Objective:To evaluate corrective intra-articular osteotomy in the treatment of malreduced tibial pilon fractures in young patients.Methods:A retrospective study was conducted to analyze the 23 patients who had been treated for malreduced tibial pilon fractures by corrective intra-articular osteotomy from January 2013 to December 2022 at Department of Orthopedics, Orthopedic Research Institute, West China Hospital. They were 21 males and 2 females with a median age of 42.9(28.6, 48.1) years. The median interval between intra-articular osteotomy and initial injury or previous surgery was 97 (51, 166) d. The clinical efficacy was assessed by the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS), MOS item short form health survey (SF-36), visual analog scale (VAS) pain score, ankle range of motion (ROM), modified Kellgren-Lawrence arthritis grading, and complications.Results:The median follow-up period was 35.4 (26.2, 72.2) months. At the last follow-up, the AOFAS ankle-hindfoot score, SF-36, VAS pain score, and ankle ROM for all patients were, respectively, (80.7±12.1) points, (72.2±13.9) points, 2.0(0, 3.0) points and 23.0°(18.0°, 30.0°), and the modified Kellgren-Lawrence arthritis grading revealed stage Ⅱ in 17 cases, stage Ⅲ in 5 cases, and stage Ⅳ in 1 case. For the 12 patients with sufficient preoperative data, the AOFAS ankle-hindfoot score [(80.9±10.1) points], SF-36 [(72.9±12.0) points], VAS pain score [2.5 (0.5, 3.0) points], and ankle ROM (26.5°±7.9°) at the last follow-up were significantly better than the preoperative values [(42.2±16.0) points, (36.0±8.8) points, 6.0 (5.5, 6.5) points, and 21.3°±7.0°] (all P<0.05). One patient who experienced significant pain postoperatively planned to receive ankle fusion surgery. No patients experienced deep infection, fracture non-union, or failure of internal fixation. Conclusion:Corrective intra-articular osteotomy may be a viable alternative treatment of malreduced tibial pilon fractures in young patients, because it can effectively improve short-term clinical and radiographic outcomes.

Objective:To evaluate corrective intra-articular osteotomy in the treatment of malreduced tibial pilon fractures in young patients.Methods:A retrospective study was conducted to analyze the 23 patients who had been treated for malreduced tibial pilon fractures by corrective intra-articular osteotomy from January 2013 to December 2022 at Department of Orthopedics, Orthopedic Research Institute, West China Hospital. They were 21 males and 2 females with a median age of 42.9(28.6, 48.1) years. The median interval between intra-articular osteotomy and initial injury or previous surgery was 97 (51, 166) d. The clinical efficacy was assessed by the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS), MOS item short form health survey (SF-36), visual analog scale (VAS) pain score, ankle range of motion (ROM), modified Kellgren-Lawrence arthritis grading, and complications.Results:The median follow-up period was 35.4 (26.2, 72.2) months. At the last follow-up, the AOFAS ankle-hindfoot score, SF-36, VAS pain score, and ankle ROM for all patients were, respectively, (80.7±12.1) points, (72.2±13.9) points, 2.0(0, 3.0) points and 23.0°(18.0°, 30.0°), and the modified Kellgren-Lawrence arthritis grading revealed stage Ⅱ in 17 cases, stage Ⅲ in 5 cases, and stage Ⅳ in 1 case. For the 12 patients with sufficient preoperative data, the AOFAS ankle-hindfoot score [(80.9±10.1) points], SF-36 [(72.9±12.0) points], VAS pain score [2.5 (0.5, 3.0) points], and ankle ROM (26.5°±7.9°) at the last follow-up were significantly better than the preoperative values [(42.2±16.0) points, (36.0±8.8) points, 6.0 (5.5, 6.5) points, and 21.3°±7.0°] (all P<0.05). One patient who experienced significant pain postoperatively planned to receive ankle fusion surgery. No patients experienced deep infection, fracture non-union, or failure of internal fixation. Conclusion:Corrective intra-articular osteotomy may be a viable alternative treatment of malreduced tibial pilon fractures in young patients, because it can effectively improve short-term clinical and radiographic outcomes.

OBJECTIVE: To investigate the short-term effectiveness of INBONE ^TM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis. METHODS: The clinical and radiographic data of patients with moderate to severe varus-type ankle arthritis, who were admitted between May 2017 and November 2021 and treated with total ankle arthroplasty (TAA) using INBONE ^TM Ⅱ prosthesis, was retrospectively analyzed. A total of 58 patients (58 ankles) met the selection criteria and were included in the study. Among them, there were 24 males and 34 females, with an average age of 62.6 years (range, 41-85 years). According to the preoperative tibiotalar angle (TTA), the patients were divided into a moderate varus group (group A, TTA 5°-15°, n=34) and a severe varus group (group B, TTA>15°, n=24). There was no significant difference in gender, side, etiology, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle dorsiflexion, plantarflexion, and total range of motion, and tibial lateral surface angle (TLS) between the two groups ( P>0.05). Yet the patients in group A were younger than group B, the degrees of oesteoarthritis (Takakura stage) and ankle pain [visual analogue scale (VAS) score] were milder, and the TTA, talar tilt angle (TT), hindfoot alignment angle (HAA) were smaller while the tibial articular surface angle (TAS) was larger, showing significant differences ( P<0.05). The pre- and post-operative VAS score, AOFAS score, the occurrence of early and late complications, the radiographic parameters of the ankle (TTA, TAS, TT, HAA, TLS), ankle dorsiflexion, plantarflexion, and total range of motion were recorded and compared. RESULTS: All patients were followed up 19-72 months, with an average of 38.9 months. Compared with the preoperative data, the VAS score of all patients significantly decreased ( P<0.05); the AOFAS score, ankle dorsiflexion range of motion, and total range of motion significantly increased ( P<0.05); and the TTA, TAS, TT, HAA, and TLS significantly improved at last follow-up ( P<0.05); but there was no significant difference in plantarflexion range of motion ( P>0.05). Early complications occurred in 13 patients, and only 1 patient underwent revision surgery due to a larger size of the talar component. At last follow-up, there was no significant difference in the difference of clinical parameters before and after operation between the two groups ( P>0.05); there was a significant difference in the difference of other radiographic parameters ( P<0.05) except TLS. No significant difference in the incidence of complications between the two groups was found ( P>0.05). CONCLUSION TAA using the INBONE ^TM Ⅱtotal ankle prosthesis is an effective treatment for moderate or severe varus-type ankle arthritis, and good clinical and radiographic results can be obtained. Correcting bony deformities and balancing soft tissue are the keys to successful surgery.
Male ; Female ; Humans ; Middle Aged ; Ankle/surgery* ; Retrospective Studies ; Arthroplasty, Replacement, Ankle/methods* ; Arthritis/surgery* ; Ankle Joint/surgery* ; Joint Prosthesis ; Treatment Outcome