OBJECTIVES: Magnetic resonance imaging (MRI) was used to study the efficacy of modified anterior splint (MAS) combined with anterior repositioning splint (ARS) in maintaining the normal disk-condyle relationship. METHODS: We obtained clinical and imaging data of 10 patients with acute anterior disk displacement without reduction (ADDwoR) of the temporomandibular joint undergoing successful mandibular manipulation in the Affiliated Stomatological Hospital, Nanchang University from January to June 2024. The MAS and ARS were used for subsequent treatment. Maximum active mouth opening (MMO) and visual analogue score (VAS) were recorded before treatment and 2 weeks, 1 month, and 3 months after treatment. The changes in the disk-condyle relationship, disk-condyle angle, joint effusion, and double contour sign before and after treatment were analyzed through MRI. RESULTS: Three months after treatment, the MMO increased from 28.90 mm to 46.85 mm, VAS decreased from 4.68 to 0.61, and the disk-condyle angle decreased from 58.84° to 25.99°. MRI analysis found that 6 patients showed normal disk-condyle relationship, 2 patients exhibited displacement with reduction, and 2 patients exhibited ADDwoR. The disk-condyle angle was 58.84° before treatment and 25.99° after treatment. CONCLUSIONS The MAS combined with ARS could further stabilize the coordinated disk-condyle relationship and reduce the recurrence rate.
Humans ; Male ; Magnetic Resonance Imaging ; Female ; Adult ; Temporomandibular Joint Disorders/diagnostic imaging* ; Splints ; Middle Aged ; Mandible ; Temporomandibular Joint Disc ; Occlusal Splints ; Temporomandibular Joint ; Young Adult ; Joint Dislocations/therapy*

OBJECTIVE: To investigate the effectiveness of free latissimus dorsi myocutaneous flap transplantation combined with external fixation in the treatment of bone and soft tissue defects around the knee joint. METHODS: A retrospective analysis was conducted on the clinical data of 13 patients with high-energy trauma-induced bone and soft tissue defects around the knee joint admitted between January 2016 and July 2023. Among them, 11 were male and 2 were female, the age ranged from 23 to 61 years, with an average of 35.7 years. The causes of injury included 10 cases of traffic accident, 2 cases of machine entanglement injury, and 1 case of heavy object crush injury. According to the Gustilo-Anderson classification, 11 cases were type Ⅲ B and 2 cases were type Ⅲ C. Post-injury, 2 cases had wound infection and 2 cases had popliteal artery injury. The time from injury to flap repair was 40-49 days, with an average of 27.5 days. The wound size was 18 cm×13 cm to 32 cm×20 cm, all accompanied by distal femoral bone defects and quadriceps muscle defects. After primary debridement, vacuum sealing drainage combined with external fixation was used for treatment. In the second stage, free latissimus dorsi myocutaneous flaps were transplanted to repair soft tissue defects, with the flap size ranging from 20 cm×15 cm to 34 cm×22 cm. The donor sites of 9 flaps were directly sutured, and 4 cases with large tension were repaired with a keystone flap based on the posterior intercostal artery perforator. At 6-15 months postoperatively, with an average of 10.5 months, 11 patients underwent knee arthrodesis surgery; 2 patients with large bone defects at the distal femur and proximal tibia underwent multi-segment bone transport reconstruction of the bone defect. At last follow-up, the recovery of the flap and the donor site was recorded, and the function of the shoulder joint was evaluated by the American Shoulder and Elbow Surgeons (ASES) score, and the function of the affected knee joint was evaluated by the Knee Society Score (KSS). RESULTS: All the flaps survived after operation, the wounds and donor site incisions healed by first intention. All 13 patients were followed up 15-55 months, with an average of 21.6 months. Four patients who underwent the restoration of the donor site with the thoracodorsal keystone perforator flap had obvious scar hyperplasia around the wound, but no contracture or symmetrical breasts on both sides. At last follow-up, the appearance and texture of the flaps were good; the bony fusion of the knee joint was good, and the range of motion and function recovered well; the shoulder joint function on the flap-harvested side was not significantly affected, and the range of motion was satisfactory. The ASES shoulder joint score of the latissimus dorsi muscle-harvested side was 85-95, with an average of 89.5. The knee joint function KSS score was 75-90, with an average of 81.2. CONCLUSION Free latissimus dorsi myocutaneous flap transplantation combined with external fixation for the treatment of bone and soft tissue defects around the knee joint caused by high-energy trauma can repair bone and soft tissue defects and reconstruct the stability of the knee joint, effectively preserve the integrity of the limb and soft tissues, and improve the patient's ability of self-care.
