This study aims to examine whether the preoperative controlling nutritional status (CONUT) score was associated with SSI following elective foot and ankle surgeries. This study retrospectively reviewed adult undergoing elective foot and ankle surgeries in a tertiary university-affiliated hospital between January 2019 and May 2023, and identified who subsequently developed an SSI within 12 months postoperative. CONUT score was calculated from serum albumin, lymphocyte count, and toral cholesterol concentration, and its optimal cut-off value for differentiating SSI risk was determined by the receiver operating characteristic curve. Three independent hierarchical multivariable logistic regression models, adjusting demographics, confounders or covariates were constructed to examine the association. Among 1,424 surgical procedures performed in 1,221 patients, 36 (2.5 %) SSIs were identified, with 21 (1.5 %) superficial cases and 15 (1.1 %) deep cases, respectively. The optimal cut-off for CONUT was 3, and significant differences were observed between patients with CONUT ≥ 3 and those <3, in terms of age, BMI, anesthesia, procedure, bleeding, preoperative prophylactic antibiotics, and admission sodium. Multivariate analyses showed consistent significant results (OR 4.66 and 95 % CI 2.32 to 9.37 after adjustment for demographics; OR 4.72 and 95 % CI 2.22 to 10.02 for adjustment for confounders, and OR 3.80 and 95 % CI 1.68 to 8.59 for further covariates). This finding may aid clinicians in conducting individualized assessments of SSI and developing a more tailored SSI risk profile for patients undergoing such procedures.

Background To explore the risk factors and develop a nomogram in order to predict surgical site infection (SSI) after open reduction and internal fixation (ORIF) for closed pilon fractures (CPF). Methods A prospective cohort study with one-year follow-up was carried out in a provincial trauma center. From January 2019 to January 2021, 417 adult patients with CPFs receiving ORIF were enrolled. A Whitney U test or t test, Pearson chi-square test, and multiple logistic regression analyses were gradually used for screening the adjusted factors of SSI. A nomogram model was built to predict the risk of SSI, and the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used for evaluating the prediction performance and consistency of the nomogram model. The bootstrap method was employed to test the validity of the nomogram. Results The incidence of SSI after ORIF for CPFs was 7.2% (30/417): 4.1% (17/417) of superficial SSIs and 3.1% (13/417) of deep SSIs. The most common pathogenic bacteria were Staphylococcus aureus (36.6%, 11/30). The multivariate analysis showed tourniquet use, longer preoperative stay, lower preoperative albumin (ALB), higher preoperative body mass index (BMI) and hypersensitive C-reactive protein (Hs-CRP) were independent risk factors of SSI. Additionally, the C-index and bootstrap value of the nomogram model were 0.838 and 0.820, respectively. Finally, the calibration curve indicated that the actual diagnosed SSI had good consistency with the predicted probability, and the DCA showed that the nomogram had clinical value. Conclusions Tourniquet use, longer preoperative stay, lower preoperative ALB, higher preoperative BMI and Hs-CRP were five independent risk factors of SSI after closed pilon fractures treated by ORIF. These five predictors are shown on the nomogram, with which we may be able to further prevent the CPS patients from SSI. Trial registration NO 2018-026-1, October /24/2018, prospectively registered. The study was registered in October 24, 2018. The study protocol was designed based on the Declaration of Helsinki and admitted by the Institutional Review Board. The ethics committee approved the study on factors related to fracture healing in orthopedic surgery. Data analyzed in the present study were acquired from the patients who underwent open reduction and internal fixation from January 2019 to January 2021.

目的 探讨距下关节稳定器治疗儿童柔韧性平足症的手术疗效.方法 回顾性分析2018年6月至2020年8月在河北医科大学第三医院足踝外科采用距下关节稳定器治疗的28例(40足)柔韧性平足症患者的资料,其中男16例(24足),女12例(16足),所有患者经保守治疗无效,故选择行距下关节制动手术治疗.术前和术后末次随访时,通过美国足踝外科协会(American Orthopedic Foot Ankle Society,AOFAS)踝-后足评分来评价踝关节功能恢复情况;采用视觉模拟评分法(visual analogue scale,VAS)评分对患者术后的主观本体感觉进行评估;比较治疗前后距骨第1跖骨角(Meary角)、跟骨倾斜角(Pitch角)、距舟覆盖角(talonavicular coverage angle,TCA)、距骨第 1 跖骨角(talar 1 metatarsal angle,T1MT)、距骨第2跖骨角(talar 2 metatarsal angle,T2MT);观察随访期间的手术并发症情况.结果 28例患者(40足)均获随访12～18个月,平均15.2个月.术后切口均一期愈合,无软组织并发症.4足出现跗骨窦区域疼痛,2足给予局部封闭及冲击波治疗后好转;2足经更换较小型号的螺钉后,跗骨窦区域疼痛消失;其余患者拆除支具后逐渐开始使用矫形鞋垫负重行走,无不适主诉.末次随访时的VAS评分、AOFAS踝-后足功能评分和影像学相关指标较术前显著改善,差异有统计学意义(P＜0.01).结论 应用距下关节稳定器治疗儿童柔韧性平足症,操作简单,创伤小,安全可靠,疗效显著.

