RATIONALE AND OBJECTIVES:Multiple approaches are available for defining the tibial anatomical axis when measuring the posterior tibial slope (PTS) with MRI. This study aims to evaluate the reliability of PTS measurements on MRI when the anatomical axis is defined at different tibial levels. MATERIALS AND METHODS:This study included 103 patients who underwent two distinct MRI examinations of the same knee between 2018 and 2023, with each pair of scans performed within a one-year interval and without significant morphological changes. Two anatomical axes were defined: one below the tibial plateau and another below the tibial tuberosity. The medial and lateral posterior tibial slopes (MPTS and LPTS) were measured relative to each axis. Reliability was evaluated by assessing inter-scan (test-retest), intra-rater, and inter-rater agreement. Variability between scans was further examined using Bland-Altman limits of agreement (LOA). RESULTS:Defining the anatomical axis below the tibial plateau resulted in only moderate inter-scan agreement (MPTS: ICC = 0.651; LPTS: ICC = 0.618), whereas defining it below the tibial tuberosity yielded good agreement (MPTS: ICC = 0.864; LPTS: ICC = 0.852). The 95% LOA between scans for MPTS were -6.8° to 6.4° with the plateau-based axis and -4.4° to 4.8° with the tuberosity-based axis, while those for LPTS were -6.4° to 6.5° and -4.6° to 4.5°, respectively. Both definitions of the axis demonstrated good to excellent intra- and inter-rater reliability for MPTS and LPTS measurements. CONCLUSION:Defining the anatomical axis below the tibial tuberosity yields more reliable PTS measurements, with better inter-scan agreement and good intra- and inter-rater agreement.

INTRODUCTION:Long proximal femoral intramedullary nails present challenges in the treatment of subtrochanteric fractures. Short nails may represent a suitable alternative; however, conventional preoperative planning has limitations in evaluating their appropriateness. This study investigated whether computer-assisted virtual planning can enhance implant selection consistency, short nail utilisation, and surgical outcomes. METHODS:This retrospective cohort study analysed 103 patients (57 virtual planning, 46 conventional planning) treated with proximal femoral intramedullary nailing at a Level I trauma centre in China between 2009 and 2018. Conventional planning relied on imaging and surgeon experience. Virtual planning used three-dimensional computed tomography reconstruction to simulate fracture reduction and determine optimal implant dimensions. Primary outcomes were the planned and actual implant dimensions selected. Secondary outcomes included operative parameters, complications, implant-associated adverse events, and functional scores at 12 months. Robust multivariate analysis of covariance and logistic regression analyses were performed. RESULTS:Compared with conventional planning, virtual planning demonstrated higher consistency between planned and actual short/long nail selection (kappa coefficient=0.95 vs 0.54) and implant dimensions (intraclass correlation coefficient=0.889-0.971 vs 0.786-0.870), with a higher actual short nail utilisation rate (75.4% vs 52.2%). Virtual planning reduced operative duration (90.21 vs 141.67 minutes; P<0.001), closed reduction duration (23.02 vs 30.43 minutes; P<0.001), blood loss (203.51 vs 294.78 mL; P<0.001), and number of fluoroscopy exposures (19.95 vs 29.67; P<0.001), and was associated with faster learning curves. Complications and functional scores were statistically similar between groups but numerically favoured the virtual planning group. CONCLUSION:Virtual planning improved implant selection consistency, short nail utilisation, and surgical efficiency. It demonstrated numerically superior clinical outcomes.

BACKGROUND:Preoperative planning is critical for the operative management of any fracture. Unfortunately, conventional planning methods for pilon fractures have not yielded satisfactory results. Therefore, the purpose of this study was to evaluate whether the outcomes of surgically treated pilon fractures could be improved with computer-assisted preoperative planning. METHODS:Between January 2010 and December 2019, 611 East Asian patients (≥18 years old) with a pilon fracture were identified. After 107 patients were excluded, the final cohort comprised 504 patients: 294 received conventional planning and 210 received computer-assisted preoperative planning. The primary outcome measure was the Olerud-Molander Ankle Score (OMAS) at 12 months. The secondary outcomes were lower-limb function, pain, quality of life, quality of fracture reduction, and complications related to soft-tissue and bone healing. Propensity score matching for 20 baseline characteristics yielded 204 patient pairs. RESULTS:In the entire cohort of 504 patients, the median age was 41 years (interquartile range, 37 to 46 years) and 375 patients (74.4%) were male. After matching (408 patients; 204 patients in each cohort), patients who received computer-assisted preoperative planning had a better mean OMAS value at 12 months (80.3 points [95% CI, 79.5 to 81.1]) than patients for whom the conventional planning method was used (73.2 points [95% CI, 72.5 to 74.0]; mean difference, -7.1 points [95% CI, -8.2 to -6.0]; p < 0.001). Similarly, better outcomes were observed for lower-limb function, pain, quality of life, and reduction quality in the computer-assisted planning group. Patients who received computer-assisted planning had a lower rate of soft-tissue complications (9.3% [19 of 204 patients]) than patients who received conventional planning (18.6% [38 of 204 patients]; absolute rate difference, -9.3% [95% CI, -16.1% to -2.6%]; relative risk, 0.45 [95% CI, 0.25 to 0.81]; p = 0.008), but a significant difference was not found with respect to bone-healing complications. CONCLUSIONS:In patients with a pilon fracture, the use of computer-assisted preoperative planning yielded better functional and radiographic outcomes and a lower rate of soft-tissue complications compared with the use of conventional planning methods. LEVEL OF EVIDENCE:Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