Humans ; Male ; Female ; Adult ; Middle Aged ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Plastic Surgery Procedures/methods* ; Superficial Back Muscles/transplantation* ; External Fixators ; Myocutaneous Flap/transplantation* ; Knee Joint/surgery* ; Young Adult ; Treatment Outcome ; Knee Injuries/surgery* ; Free Tissue Flaps/transplantation*

OBJECTIVE: To investigate the surgical technique and effectiveness of tension band-assisted plate fixation combined with external fixator for volar marginal fractures of the distal radius. METHODS: A retrospective analysis was performed on the clinical data of 12 patients with volar marginal fractures of the distal radius treated by Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator between October 2018 and July 2023. The cohort included 9 males and 3 females, aged from 20 to 52 years (mean, 35.5 years). The injury causes included traffic accidents in 6 cases, falls from height in 3 cases, and fall in 3 cases. According to AO/Orthopaedic Trauma Association (AO/OTA), there were 1 case of type B2, 4 cases of type B3, 2 cases of type C1, 3 cases of type C2, and 2 cases of type C3. According to Fernandez classification, there were 2 cases of type Ⅲ, 5 cases of type Ⅳ, and 5 cases of type Ⅴ. Associated injuries included radiocarpal joint dislocation or subluxation in 7 cases and median nerve injury in 2 cases. The time from injury to operation was 2-7 days (mean, 3.2 days). Postoperatively, functional outcomes were evaluated using the modified Mayo wrist score and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Grip strength was measured as the ratio to the unaffected side, and wrist range of motion (ROM) including dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was assessed. RESULTS: All procedures were successfully completed, with an operation time of 55-110 minutes (mean, 65 minutes). All patients were followed up 6-36 months (mean, 13.7 months). Surgical incisions healed by first intention, without complications such as vascular-nerve injury or infection. Bony union and articular congruency were attained in all patients, with a healing time of 3-5 months (mean, 3.8 months). During follow-up, 1 case of Kirschner wire migration occurred with no instances of infections, radiocarpal dislocations, internal fixation failures, or extensor pollicis longus tendon ruptures. At last follow-up, the modified Mayo wrist score ranged from 65 to 92 (mean, 80.8), the DASH score ranged from 7 to 15 (mean, 11.6), the grip strength was 65%-90% (mean, 78.2%) of the unaffected side; and wrist ROM was palmar flexion 60°-85° (mean, 77.4°), dorsiflexion 55°-80° (mean, 74.8°), radial deviation 10°-25° (mean, 18.8°), and ulnar deviation 15°-30° (mean, 24.5°). CONCLUSION Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator for volar marginal fractures of the distal radius is a simple method with reliable fixation, which can achieve satisfactory effectiveness.