OBJECTIVE:To explore clinical effect of Scarf osteotomy combined with soft tissue balance in treating severe hallux valgus.METHODS:Totally 38 patients(50 feet) with severe hallux valux who underwent Scarf osteotomy combined with soft tissue balance surgery from June 2019 to June 2021 were retrospectively analyzed, aged from 29 to 64 years old with an average of(54.7±6.8) years old; 26 feet on the left side and 24 feet on the right side;the courses of disease ranged from 5 to 23 years with an average of (12.4±3.9) years. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were compared before and after operation, and postoperative complications was observed. American orthopedic foot ankle society(AOFAS) score before operation and final follow-up was used to evaluate recovery of forefoot function, and visual analogue scale (VAS) was used to evaluate pain relief.RESULTS:Thirty-eight patients (50 feet) were followed up from 15 to 23 months with an average of (18.3±3.2) months. Preoperative HVA, IMA and DMAA were (44.61±3.92)°, (18.74±2.51)°, (12.85±2.11)°, and improved to (13.45±2.13)°, (7.83±1.36)°, (7.03±1.39)°at final follow-up, which had statistical differneces(P<0.05). No delayed union or nonunion of osteotomy end, fracture or loosening of internal fixation, hallux varus occurred. VAS and AOFAS score improved from (6.81±2.14), (43.6±8.4)points before operation to (1.97±0.78), (87.6±5.2) points at final follow-up, which had statistical difference(P<0.01). According to AOFAS at final follow-up, 20 feet got excellent result, 28 feet good and 2 feet moderate.CONCLUSION:Scarf osteotomy combined with soft tissue balance release for severe hallux valgus has good stability and corrective effect, but learning curve and postoperative complications should be paid attention.

目的 探讨三关节截骨矫形融合术治疗成人僵硬性高弓足的临床效果.方法 回顾性分析2018年1月至2020年1月应用三关节融合(距下关节、跟骰关节、距舟关节)治疗10例成人僵硬性高弓足患者;患者行三关节融合术的同时联合跟腱Z行延长及跖筋膜松解作为辅助术式改善足部功能,同时保证术后踝关节的功能位,采用美国足踝外科协会(AOFAS)踝-后足评分、视觉模拟疼痛评分(VAS)及患者术前术后的主观满意度,末次随访时通过影像学分析对比跟骨倾斜角(Pitch角)、距骨第一跖骨角(Meary角)等.结果 术后10例患者全部获得随访,随访时间为15～36个月,平均23.4个月,患者均未出现手术切口感染,且术后患者的外观、症状、步态等方面均有明显的提高,末次随访时满意度评价:非常满意7例,满意2例,一般1例,不满意0例.术后AOFAS评分高于术前,VAS评分低于术前,Meary角、Pitch角及第一跖楔关节高度较术前明显改善,差异有统计学意义(P<0.05).结论 三关节截骨矫形融合治疗成人僵硬性高弓足可以显著纠正关节畸形,解除足部疼痛,提高患者的生活质量,但三关节融合术主要应用后足僵硬型高弓足,因其限制了足部部分功能,故应严格把握手术适应证.

Background This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors. Methods This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI. Results A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showedPseudomonas aeruginosain 7 cases,methicillin-resistant Staphylococcus aureus(MRSA) in 6,methicillin-susceptible Staphylococcus aureus(MSSA) in 5,methicillin-resistant coagulase-negative Staphylococci(MRCNS) in 2,Escherichia coliin 2, andProteus mirabilisin 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12). Conclusions SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.