The lateral femoral wall is an important anatomical parameter of the proximal femur, but intramedullary nail fixation for intertrochanteric fractures may cause iatrogenic lateral wall fractures due to population-based design differences. This study aims to measure the anatomical parameters of the proximal femoral medullary cavity and provide data to help design intramedullary nails tailored to the Chinese population to reduce the risk of complications such as lateral wall fractures. Consecutive patients undergoing full-length or upper half CT scans of the femur were included from January 2010 to December 2021. The anatomical parameters of medullary cavity were defined and measured, including prominence length, canal-shaft angle and proximal minimum diameter. Intraclass Correlation Coefficient (ICC) was used to estimate the inter- and intra-observer agreements. A total of 168 patients, comprising 78 men and 90 women, were included. The mean prominence length was 67.4 ± 4.9 mm (males: 70.8 ± 3.6 mm, females: 64.4 ± 3.9 mm). The mean canal-shaft angle was 5.5° ± 0.7° (males: 5.6 ± 0.8°, females: 5.5 ± 0.7°). The mean proximal minimum diameter was 22.7 ± 1.8 mm (males: 24.0 ± 1.5 mm, females: 21.6 ± 1.4 mm) at the level of 1/3 prominence length from bottom to top. Gender differences were observed in these parameters (p < 0.001) except for the canal-shaft angle (p = 0.45). The mean proximal minimum diameter was significantly larger in the group aged 50 years and older (23.1 ± 1.7 mm) compared to the group younger than 50 years (22.4 ± 1.9 mm) (p = 0.02). Inter- and intra-observer agreement was almost perfect for all the parameters (all ICC values > 0.8). Males have a longer prominence length and larger proximal minimum diameter than females. The proximal minimum diameter is larger in the older population than in the younger population. The measurement results help support the design of intramedullary nails tailored to the Chinese population. Not applicable.