Humans ; Male ; Adult ; Female ; Radius Fractures/diagnostic imaging* ; Retrospective Studies ; Middle Aged ; Bone Plates ; Bone Wires ; External Fixators ; Young Adult ; Fracture Fixation, Internal/instrumentation* ; Treatment Outcome ; Range of Motion, Articular ; Hand Strength ; Wrist Injuries/surgery*

OBJECTIVE: To explore the corrective strategies and effectiveness of osteotomy surgery for severe lower limb deformities in hypophosphatemic rickets. METHODS: A retrospective analysis was conducted on 29 patients with severe lower limb deformities of hypophosphatemic rickets who underwent surgical treatment between February 2012 and August 2024. There were 9 males and 20 females. The age ranged from 13 to 53 years, with an average of 24.6 years. All patients were deformities of both lower limbs, presenting as 24 cases of O-shaped legs, 2 cases of wind-blown deformities, and 3 cases of X-shaped legs. Based on the full-length films of both lower limbs in the standing position before operation, the osteotomy planes of the femur, tibia, and fibula were designed. Among them, if both the same-sided thigh and leg were deformed, staged surgeries of both lower limbs were selected. If only the thigh or leg were deformed, simultaneous surgeries of both lower limbs were selected. The femur deformity was corrected immediately after osteotomy at the deformed plane; the osteotomy fragment was temporarily controlled with an external fixator, which was removed after perform internal fixation with a steel plate. After fibular osteotomy, the Ilizarov frame or Taylor frame was installed on the tibia and fibula. The threaded rods were removed and then tibial osteotomy was performed on the deformed plane. Patients using the Taylor frame did not undergo deformity correction during operation. The external fixators were adjusted starting 7 days after operation to correct the varus, valgus, and rotational deformities of the lower limb. Patients using the Ilizarov frame corrected the rotational deformity of the tibia during operation. The external fixator was adjusted starting 7 days after operation to correct the varus and valgus deformities of the lower limb. During the treatment period, the patient could walk with partial weight-bearing on the operated limb with crutches. The external fixator was removed after the bone healed. Before operation and at last follow-up, the medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), anatomic lateral distal femoral angle (aLDFA), posterior distal femoral angle (PDFA), and mechanical axis deviation (MAD), lower limb rotation, limb length discrepancy (LLD) were measured. The self-made scoring criteria were adopted to evaluate the degree of lower limb deformity of the patients. RESULTS: All operations were successfully completed, and no complications such as nerve or vascular injury occurred. The adjustment time of the external fixator of the lower limb after operation was 28-46 days, with an average of 37.4 days. The wearing time of the external fixator ranged from 134 to 398 days, with an average of 181.5 days. Mild pin tract infections occurred in 2 limbs. The osteofascial compartment syndrome occurred in 1 limb after operation. No complications related to orthopedic adjustment of the external fixator occurred in other patients. All patients were followed up 6-56 months, with an average of 28.2 months. At last follow-up, full-length films of both lower limbs in the standing position showed that the coronal mechanical axes of the lower limbs of all patients returned to the normal. At last follow-up, MPTA, LDTA, PPTA, aLDFA, PDFA, MAD, lower limb rotation, LLD, and the score of lower limb deformity significantly improved when compared with those before operation ( P<0.05). There was no significant difference in ADTA between pre- and post-operation ( P>0.05). The degree of lower limb deformity were rated as moderate in 2 cases and poor in 27 cases before operation and as excellent in 7 cases, good in 18 cases, and moderate in 4 cases at last follow-up, with an excellent and good rate of 86.2%. CONCLUSION For severe lower limb deformities in hypophosphatemic rickets, immediate correction of deformities with femoral osteotomy and internal plate fixation, as well as gradually correction of deformities with tibiofibular osteotomy and circular external fixation (Ilizarov frame or Taylor frame), have satisfactory therapeutic effects.
Humans ; Male ; Osteotomy/instrumentation* ; Female ; Adult ; Retrospective Studies ; Tibia/abnormalities* ; Adolescent ; Femur/abnormalities* ; Middle Aged ; Fibula/surgery* ; Rickets, Hypophosphatemic/complications* ; Young Adult ; Treatment Outcome ; External Fixators ; Bone Plates ; Lower Extremity Deformities, Congenital/etiology*

OBJECTIVE: To summarize the biomechanical research progress on different fixation methods in medial opening-wedge high tibial osteotomy (MOWHTO) and provide references for selecting appropriate fixation methods in clinical applications of MOWHTO for treating knee osteoarthritis (KOA). METHODS: Recent domestic and international literature on the biomechanical studies of MOWHTO fixation methods was reviewed to analyze the characteristics and biomechanical performance of various fixation techniques. RESULTS: The medial-specific osteotomy plate system has become the mainstream due to its high stiffness and stability, but issues such as soft tissue irritation and stress shielding remain. The use of filler blocks significantly enhances fixation stability and promotes bone healing when the osteotomy gap is large, reducing axial displacement by 73%-76% and decreasing plate stress by 90%. Auxiliary screws improve axial and torsional stability, particularly in cases with large correction angles, effectively preventing lateral hinge fractures. Alternative fixation methods like external fixators hold unique clinical value by minimizing soft tissue irritation and allowing postoperative adjustment. CONCLUSION There is currently no unified standard for selecting MOWHTO fixation methods. Clinical decisions should comprehensively consider factors such as bone quality, correction angle, and postoperative rehabilitation needs.