Background: This study was performed to compare the operative outcome between percutaneous repair (modified Bunnell suture) and open repair (bundle-to-bundle suture) for treatment of acute Achilles tendon rupture.Methods: Seventy-two consecutive patients who underwent surgical treatment of Achilles tendon rupture were evaluated. Thirty-six patients were treated by the bundle-to-bundle suture technique (Group A), and 36 patients were treated by the modified Bunnell suture technique (Group B). Functional examination included measurement of the calf muscle circumference and performance of the single-leg heel-rise test. The length and diameter of the Achilles tendon were compared between the injured and uninjured sides using magnetic resonance imaging. The number of single-leg heel rises (height of >5 cm) performed within 15 s was compared between the injured and uninjured sides. The ankle joint range of motion was also recorded. The Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, and visual analog scale (VAS) pain score were used to evaluate the clinical outcome after a minimum 12-month postoperative follow-up period.Results: In total, 61 patients were followed up. The mean follow-up time was not significantly different between Group A (23.73 ± 2.81 months) and Group B (22.61 ± 3.96 months). However, there were significant differences in the heel-rise test (Group A, 1.74 ± 0.96; Group B, 2.37 ± 1.42) and length of the Achilles tendon (Group A, 11.98 ± 1.64 cm; Group B, 11.11 ± 1.74 cm). The calf circumference of the injured side was significantly larger in Group A than B (p = 0.043). The cross-sectional diameter of the Achilles tendon after open repair was significantly different from that after percutaneous repair. There were no significant differences in the ATRS, AOFAS score, or VAS score at the final follow-up between the two groups. One patient in Group A had delayed wound healing, which resolved in about 40 days.Conclusions: Both suture methods described in this report can provide good clinical results. The bundle-to-bundle suture technique is more effective for restoration of the Achilles tendon length and muscle function. This method is safe, effective, and worthy of promotion.

目的 探讨Chevron截骨导向器引导下截骨治疗轻中度外翻的临床效果.方法 2019年1至3月,对15例(24足)轻中度外翻患者进行截骨导向器引导下的Chevron截骨术.术前、术后测量外翻角(hallux valgus angle,HAV)、第一二跖骨间角(intermetatarsal angle,IMA),评估患者美国足踝外科协会(American orthopaedic foot&ankle society,AOFAS)踝-前足评分、视觉模拟评分(visual analogue scale,VAS)、主观满意度评价.结果 术后所有患者随访12～16个月,HAV术前平均(34.0±4.8)°、术后平均(9.7±1.7)°;IMA术前平均(11.8±1.2)°、术后平均(8.5±1.2)°;AOFAS评分术前平均(58.9±6.2)分、术后平均(93.5±4.5)分;VAS评分术前平均(6.8±0.6)分、术后平均(0.9±0.8)分;满意率为93.33％.结论 Chevron截骨导向器能够在术中进行精确截骨,保证截骨角度,提高截骨质量,保证截骨安全,对轻中度外翻矫形有良好的辅助作用.

This retrospective study aimed to investigate the preoperative incidence and locations of deep venous thrombosis (DVT) in patients undergoing surgeries for ankle fractures and identify the associated risk factors. From January 2016 to June 2019, 1,532 patients undergoing surgery of ankle fractures were included. Their inpatient medical records were inquired for data collection, including demographics, comorbidities, injury-related data and preoperative laboratory biomarkers. DVT of bilateral lower extremities was diagnosed by routine preoperative Doppler examination. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Totally, 98 patients had a preoperative DVT, indicating an incidence rate of 6.4%. A total of 164 clots for 6 veins were found, representing an average of 1.7 for each patient. The detailed DVTs involving veins were as follows: 2 in femoral common vein, 7 in superficial femoral vein, 2 in deep femoral vein, 16 in popliteal vein, 49 in posterior tibial vein, and 88 in peroneal vein. In the multivariate model, 5 risk factors were identified to be associated with DVT, including age (10-year increase), gender, lower ALB level, reduced LYM count and elevated D-dimer level. There was a tendency for diabetes mellitus to increase the risk of DVT, although there was no statistical significance (p=0.063). These epidemiologic data on DVT may help counsel patients about the risk of DVT, individualized risk assessment and accordingly the risk stratification.

Objective To investigate the incidence of postoperative deep venous thrombosis (DVP) in patients undergoing surgeries for ankle fractures and identify the associated risk factors. Methods This was a retrospective study. A total of 1451 patients undergoing surgery of ankle fractures from January 2016 to June 2019 were included. The inpatient medical record system was inquired for data collection, including demographics, comorbidities, injury and surgery-related data and laboratory biomarkers. DVT of lower extremity was diagnosed by routine doppler examination. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 1451 patients, DVT was confirmed in 38 cases, indicating an incidence of 2.6%. DVT involved both the operated and non-operated limbs in 8 patients (21.1%). DVT involved superficial femoral vein in 4 cases (6.6%), deep femoral vein in 2 (3.3%), popliteal vein in 5 (8.2%), posterior tibial vein in 11 (18.0%) and peroneal vein in 39 (63.9%). The median interval between operation and diagnosis of DVT was7 days. Six risk factors were identified to be independently associated with DVT, including age (10-year increase) (OR, 1.44), preoperative stay (delay of each day) (OR, 1.11), anesthesia (general vs regional) (OR, 3.51), lower hemoglobin level (OR, 2.02), total cholesterol >5.2mmol/L (OR, 3.20) and reduced lymphocyte count (OR, 3.16). Conclusion These identified factors, although not easily modifiable, do help counsel patients about the risk of DVT and help individualized assessment of the risk factors and accordingly the risk stratification.

