduction,and the lateral displacement was partially restored in one cases.Five cases of intervertebral bone grafting all had bone fusion.There was no fixation failure.The VAS was (7.4 ± 0.6) points before surgery,(4.5 ± 1.6) points at one week after surgery and (1.8 ± 0.3) points at final visit of follow-up,which had significant difference from the preoperative status (P ＜ 0.05).One case of ASIA grade E had no postoperative aggravation and four cases of grade A had no improvement.Conclusion Posterior decompression and pedicle screw fixation system is optimal choice of treatment for complete thoracic fractures and dislocations for it can attain reduction of fracture and dislocation as well as bone fusion,provide stability for spine and relieve pain.

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Perforator-based intermediate dorsal pedal flap with vessels of cutaneous nerve nutrition for repair of soft tissue defects of the forefoot

Xudong WEI ; Jian LIN ; Lei HUANG ; Deqing HU ; Peng NIU ; Xu HONG ; Ruilin QI ; Heping ZHENG

Chinese Journal of Trauma.2017;33(10):878-882. doi:10.3760/cma.j.issn.1001-8050.2017.10.004

Objective To explore the feasibility of the perforator-based intermediate dorsal pedal flap with vessels of cutaneous nerve nutrition for repair of soft tissue defects of the forefoot.Methods A retrospective case series study was performed for seven cases of soft tissue defects of the forefoot hospitalized between February 2013 and January 2017.There were five males and two females,with a mean age of 38 years (range,18-73 years).Injury regions were lateral plantar skin defect in the forefoot in three cases,dorsal skin defect in the third webbed toe in two cases and proximal dorsal skin defect in the fourth toe in two cases.The defect area was about 2.5 cm × 1.5 cm-4.5 cm × 2.0 cm.The perforator-based intermediate dorsal pedal flap with vessels of cutaneous nerve nutrition was designed on the lateral dorsum of the foot and then was incised and transferred to repair the forefoot wound based on its surgical anatomy.The time of surgery and the amount of intraoperative blood loss were recorded.An observation was done on feeling,appearance,texture,blood supply and survival of the flap as well as swelling,hypertrophic scar,itching,paralysis of the skin grafting area.The recovery of the activity function was assessed by American Orthopedic Foot & Ankle Society (AOFAS) score.Results The surgery time was 1.0-1.5 h (mean,1 h),and intraoperative bleeding was about 50 ml (range,30-100 ml).Seven cases of perforator-based dorsal medial skin flap with vessels of cutaneous nerve nutrition all survived,with early wound healing.After 2 to 15 months follow-up,two-point discrimination of flaps was 9-15 mm(average,12.5 mm).Skin flaps were with excellent texture and without swelling,the color of which was close to normal color with good appearance.The postoperative foot did not have bone resorption,wound infection,tendon adhesion,line-type or flaky scar left locally,lower limb walking dysfunction or other complications.Patients were satisfied with the functions of donor and recipient sites and the appearance of the flap.Conclusions Perforation-based dorsal flap with vessels of cutaneous nerve nutrition has high survival rate,satisfaction of appearance and fast recovery of recipient site,with no obvious foot pain,limitation of joint movement or other complications,and therefore is a reliable method to repair soft tissue defects in forefoot.

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Effect and mechanism of SS31 peptide on autophagy after spinal cord injury in rats

Chengjun WANG ; Yanli CAO ; Zhenyan SU ; Guangheng LI ; Xinguang QIU

Chinese Journal of Trauma.2017;33(10):940-944. doi:10.3760/cma.j.issn.1001-8050.2017.10.015