Humans ; Osteotomy/instrumentation* ; Biomechanical Phenomena ; Tibia/surgery* ; Bone Plates ; Osteoarthritis, Knee/surgery* ; Bone Screws ; External Fixators ; Knee Joint/surgery*

External fixation devices are essential tools in the field of foot and ankle reconstruction. Mastering the fundamental knowledge and skills of external fixation is crucial for the effective application of this technique. Currently, domestically produced external fixation systems for the foot and ankle can meet the needs of treating various foot and ankle traumas, deformities, and functional reconstruction. Through this special issue on "External fixation and foot and ankle reconstruction", we provide a detailed introduction to the essential knowledge and skills that physicians must acquire to proficiently manage external fixation and foot and ankle reconstruction.
Humans ; External Fixators ; Ankle Injuries/surgery* ; Plastic Surgery Procedures/methods* ; Foot Injuries/surgery* ; Fracture Fixation/instrumentation* ; Foot/surgery*

OBJECTIVE: To review the research progress on correction of severe foot and ankle deformities with digital hexapod external fixators. METHODS: The relevant research literature on digital hexapod external fixators at home and abroad in recent years was reviewed and analyzed. Taking Taylor spatial frame (TSF) as a representative, this article elaborates on the research progress of this technology in the treatment of severe foot and ankle deformities from aspects such as device principle, technical characteristics, clinical application, complication management, and controversial perspectives, aiming to provide theoretical references for clinical application. RESULTS: The treatment of severe foot and ankle deformities is a complex challenge in orthopedics, often involving multiple plane alignment abnormalities, muscle weakness, soft tissue contractures, and joint dysfunction. The digital hexapod external fixators (such as TSF), based on the principle of six degrees of freedom motion and combined with computer-assisted technology, enables precise correction of multi-dimensional deformities. CONCLUSION The digital hexapod external fixators provides a minimally invasive and efficient option for the treatment of severe foot and ankle deformities, and shows significant advantages in the treatment of complex post-traumatic deformities, neuromuscular deformities, diabetes Charcot arthropathy, and other diseases.
Humans ; External Fixators ; Foot Deformities/surgery* ; Ankle Joint/abnormalities* ; Ankle/abnormalities* ; Equipment Design

OBJECTIVE: To investigate the safety and effectiveness of using the Taylor spatial frame (TSF) based on the Ilizarov tension-stress principle for treatment of post-burn foot and ankle deformities in adults. METHODS: A clinical data of 6 patients with post-burn foot and ankle deformities treated between April 2019 and November 2023 was retrospectively analyzed. There was 1 male and 5 females with an average age of 28.7 years (range, 20-49 years). There were 3 cases of simple ankle equinus, 2 cases of ankle equinus, midfoot rocker-bottom foot, and forefoot pronation, and 1 case of calcaneus foot and forefoot pronation. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 45.3±18.2, 12-Item Short-Form Health Survey (SF-12)-Physical Component Summary (PCS) score was 34.3±7.3 and Mental Component Summary (MCS) score was 50.4±8.8. Imaging examination showed tibial-calcaneal angle of (79.8±31.5)°, calcaneus-first metatarsal angle of (154.5±45.3)°, talus-first metatarsal angle of (-19.3±35.0)°. Except for 1 case with severe deformity that could not be measured, the remaining 5 cases had talus-second metatarsal angle of (40.6±16.4)°. The deformities were fixed with TSF after soft tissue release and osteotomy. Then, the residual deformities were gradually corrected according to software-calculated prescriptions. TSF was removed after maximum deformity correction and osteotomy healing. External fixation time, brace wearing time after removing the TSF, and pin tract infection occurrence were recorded. Infection severity was evaluated based on Checketts-Otterburns grading. Joint function was evaluated using AOFAS score and SF-12 PCS and MCS