Objective To introduce a new CT classification system we designed for Hoffa fractures and compare the interrater reliability between the CT and X-ray classification systems.Methods A total of 20 isolated Hoffa fractures from January 2008 to December 2011 were randomly selected for the present analysis of their imaging data (anteroposterior and lateral X-ray films of the knee joint and three-dimensional CT reconstruction of the femoral condyle).At the same time,a total of 20 independent observers (clinicians with junior,intermediate and senior professional qualifications) were selected for classification of the Hoffa fractures in the same manner respectively according to the Letenneur's X-ray system and our self-designed CT system.We used Kappa statistics to evaluate the interrater reliability among the clinicians between the 2 classification systems for Hoffa fractures.Results According to the CT classification of the 20 Hoffa fractures by the 20 clinicians,type Ⅰ,Ⅱ and Ⅲ fractures accounted for 66.0％,30.5％ and 3.5％ respectively.In type Ⅰ fractures,type Ⅰb involving zone b accounted for the most (50.0％),next by type Ⅰc(31.0％) and type Ⅰa (19.0％).In type Ⅱ comminuted fractures,fracture fragments were mostly seen in zone b.The overall incidence of fractures involving zone b by CT classification was 67％.According to the X-ray classification,type Ⅰ,Ⅱ,Ⅲ and Ⅳ fractures accounted for 31.4％,14.3％,28.0％ and 26.3％,respectively.The interrater reliability for CT classification agreement (Kappa =0.681) among clinicians was higher than that for X-ray agreement (Kappa =0.261).Conclusion For Hoffa fractures,communicated ones in particular,our CT classification system may be better than the X-ray classification system.

Objective To report the outcomes of Lisfranc injury treated with bridging plating or external fixation.Methods From August 2008 to February 2011,26 cases of Lisfranc injury were treated with bridging plating or external fixation in our department.After diagnosis was confirmed by X-ray examination or/and CT scanning,open reduction and internal fixation was performed with a bridging plate or external fixator.Regular X-ray follow-ups were carried out to evaluate functional recovery by the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score.The AOFAS scores 6 months and 18 months after operation were compared.Results This series got an average follow-up of 27 months,ranging from 18 to 49 months.The AOFAS midfoot score 6 months after operation was 59.6 ± 15.4 points,significantly lower than that 18 months after operation (76.8 ± 11.5 points) (t =12.620,P =0.000).Secondary post-traumatic arthritis occurred in 12 cases,2 of which had secondary arthrodesis as a result of severe pain.There was no internal fixation breakage.Conclusions For cases of low energy Lisfranc injury,bridging plating can reduce secondary injury to the articular cartilage.For cases of high energy Lisfranc injury,bridging external fixation can lead to reliable fixation and anatomical reduction to restore the shortened column height.

患者资料 男性患者,46岁,因"高处坠落伤及双足、左股部疼痛、活动受限10d"入院,患者10d前施工时不慎由9m高处坠落,伤及左大腿、双足,在当地医院住院治疗,给予左跟骨骨牵引、消肿治疗,患者为进一步治疗转入我院.入院查体:左股部肿胀畸形,双下肢多处皮肤软组织挫伤,左踝关节外侧皮肤坏死,面积2 cm×3 cm,双足、左下肢肿胀明显.双足血供好,神经除左侧足背、足底感觉略差于对侧外,足趾屈伸活动存在.

目的探索使用外固定架临时固定、微创截骨、快速矫正畸形、髓内针或锁定钢板内固定治疗膝关节内翻或外翻畸形的新方法。方法共治疗膝关节内外翻畸形8例患者,其中胫骨平台骨折后内翻畸形4例,股骨髁外翻3例和股骨髁内翻1例,术中仅对1例行自体髂骨植骨,其余病例均未植骨。术后即开始膝关节非负重功能锻炼。结果患者截骨端均愈合,愈合时间平均为4个月,平均矫正角度为14°,术后双下肢力线片的胫骨近端内侧角或股骨远端外侧角与健侧对比相差约3°。结论外固定架临时固定、微创截骨、快速矫正畸形、最终使用髓内针或锁定钢板内固定具有容易调节、精确矫正畸形、固定稳定和无需植骨等优点,是治疗膝关节干骺端内翻或外翻畸形的一种可靠方法 。

Objective To explore the anti-sliding plating for Hoffa fractures by comparing the me-chanical properties of anti-sliding plates and cancellous bone screws. Methods Twenty cases of the same type of Hoffa fracture in the model femur were randomly divided into 4 even groups. Group A used 2 antegrade cancellous bone screws; Group B used 2 retrograde cancellous bone screws forwards; Group C used anti-sliding plate and locking screw fixation; Group D used anti-sliding plate and cancellous bone screw fixation. All the samples were subjected to the cycle fatigue and the maximum failure load tests. Results The fatigue test revealed no significant difference in the mean maximum displacements at the 10, 100, 1000, 10 000 cycles between the 4 groups. In the maximum failure load test, there were significant differences between Group A [(1224±72) N] and Groups C and D [(2183±227) N and (2124±235) N], as well as between Groups B [(1405±235) N] and Groups C and D; there was no significant difference between Group A and Group B, neither between Group C and Group D, Conclusions In the initial period after secure fixation for Hoffa fractures, anti-sliding plates and cancellous bone screws can all provide satisfactory mechanical stability and strength. But anti-sliding plating is recommended for cases of long healing expected, patients with great body mass index, and patients with poor compliance.

Objective To compare the curative outcomes of open reduction and internal fixation (ORIF) between talar body fractures and talar neck ones. Methods Seventeen cases of talar body fractures of Sneppen type Ⅱ and 19 cases of talar neck fractures of Hawkins types Ⅰ and Ⅱ were treated with ORIF from April 1996 to September 2003 in our department. Their Hawkins scores, incidence of ischemic necrosis of talus and incidence of traumatic arthritides of tibial-talar joint and subtalar joint were compared and analyzed with Fisher s exact test (2-sided). Results In the 17 cases of talar body fractures of Sneppen type Ⅱ , the good-to-excellent rate of Hawkins scoring, incidence of ischemic necrosis of talus, incidence of traumatic arthritis of tibial-talar joint and incidence of traumatic arthritis of subtalar joint were 64.7% (11/17), 17.6% (3/17), 41.2% (7/17) and 64.7% (11/17) respectively, while those were 73.7% (14/19), 15.8% (3/19), 15.8% (3/19) and 36.8% (7/19) respectively in the 19 cases of talar neck fractures of Hawkins types Ⅰ and Ⅱ . There were no statistical differences in the curative effects between these two kinds of common talar fractures (P 0.05). Conclusions Our findings reveal that ORIF will not result in different prognostic outcomes for talar body fractures and talar neck ones. The displaced(≥ 2 mm) fractures of both talar body and neck must be treated by open reduction and internal fixation depending on conditions of soft tissue. We should protect the residual blood supply, reduce the fracture anatomically and decrease the rate of posttraumatic arthritis, ischemia and necrosis of talus.