Objective To explore the eftect of SS31 peptide on autophagy after spinal cord injury (SCI) and possible mechanism.Methods Allen nethod was used to construct the spinal cord injury model in rats.Sprague-Dawley rats were randomly divided into sham surgery group (sham group),SCI group and SS31 peptide group,with 30 rats in each group.The sham group only received laminectomy.The rats in SCI group were sustained SCI and were given no intervention.The rats in SS31 group received SS31 peptide injection after SCI.Scores of Basso Beattie Bresnahan (BBB) motor functions were assessed at 6 h,1,3,7 and 14 d after the injury.The changes in related proteins of Beclin-1 and LC3-Ⅱ were also detected.Results Scores of BBB scale at 6 h and at days 1,3,7 and 14 after injury in SCI group (0,1.7 ±0.4,3.5 ±0.6,6.1 ±0.7,10.1 ±0.6) and SS31 peptide group (0,2.5 ±0.7,4.1 ±0.7,9.3 ±0.6,13.4 ±0.6) were lower than that in sham group (21 at all time points) (P ＜0.05).Scores of BBB scale at days 7 and 14 after injury in SS31 peptide group (9.3 ±0.6,13.4 ±0.6) was higher than that in SCI group (6.1 ± 0.7,10.1 ± 0.6) (P ＜ 0.05).There was no significant difference upon scores of BBB scale of SS31 peptide group at 6 h and at days 1 and 3 after injury (0,2.5 ±0.7,4.1 ± 0.7),compared with SCI group (0,1.7 ± 0.4,3.5 ± 0.6) (P ＞ 0.05).Compared with sham group,the expression of Beclin-1 in SCI group and SS31 peptide group was increased,reached a peak at day 3 (1.478 ± 0.030,1.841 ± 0.051),remained high level at day 7 (1.302 ± 0.049,1.551 ± 0.032) and showed high expression at day 14 (1.252 ±0.048,1.471 ± 0.062) (P ＜ 0.05).Compared with sham group,the expression of LC3-Ⅱ in SCI group and SS31 peptide group also increased,reached a peak at day 3 (0.348 ± 0.028,0.655 ± 0.052),remained high level at day 7 (0.301 ± 0.053,0.432 ± 0.052) and also showed high expression at day 14 (0.268 ± 0.049,0.371 ± 0.052) (P ＜ 0.05).The expressions of Beclin-1 and LC3-Ⅱ in SS31 peptide group at day 3 after injury were 1.841 ± 0.051 and 0.455 ± 0.052,higher than that in SCI group (1.478 ± 0.030,0.348 ± 0.028) (P ＜ 0.05).In SS31 peptide group at 6 h and days 1,7 and 14 after injury,the expressions of Beclin-1 (0.582 ± 0.028,0.723 ±0.049,1.551 ±0.032,1.471 ±0.062) and LC3-Ⅱ (0.172 ±0.031,0.256 ±0.051,0.432 ± 0.052,0.371 ± 0.052) had no significant difference in comparison with corresponding expressions of Beclin-1 (0.584 ±0.021,0.642 ±0.051,1.302 ±0.049,1.252 ±0.048) and LC3-Ⅱ (0.156 ± 0.019,0.184±0.050,0.301 ±0.053,0.268 ±0.049) in SCI group (P＞0.05).Conclusion SS31 peptide can improve motor function and enhance the autophagy of nerve cells after SCI in rats,which may be one of the mechanisms for SS31 peptide treating spinal cord injury.

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Limited open reduction combined with percutaneous medial locking plate for treatment of Rüedi-Allg(o)wer type Ⅱ and Ⅲ closed tibial pilon fractures

Ruigang JIA ; Xinqiang WANG ; Weilong ZHANG ; Shouyun XIAO ; Yanying CHEN

Chinese Journal of Trauma.2017;33(10):904-910. doi:10.3760/cma.j.issn.1001-8050.2017.10.009

Objective To evaluate the clinical efficacy of limited open reduction combined with percutaneous medial locking plate in treatment of Rüedi-Allg(o)wer type Ⅱ and Ⅲ closed tibial pilon fractures.Methods A retrospective case-control analysis was made on 45 cases of closed tibial pilon fractures treated surgically between June 2008 and December 2015.There were 33 males and 12 females,aged from 26-66 years (mean,44.6 years).All cases were unilateral tibial pilon fractures,among which 18 were on the left while 27 were on the right.Thirty-four cases were combined with fibular fractures.There were 14 cases of type Ⅱ fractures and 31 type Ⅲ fractures according to the Rüedi-Allg(o)wer classification.Using the Tscheme-Gotzen system to evaluate soft tissue injury,two patients were in grade 1,29 patients in grade 2,and five patients in grade 3.On the basis of surgical methods,the cases were divided into Group A,limited open reduction with percutaneous medial locking plate and Group B,conventional open reduction.The operation time,reduction quality,fracture healing time,American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale at final follow-up visit and complications were recorded and compared between the two groups.Results The operation time of Group A was shorter than that of Group B (P ＜ 0.05).All patients had been followed up for 12-24 months,among which Group A was 22.5 months and Group B was 20.0 months (P ＞ 0.05).Compared with Group B,Group A was superior in fracture healing time (P ＜ 0.05) and AOFAS ankle-hindfoot scale(P ＜0.05),but was inferior in reduction quality (P ＜ 0.05).Poor wound healing was observed in two cases in each group,yet there was no nonunion in all cases.Conclusion Compared with conventional open reduction,the limited open reduction combined with percutaneous medial locking plate has more advantages in operation time and fracture healing,which can achieve better ankle functions for closed tibial pilon fractures.