Background: Preoperative planning is critical for the operative management of any fracture. Unfortunately, conventional planning methods for pilon fractures have not yielded satisfactory results. Therefore, the purpose of this study was to evaluate whether the outcomes of surgically treated pilon fractures could be improved with computer-assisted preoperative planning. Methods: Between January 2010 and December 2019, 611 East Asian patients (≥18 years old) with a pilon fracture were identified. After 107 patients were excluded, the final cohort comprised 504 patients: 294 received conventional planning and 210 received computer-assisted preoperative planning. The primary outcome measure was the Olerud-Molander Ankle Score (OMAS) at 12 months. The secondary outcomes were lower-limb function, pain, quality of life, quality of fracture reduction, and complications related to soft-tissue and bone healing. Propensity score matching for 20 baseline characteristics yielded 204 patient pairs. Results: In the entire cohort of 504 patients, the median age was 41 years (interquartile range, 37 to 46 years) and 375 patients (74.4%) were male. After matching (408 patients; 204 patients in each cohort), patients who received computer-assisted preoperative planning had a better mean OMAS value at 12 months (80.3 points [95% CI, 79.5 to 81.1]) than patients for whom the conventional planning method was used (73.2 points [95% CI, 72.5 to 74.0]; mean difference, −7.1 points [95% CI, −8.2 to −6.0]; p < 0.001). Similarly, better outcomes were observed for lower-limb function, pain, quality of life, and reduction quality in the computer-assisted planning group. Patients who received computer-assisted planning had a lower rate of soft-tissue complications (9.3% [19 of 204 patients]) than patients who received conventional planning (18.6% [38 of 204 patients]; absolute rate difference, −9.3% [95% CI, −16.1% to −2.6%]; relative risk, 0.45 [95% CI, 0.25 to 0.81]; p = 0.008), but a significant difference was not found with respect to bone-healing complications. Conclusions: In patients with a pilon fracture, the use of computer-assisted preoperative planning yielded better functional and radiographic outcomes and a lower rate of soft-tissue complications compared with the use of conventional planning methods. Level of Evidence: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND:Accurate preoperative planning is essential for the treatment of complex fractures, but the proportion of patients who have access to this service remains low. Therefore, the purpose was to evaluate the association of computer-assisted preoperative planning via digital telemedicine with the risk of postoperative in-hospital complications for periarticular fractures of the extremities. METHODS:A multicenter retrospective cohort study was performed from January 2010 to December 2019. A total of 11 192 patients (≥18 years) with periarticular fractures of the extremities (proximal humerus, distal humerus, distal radius, intertrochanteric, distal femur, tibial plateau, distal tibia, and trimalleolar) were identified and divided into two cohorts: 7130 (63.7%) patients received conventional preoperative planning and 4062 (36.3%) patients received computer-assisted preoperative planning via telemedicine. Propensity score matching for 23 baseline characteristics yielded 4050 patient pairs. Primary outcome was in-hospital complications (surgical site infection, urinary tract infection, pneumonia, sepsis, thromboembolic event, stroke, and myocardial infarction). RESULTS:Among 11 192 unadjusted patients, the mean (SD) age was 60.2 (12.3) years, and 7052 (63.0%) were female. After propensity score matching (total 8100 patients, 4050 patients in each group), patients with computer-assisted preoperative planning via telemedicine had the lower in-hospital complications [7.9% (318/4050 patients) vs. 10.9% (442/4050 patients); hazard ratio, 0.72 (95% CI, 0.59-0.89); P = 0.002] compared with those with the conventional method. CONCLUSION:For patients undergoing complex periarticular fractures of the extremities, the use of computer-assisted preoperative planning via digital telemedicine was associated with a lower incidence of in-hospital complications compared with the use of the conventional method.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Development of biomimetic hydrogel-based wound dressing is highly desirable for addressing life-threatening infectious skin injuries but has proved to be extremely challenging. However, poor tissue adhesive performance, stretchability and difficult fixation lead to conventional wound dressings failing to adapt to dynamic wounds with high-frequency movement or special fluctuant positions. Herein, we present a new biomimetic natural-synthetical combination by integrating Osteichthyes-extracted gelatins into hydrophilic polymeric networks to form unique tough, adhesive, self-healable composite hydrogels. The resultant Gelatin/PHEAA hydrogel without any growth factors/fungicides has high mechanical strength (~1.0 MPa), high interfacial toughness (>1000 J/m2), and remarkable antifouling activity, enabling the hydrogel to effectively inhibit bacterial proliferation and promote the wound healing. Moreover, due to the abundant hydrogen bonds in composite crosslinked networks, the Gelatin/PHEAA hydrogels maintain high, repeatable adhesion even in high dynamic cases, regardless of wet or dry environments and the types of solid nonporous substrates. Further in vitro and in vivo full-thickness skin defect model confirms that the Osteichthyes-extracted proteins can accelerate collagen deposition and vascular regeneration, leading to a faster wound closure efficiency. Ultimately, we believe that the designed tough Gelatin/PHEAA hydrogels can be high-value candidates for managing rapid wound healing, while the proposed structural biomimetic combination can inspire researchers to design more interesting and effective biomaterials for clinical translation and health care.

Osteoporotic fractures, also known as fragility fractures, are prevalent in the elderly and bring tremendous social burdens. Poor bone quality, weak repair capacity, instability, and high failure rate of internal fixation are main characteristics of osteoporotic fractures. Osteoporotic bone defects are common and need to be repaired by appropriate materials. Proximal humerus, distal radius, tibia plateau, calcaneus, and spine are common osteoporotic fractures with bone defect. Here, the consensus from the Osteoporosis Group of Chinese Orthopaedic Association concentrates on the epidemiology, characters, and management strategies of common osteoporotic fractures with bone defect to standardize clinical practice in bone repair of osteoporotic fractures.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