PurposeThis study aims to investigate the incidence of low-energy fractures in men aged 50 years and older in China and to explore associated risk factors.MethodsAll the relevant data were available from the China National Fracture Survey (CNFS), which was a cross-sectional survey carried out in eight Chinese provinces (municipalities) between January and May 2015.ResultsThrough 2014, 76,687 men above 50 years participated in this study and 223 participants had low-energy fractures, indicating the incidence rate 290.8 (95%CI, 252.7-328.9)/100,000 men. Over 80% of the fractures occurred at home and on the common road. The fracture incidence rate presented a significant rising trend with advanced age (p = 0.039). Current smoking, alcohol overconsumption, insufficient sleep duration, and history of past fracture were identified as significant risk factors associated with low-energy fracture (p < 0.05).ConclusionsThese results will assist the decisions regarding allocation of healthcare provision to populations of greatest need and aid the design and implementation of strategies to reduce fracture incidence. Accordingly, individuals should be encouraged to reduce alcohol consumption, immediately quit smoking, and get sufficient sleep, especially in those with a history of past fracture. In addition, primary preventives especially home prevention should be emphasized.

BACKGROUND:This study aimed to investigate incidence of surgical site infection (SSI) following the surgery of intra-articular fractures of distal femur.METHODS:Between July 2014 and December 2017, inpatient medical records of consecutive patients who had intra-articular fractures of distal femur treated by open reduction and plate/screw fixation were inquired to identify whether they had a SSI. After discharge, patients who had a SSI and were readmitted for treatment of SSI were also allocated to the case group. Univariate and multivariate logistic regression analyses were performed to determine whether some clinical factors were independently associated with SSI, after adjustment for confounding variables.RESULTS:During the study period, 434 patients were evaluated and 21 patients were confirmed to develop a SSI, indicating the accumulated incidence of 4.8% within 1 year. A total of six deep and 15 superficial SSIs were identified, with respective incidence being 1.4% and 3.4%. The most common causative pathogen was Staphylococcus aureus (8, 50.0%), followed by mixed bacteria (5, 31.3%). Open fracture, prolonged surgical duration, increased body mass index and current smoking were identified as independent risk factors for development of SSI (P < 0.05).CONCLUSIONS:It should be noted that it was likely difficult to modify these risk factors, but they do prove useful for preoperative counselling of patients and their relatives regarding their own risk profile of SSI, and the perioperative medical optimization.

跟骨骨折是跗骨骨折中最常见类型,多发生于中年男性,常因高处坠落或挤压所致 [1],约 60％跗骨骨折为跟骨骨折,占全身骨折的 1％ ～ 2％.移位的跟骨骨折会导致一系列问题,最终造成足部功能障碍.跟骨骨折的治疗对于骨科医生仍旧是一个挑战 [2].由于跟部周围软组织菲薄,且血供较差,损伤易累及关节面,手术或保守治疗不当,并发症发生率均较高,常遗留后遗症,严重影响患者的生活质量 [3].传统手术方式术后常常会出现手术切口感染、皮缘坏死、切口延迟愈合乃至不愈合、内固定物及骨外露等问题.2018 年9 月河北医科大学第三医院足踝外科采用闭合复位无头加压空心螺钉治疗 Sanders Ⅱ、Ⅲ型跟骨骨折各 1 例,取得满意疗效,报道如下.

目的 探讨自体髂骨移植治疗重度距骨软骨缺损的临床疗效分析.方法 选择2012年7月至2017年7月入院符合入选标准(距骨内侧缺损面积>1.5 cm2或病变深度>7 mm)的距骨软骨缺损患者35例,经内踝截骨、取同侧髂骨移植修复缺损部位,患者术前、术后随访均行CT和MRI检查,测量踝关节活动范围(ROM),采用美国矫形足踝协会(AOFAS)及视觉疼痛量表(VAS)对术前术后踝关节的功能及疼痛评定治疗效果,将手术前后相关指标进行统计学分析.结果 术后随访12～36个月,平均(20.6±8.3)个月.91.4％(32/35)的患者术后3个月踝关节肿痛消失,余患者肿痛消失时间较长,最终所有患者踝关节肿痛均消失,末次随访时,测量踝关节活动范围,ROM由术前平均(47.7±6.3)°增加到术后(63.4±7.4)°差异有统计学意义(P<0.01),AOFAS评分较术前显著提高(70.5±7.2,91.3±4.9,P<0.01),VAS评分较术前显著降低(7.2±1.2,1.7±1.1,P<0.01),随访MRI检查关节面修复满意,无明显术后并发症.结论 对于距骨内侧缺损面积>1.5 cm2或病变深度>7 mm的患者,取同侧髂骨移植修复缺损是一种疗效明显的外科手术方法,可广泛应用于临床.