scores. Patient satisfaction was assessed using Likert score. Imaging follow-up measured relevant indicators to evaluate the degree of deformity correction. Deformity recurrence was observed during follow-up. RESULTS: The external fixation time was 103-268 days (mean, 193.5 days). The mild pin tract infections occurred during external fixation in all patients, which healed after pin tract care and oral antibiotics. No serious complication such as osteomyelitis, fractures, neurovascular injury, or skin necrosis occurred. After external fixation removal, 3 cases did not wear braces, while the remaining 3 cases wore braces continuously for 6 weeks, 8 weeks, and 3 years, respectively. All patients were followed up 13.9-70.0 months, with an average of 41.7 months. During follow-up, none of the 6 patients had recurrence of foot deformity. At 1 year after operation, the AOFAS score was 70.0±18.1, SF-12-PCS and MCS scores were 48.9±4.5 and 58.8±6.4, respectively, all showing significant improvement compared to preoperative values ( P<0.05). Imaging follow-up showed that all osteotomies healed, and all distraction cases achieved bony union at 6 months after stopping stretching. At 1 year after operation, tibial-calcaneal angle was (117.5±12.8)° and talus-first metatarsal angle was (-3.3±19.3)°, both showing significant improvement compared to preoperative values ( P<0.05). Calcaneus-first metatarsal angle was (132.0±14.4)°, which also improved compared to preoperative values but without significant difference ( P>0.05). Except for 1 case with severe deformity that could not be measured, the remaining 5 cases had talus-second metatarsal angle of (18.0±6.4)°. And there was no significant difference ( P>0.05) between pre-and post-operative data of 4 patients with complete data. At 1 year after operation, 1 patient was satisfied with effectiveness and 5 patients were very satisfied. CONCLUSION The TSF, by applying the Ilizarov tension-stress principle for gradual distraction and multi-planar adjustment, combined with soft tissue release and osteotomy, can effectively correct foot and ankle deformities after burns, especially equinus deformity with contracture of the posterior soft tissues of the lower leg. There are still limitations in treating cases with tight, adherent scars on the dorsum of the foot that require long-distance distraction. If necessary, a multidisciplinary approach combined with microsurgical techniques can be utilized.
Humans ; Adult ; Male ; Female ; Middle Aged ; Retrospective Studies ; External Fixators ; Young Adult ; Burns/complications* ; Foot Deformities, Acquired/etiology* ; Treatment Outcome ; Ilizarov Technique/instrumentation*

OBJECTIVE: To evaluate the effectiveness of correcting post-traumatic equinovarus deformity using Ilizarov external fixation technique combined with limited osteotomy. METHODS: A retrospective analysis was conducted on clinical data from 29 patients with post-traumatic equinovarus deformity treated between July 2018 and March 2023. The cohort included 18 males and 11 females, with ages ranging from 15 to 57 years (mean, 24.3 years). All patients exhibited ankylosed ankle joints with equinovarus deformity. During surgery, external fixators were installed according to Ilizarov pinning principles, and minimally invasive osteotomy was performed at the ankle joint. Concurrently, soft tissue release was achieved via minimally invasive Achilles tendon lengthening. Postoperatively, multiplanar deformity correction was accomplished through gradual adjustment of the external fixator. The fixator was removed after bony union at the osteotomy site, followed by bracing. The surgical duration, intraoperative blood loss, fixator wear time, and complications were recorded. Postoperative outcomes included assessment of deformity correction and bony union at the osteotomy site. Functional improvement and pain relief were evaluated using pre- and post-operative scores from the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) score. RESULTS: All 29 patients were followed up 12-24 months (mean, 18 months). The mean surgical duration was 85.6 minutes, with a mean intraoperative blood loss of 110 mL. Full deformity correction