Introduction: The purpose of this study was to determine whether immediate weight-bearing as tolerated increased the risk of implant failure and decreased functional outcomes compared with restricted weight-bearing.Methods: From January 2010 to December 2018, 1,125 consecutive patients (≥65 years) with intertrochanteric fractures were identified. Of them, 130 patients were excluded, resulting in 995 patients in final cohort (563 receiving immediate weight-bearing and 432 receiving restricted weight-bearing). Propensity score (PS) matching yielded 403 patient pairs. Primary outcome was implant failure at 12 months. Secondary outcomes were implant failure at 3 months, functional outcomes at 12 months, and time to full weight-bearing.Results: Among 806 patients who were matched by PS, the mean age was 77.8 years (SD, 7.6), and 603 patients (74.8%) were women. After matching, there was no significant difference between immediate (10.0% [39/389]) and restricted (9.1%, [35/385]) weight-bearing for implant failure at 12 months (absolute risk difference, 0.93% [95% CI, −3.26 to 5.13%]; RR, 1.11 [95% CI, 0.69 to 1.80]; p = 0.66). Additionally, no significant difference was seen for implant failure at 3 months and functional outcomes at 12 months. Patients with immediate weight-bearing had shorter time to full weight-bearing (mean [SD], 87.6 days [7.5] vs. 121.3 days [11.0]; mean difference, −33.7 [95% CI, −35.0 to −32.3]; p < 0.001).Conclusions: Among older patients with intertrochanteric fractures, receipt of immediate weight-bearing as tolerated did not increase risks of implant failure or worsen functional outcomes compared with receipt of restricted weight-bearing. However, patients receiving immediate weight-bearing had a shorter time to full weight-bearing.

Objective:To analyze the application value of three-dimensional computed tomography (3-D CT) reconstruction technique in the evaluation of related predictive parameters of osteoporotic hip fractures.Methods:From February 2014 to March 2019, 106 patients with hip fracture who underwent dual-energy X-ray bone density test of T≤ -2.5 SD on the hip were analyzed retrospectively. There were 58 males and 48 females; Age 73.50±5.59 years old (range, 65-88 years old); Height 170.12±7.43 cm (range, 152-187 cm); Weight (69.26±11.85) kg (range, 37-94 kg); Body mass index 23.60±2.37 kg/m 2 (range, 18.3-28.9 kg/m 2); There were 32 cases of femoral neck fractures, 68 cases of intertrochanteric fractures and 6 cases of subtrochanteric fractures. Anatomic parameters of the hip were the cortical thickness index (CTI), hip axis length (HAL), and femoral offset (FO). The above-mentioned predictive parameters of the hip fractures were measured based on X-ray and 3-D CT reconstruction images. Comparison of the two methods were analyzed using paired t test, liner Pearson analysis, and Bland-Altman analysis. Pearson analysis was used to evaluate correlation between CTI, HAL, and FO and T value. Results:106 cases were compared and analyzed with the measured values of X-ray and 3-D CT reconstruction images according to the preset measurement scheme. The mean value of CTI measured by conventional X-ray measurement method was 0.31±0.05, and the mean value of CTI measured by 3-D CT reconstruction images was 0.31±0.05. The result was not statistically significant ( t=0.938, P=0.35). The mean values of HAL, FO measured by conventional X-ray measurement method were 123.35±12.74 mm, 43.99±2.81 mm, and the mean values of HAL, FO measured by 3-D CT reconstruction images were 121.11±14.51 mm, 40.73±3.11 mm. The results were statistically different ( t=2.578, 18.502; all P< 0.05). The Bland-Altman results showed that there was no difference in the consistency of the two measurement methods for CTI while the measurement results of HAL, FO were quite different. CTI and HAL showed strong correlations with the T scores respectively ( r=0.784, -0.748; P< 0.001). Conclusion:Based on 3-D CT reconstruction technique, accurate measurement of related predictive parameters of osteoporotic hip fractures can be realized, which provides theoretical basis for the evaluation of osteoporotic hip fractures in the elderly and the formulation of accurate rehabilitation treatment plan.

With aim to reasonably cope with the elderly patients with hip fracture during epidemic of corona virus disease 2019 (COVID-19), Professor Su Jiacan and Academician Zhang Yingze organized the "expert consensus on elderly patients with hip fractures under epidemic of novel coronavirus pneumonia" that for the first time formulated the management strategies for the elderly patients with hip fracture including selection of surgical methods and protective measures for medical staff from perspective of orthopedic surgeons. The authors interpret the clinical guiding value and key points of diagnosis and treatment of the consensus to help clinicians better understand the consensus and strengthen its practical application. Key words: Coronavirus infections; Pneumonia; Aged; Hip fractures; Interpretation of consensus