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Changes of serum neuron specific enolase and S100-β protein and their correlations with cognitive impairment in patients with moderate traumatic brain injury

Yuqin ZHANG ; Junfang MA ; Yanyan MENG

Chinese Journal of Trauma.2017;33(10):886-889. doi:10.3760/cma.j.issn.1001-8050.2017.10.006

Objective To analyze the correlation of the levels of serum neuron specific enolase (NSE) and S100-β protein with cognitive impairment in patients with moderate traumatic brain injury (mTBI).Methods A retrospective case series study enrolled 87 patients with mTBI treated from January 2015 to October 2016.There were 50 males and 37 females,aged 14-60 years [(37.8-12.6)years].The Glasgow Coma Score (GCS) was 9-12 points,among which were 9-10 points in 36 cases and 11-12 points in 51.The cognitive function was assessed by the Montreal Cognitive Assessment Scale (MoCA).The patients with MoCA ＜ 26 points were assigned into cognitive impairment group (study group,54 cases),while the patients with MoCA ≥ 26 points was assigned into non-cognitive-impairment group (control group,33 cases).The levels of serum NSE and S100-β protein were compared,and the correlation of levels of serum NSE and S100-β protein with cognitive dysfunction (assessed by MoCA and GCS) was analyzed.Results The levels of serum NSE and S100-βprotein were (35.7 ± 11.0) ng/L and (1.8 ± 0.5) ng/L,respectively in study group,which were significant higher than that in control group [(22.6 ±9.4)ng/L and (1.2 ±0.5)ng/L,respectively] (P＜0.01).The levels of NSE [(33.7 ± 10.0)ng/L] and S100-β [(1.7 ± 0.4)ng/L] in patients with GCS 9-10 points were higher than those of NSE [(19.4 ± 9.0) ng/L] and S100-β [(1.3 ± 0.5) ng/L] in patients with GCS 11-12 points (P ＜ 0.01).The levels of serum NSE and S100-β protein in mTBI patients were negatively correlated with the MoCA score (r =-0.693,-0.721,P ＜ 0.05) and GCS (r =-0.527,-0.796,P ＜ 0.05).Conclusion The levels of serum NSE and S100-β protein are increased,and are correlated to the occurrence of cognitive impairment in patient with mTBI.

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Ankle anterior perforating flaps for reconstruction of soft tissue defects on dorsum of foot

Jian LIN ; Zhijiang WANG ; Tianhao ZHANG

Chinese Journal of Trauma.2017;33(10):873-877. doi:10.3760/cma.j.issn.1001-8050.2017.10.003

Objective To explore the clinical effects of ankle anterior perforating flaps in reconstruction of the soft tissue defects on dorsum of foot.Methods A retrospective cases series study was done to analyze 11 patients with dorsal skin soft tissue defects:eight males and three females,with age ranging from 18-76 years (mean,43.5 years),treated from January 2009 to March 2017.The sizes of the soft tissues defects varied from 4.0 cm × 3.5 cm to 15.0 cm × 6.0 cm.According to the anatomical basis of ankle anterior perforating flaps,the sizes and shapes of the skin defects of the dorsal ankle,the flaps were designed and harvested in the anterior part of the lower leg to repair the dorsal skin soft tissue defects.The sizes of flaps ranged from 15.0 cm × 6.0 cm to 4.0 cm × 3.2 cm.The clinical effect was evaluated based on the flap survival,infection control,elasticity,color,appearance,scars of the donor sites,skin sensitivity and patient satisfaction.The extent of the flap swellings was also evaluated.Results All ten flaps survived after the surgery.Both the donor and recipient sites healed very well at Ⅰ stage.One case had flap distal phalanx necrosis.After changing the ointments on time,both the donor and recipient sites survived completely.Duration of follow-up was 3-24 months (mean,12 months).The flaps survived very well with good shape,and the color and elasticity were very close to the normal skin nearby.The scars of the donor sites were small and the functions of ankle and foot were satisfactory.Satisfaction extents of treatment efficacy were good in nine patients and general in two,with no unsatisfaction.Flap swelling classification were nine cases of degree Ⅱ and two cases of degree Ⅲ in early stage while 11 cases of degree Ⅰ in later stage.Conclusions The ankle anterior perforating flap has constant perforating blood vessels,reliable blood supply,high survival rate of flaps and hence is one of the simple,safe and optimal ways to repair the dorsal skin soft tissue defects.