was achieved within 26-80 days (mean, 40.7 days) through progressive fixator adjustments. At correction completion, all ankles restored to a neutral or 5°-10° dorsiflexed position with plantigrade foot function. Superficial pin tract infections occurred in 3 patients (10.3%), resolved with local wound care, enhanced nursing, and oral antibiotics. No deep or systemic infections was observed. One patient sustained a calcaneal half-pin fracture due to a fall during fixator wear, but no bone fragment displacement occurred. No vascular or neurological complication was reported. Complete bony union was achieved at all osteotomy sites without nonunion. At last follow-up, the AOFAS ankle-hindfoot score improved from preoperative 42.7±8.7 to postoperative 65.7±9.3, and the VAS score decreased from preoperative 4.5±1.3 to postoperative 2.5±1.1, with significant differences ( P<0.05). Functional outcomes were rated as excellent in 14 cases, good in 13 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 93.1%. CONCLUSION The progressive correction strategy combining Ilizarov external fixation technique with limited foot osteotomy effectively corrects post-traumatic equinovarus deformity while preserving soft tissue integrity. This method is associated with minimal, largely controllable complications and achieves alignment stability and fusion outcomes comparable to traditional open surgery, making it an effective treatment for complex foot and ankle deformities.
Humans ; Male ; Female ; Osteotomy/methods* ; Adult ; Retrospective Studies ; Ilizarov Technique ; Middle Aged ; Adolescent ; External Fixators ; Young Adult ; Treatment Outcome ; Ankle Joint/surgery* ; Clubfoot/etiology* ; Minimally Invasive Surgical Procedures/methods*

OBJECTIVE: To summarize the methods of ankle hinge position design in the correction of clubfoot deformity by Ilizarov method, and to explore its application value in the prevention of ankle dislocation. METHODS: A retrospective study was conducted including 28 patients with rigid clubfoot deformity (34 feet) who met the selection criteria and admitted between September 2021 and December 2024. There were 19 males and 9 females with an average age of 31.8 years (range, 19-47 years). According to Dimeglio classification, there were 21 feet of degree Ⅲ and 13 feet of degree Ⅳ. The causes were traumatic sequelae in 9 cases, congenital foot deformity in 15 cases, spina bifida sequelae in 1 case, peripheral neuropathy in 1 case, and cerebral palsy sequelae in 2 cases. The malformation lasted from 6 to 46 years, with an average of 29.3 years. All patients were treated with Ilizarov circular external fixator, and the hinge position of ankle joint was planned according to the standard lateral X-ray film of foot and ankle and the principle of Ilizarov limb deformity correction center of rotation angulation (CORA) before operation. The 2008 International Clubfoot Study Group (ICFSG) scoring system was used to evaluate the efficacy. RESULTS: The deformity of rigid clubfoot was completely corrected in all patients, and the patients could walk with plantar weight-bearing, and the ankle weight-bearing walking significantly improved when compared with that before operation. There was no complication such as ankle dislocation, talus impact or extrusion, local skin necrosis, needle tract infection, or numbness of extremities during the correction process. All patients were followed up 5-39 months, with an average of 18.1 months. At last follow-up, according to the ICFSG scoring system, 23 feet were excellent, 10 feet were good, and 1 foot was fair, and the excellent and good rate was 97%. CONCLUSION Designing the position of the ankle hinge according to the principle of CORA can effectively avoid ankle dislocation, talus impingement, tibiotalar joint extrusion, and other ankle adverse events in the process of correcting clubfoot deformity, which has good application value in clinical practice.
Humans ; Male ; Female ; Clubfoot/diagnostic imaging* ; Ilizarov Technique/instrumentation* ; Adult ; Retrospective Studies ; External Fixators ; Ankle Joint/diagnostic imaging* ; Middle Aged ; Joint Dislocations/prevention & control* ; Treatment Outcome ; Young Adult