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Objective:To investigate the application value of three-dimensional morphological measurement in the treatment of displaced intra-articular calcaneal fractures in the elderly.Methods:A retrospective case series study was conducted to analyze the clinical data of 44 patients with displaced intra-articular calcaneal fractures admitted to East Hospital Affiliated to Tongji University from January 2015 to January 2018. There were 33 males and 11 females, aged 60-88 years (mean, 67.2 years). According to Sanders classification, 35 patients were with type II fractures and 9 with type III fractures. All patients were evaluated with digital technology and received open reduction and internal fixation. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency and complications were recorded. Three-dimensional morphological parameters of calcaneal fractures were compared before and at latest follow-up, including horizontal length of the calcaneus, height of the posterior articular facet, height and length of the anterior process, Gissane angle, and B?hler angle. The visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot function score were also compared.Results:All patients were followed up for 12-30 months (mean, 17.1 months). There were 31 patients with posterior articular facet depression more than 2 mm, and 13 patients showed the back shift of the whole or part of posterior articular facet more than 3 mm and varying degree of fracture of the upper or lateral wall part of calcaneus body. The operative time was 55-105 minutes (mean, 85.1 minutes). The intraoperative blood loss was 30-130 ml (mean, 74.9 ml). The intraoperative fluoroscopy frequency was 5-8 times (mean, 6.5 times). During the operation, the internal fixation was not changed. Two patients suffered from skin incision infection after operation. At latest follow-up, the horizontal length of the calcaneus, height of the posterior articular facet, Gissane angle and B?hler angle were significantly improved from that before operation [(76.9±4.1)mm vs. (75.5±5.2)mm, (24.2±2.1)mm vs. (22.5±2.9)mm, (29.0±6.2)° vs. (18.3±5.5)°, (124.8±7.2)° vs. (107.6±8.5)°, respectively] ( P<0.01). No significance was found in the height and length of the anterior process ( P>0.05). At latest follow-up, the VAS and AOFAS ankle-hind foot function score were also significantly improved compared to preoperation [(1.1±0.9)points vs. (4.4±0.9)points, (86.4±6.2)points vs. (49.9±6.3)points, respectively] ( P<0.01). AOFAS ankle-hind foot function score was excellent in 13 patients, good in 26, fair in 5, with the excellent and good rate of 87%. Conclusion:Three-dimensional morphological measurement can fully evaluate the damage of calcaneal fractures and provide data reference for the preoperative planning of open reduction and internal fixation in the elderly, so as to restore the calcaneus structure, relieve pain and improve ankle function.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

Objective evaluate the efficacy of a single medial locking plate and lag screws based on computer-assisted pre-operation plan (CAPP) for the treatment of pilon fractures.Methods Between 2013 and 2016,data of 27 patients with pilon fractures who were treated using a single medial locking and lag screws based on CAPP were retrospectively analyzed.All the cases were AO/OTA 43-C type pilon fractures.According to the Rüedi-Allg(o)wer classification,there were 5 cases of type Ⅱ and 22 cases of type Ⅲ.Among 27 patients,19 patients had fibula fracture.CAPP was performed for all fractures,including simulated reduction,virtual surgery,and implantation of internal fixation.The time of CAPP,intraoperative realization of preoperative plan,operation time,intraoperative blood loss,and pre-and post-operative range of motion of ankle were recorded.Functional outcomes at final follow up were assessed using American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale,visual analogue scale (VAS).Results The mean time of CAPP was 25.8 minutes (range,14-30 minutes).The average operating time was 138.5 minutes.The average intraoperative blood loss was 225.9 ml.All the twenty-seven patients were followed up for an average period of 18.6 months.The average AOFAS score,VAS score at the final follow-up was 82.9,2.7 points respectively,which was significandy improved compared with those before operation (t=-19.358,7.720;all P＜ 0.001).Conclusion CAPP system is convenient and efficient,which can facilitate the treatment of type C pilon fractures with a single medial locking plate and lag screws.In addition,satisfactory clinical outcomes can be obtained.

跟骨骨折的保守治疗或不恰当的手术治疗会导致跟骨畸形愈合,严重者影响患者的生活质量.通过对跟骨骨折畸形愈合损伤机制、分型、治疗等相关研究发现,手术治疗是畸形愈合最佳的治疗方法.由于跟骨骨折畸形愈合后形态的不规则性,治疗方式也各有不同.如外侧壁切开减压术、距下关节原位融合术、距下关节撑开植骨融合术、保留距下关节的跟骨截骨术、微创手术、计算机辅助技术等,均可获得较好的预后.对跟骨骨折畸形愈合采取个体化治疗方案,可以获得更好的预后.本文对跟骨骨折畸形愈合的治疗现状及进展作一综述.