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Application of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of foot

Xiaoqing HE ; Jiazhang DUAN ; Yongqing XU ; Yueliang ZHU ; Guodong LI ; Xi YANG ; Fanzhe FENG ; Shuai LIU

Chinese Journal of Trauma.2017;33(10):868-872. doi:10.3760/cma.j.issn.1001-8050.2017.10.002

Objective To assess preliminary clinical efficacy of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of forefoot or midfoot.Methods From March 2013 to December 2015,eight patients with degloved injury of forefoot or midfoot were retrospectively analyzed by case series study.They were seven males and one female,with age range of 18-51 years (mean,34.5 years).The foot skin defect area ranged from 18 cm × 12 cm to 13 cm × 10 cm.All patients underwent computed tomography angiography (CTA) in lower extremities preoperatively.The CTA data were entered into Mimics 15.0 software in DICOM format.Based on perforating condition of descending branch of lateral fenoral circunflex artery and the size of foot defect,one thigh was chosen for three dimensional reconstruction of anterolateral thigh flap.The flap size ranged from 24 cm× 9 cm to 19 cm × 7 cm.All reconstructive surgeries were performed secondarily.Patients were all at Ⅱ stage recovery.The survival of flaps and healing status of flap donor sites were observed in one month after surgery.The number of debulking flaps was recorded.The appearance of flaps,shoe wearing,gait and related complications were recorded.Results The follow-up was 10-21 months (mean,15.5 months.All flaps survived uneventfully,and all donor sites were sutured directly.Three patients had twice debulking procedures,three patients had one debulking procedure,and two patients had no debulking.At the last visit in follow-up,the color and texture of flaps were good.All patients were able to wear shoes normally,two patients remained mild abnormal gait,and one patient presented superficial ulcer at the medial of the forefoot.Conclusions Double skin paddle anterolateral thigh flap for reconstruction of degloved injury of forefoot or midfoot can prompt wound healing and decrease complications.Digital assisted technology is an excellent supplementary method in double skin paddle anterolateral thigh flap for reconstruction of degloved injury of foot,which makes precise preoperative planning and intraoperative accurate cutting.

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Clinical efficacy of crossing cannulated screw fixation for treatment of intra-articluar calcaneal fractures

Kun LI ; Weizhong YIN ; Juhong DING ; Tienan FENG ; Ming NI

Chinese Journal of Trauma.2017;33(10):918-924. doi:10.3760/cma.j.issn.1001-8050.2017.10.011

Objective To assess the clinical results of crossing cannulated screw fixation for intra-articulsr calcaneal fractures.Methods A total of 65 patients (72 sides) were retrospectively studied from July 2012 to June 2015 by case-control study,including 63 males and two females at age range of 18-70 years [(45.7 ± 12.2) years].According to the Sanders classification,there were 49 fractures of type Ⅱ (25 type Ⅱa,17 type Ⅱb,7 type Ⅱc) and 23 fractures of type Ⅲ (12 type Ⅲab,6 type Ⅲac,5 type Ⅲ bc).The cases had been divided into two groups,namely,the crossing caunulated screw fixation group (CCSFG group,30 cases) and plate fixation group (PFG group,42 cases).The results were compared with regard of the hospitalization time,fracture reduction and union,AOFAS score system,and complications.The calcaneal shape was assessed by the length,width,height,Bhler angle and Gissane angle.The foot function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score system.Results All were followed up for 6-24 months [(15.2 ± 4.7)months],and presented fracture healing.The time of hospitalization was (10.2 ± 2.3)days (7-14 days) and (18.6 ±3.3)days (13-28 days) in CCSFG and PFG groups,respectively(P ＜0.05).At the first and final visits during follow-up,the changes in calcaneal width and B(o)hler angle of CCSFG group were smaller than that of PFG group (P ＜ 0.05).For Sanders Ⅱ type cases,the average AOFAS function scores in CCSFG and PFG groups were (89.3 ± 6.8) points and (90.1 ± 8.1) points,respectively (P ＞ 0.05).For Sanders type Ⅲ cases,the corresponding scores in CCSFG and PFG groups were (83.5 ± 10.8) points and (82.5 ±7.3)points,respectively (P ＞0.05).The complication rate in the CSFG and PFG groups was 20％ and 19％,respectively (P ＞ 0.05).Conclusions Compared with the plate fixation,the crossing cannulated screw fixation has advantages of less invasion,better stability,shorter hospitalization time,faster functional recovery and can be recommended as the first choice for mild to moderate comminuted calcaneal fractures.

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