目的 探讨趾长伸肌腱转位治疗小趾非僵硬型爪形趾的临床效果.方法 采用趾长伸肌腱转位治疗小趾非僵硬型爪形趾,根据美国足踝外科协会(AOFAS)踝-后足评分、视觉模拟评分(VAS)、患者主观满意度评估其疗效.结果 术后平均随访(15±3)个月,所有患者畸形矫正满意.AOFAS评分:术前平均(63.27±5.69)分,术后平均(94.45±3.93)分,差异具有统计学意义(P＜0.01).VAS评分:术前(6.64±1.67)分,术后平均(0.27±0.47)分,差异具有统计学意义(P＜0.01).患者主观满意率为90.91％.结论 趾长伸肌腱转位治疗小趾非僵硬型爪形趾,临床效果满意,畸形无复发,是治疗小趾非僵硬型爪形趾的有效方法.

Backgroup: To compare the operative outcome between modified Kessler suture method and Bundle-Bundle suture for the treatment of acute rupture of Achilles tendon. Methods: A consecutive series of 72 patients who underwent operation of Achilles tendon rupture were evaluated. Thirty patients were treated by the bundle-bundle suture method (group A) and 31 patients by modified Kessler suture (group B). Functional examination included measurement of calf muscle circumference, and a single-leg heel-rise test. The diameter of the Achilles tendon of the trouble side was recorded compared with the contralateral limb through the MRI (magnetic resonance imaging). The number of single-leg heel-rise was recorded within 15s (height>5cm) compared with the uninjured side. The ankle joint range of motion is recorded. The evaluation form ATRS(Achilles Tendon Total Rupture Score), AOFAS(American Orthopedic Foot And ankle Society) Ankle-Hindfoot scale scores and VAS( visual analogue scale) pain score were used to evaluate the clinical outcome after a minimum follow-up period of 12 months postoperatively. Results: 61 patients at 1 year following surgery. There was no difference in mean follow-up time between the two groups (group A: 23.73±2.81 months; group B: 22.61±3.96 months). There were significant differences between the groups in heel-rise test 1.74±0.96 in group A, 2.37±1.42 in group B. Compared with the group B, the calf circumference of the injured side was bigger in group A (p=0.043). The cross-sectional diameters of the Achilles tendon after open repair was significantly different from that after percutaneus repair. There were no significant differences in ATRS, AOFAS and VAS at the final follow-up between the two groups. One patients of group A experienced delayed wound healing, which resolved in about 40 days. Conclusions : Two suture methods can provide good clinical results. Bundle-Bundle suture is more effective in solving the shortcomings of traditional methods. It is a safe and effective method, and is worthy of promotion.

Objective To investigate the incidence of postoperative overall complications or secondary procedures following distal radius fractures treated by volar locking plate (VLP) Methods Electronic medical records (EMR) of 1152 patients with 1175 distal radius fractures treated by volar locking plate between January 2013 and September 2018 were retrospectively reviewed and the data were extracted. The picture archiving and communication system (PACS) was inquired to assess the fracture severity and to determine the fracture type. Univariate and multivariate logistic regression analyses were used to identify the associated risk factors. Results During the median follow-up period of 6 months, a total of 138 complications in 131 patients were determined, indicating the accumulated rate of 11.7%; there were 68 cases of secondary procedures, with the rate of 5.8%. The independent associated factors for postoperative overall complications were AO type C fracture (OR, 2.6; 95%CI, 1.2 to 4.0), open fracture (OR, 4.2; 95%CI, 1.9 to 6.5), and significant collapse of the lunate fossa (OR, 2.9; 95%CI, 13 to 4.3), and for secondary procedures were significant collapse of the lunate fossa (OR, 3.7; 95%CI, 1.7 to 6.4) and the low-volume of surgeons (OR, 95%CI, 1.2 to 3.6) Conclusions Identification of these factors is of importance for the risk assessment of postoperative complications and the additional need of surgery. For patients with the above factors, especially those with combined risk factors, optimized operation scheme and high-volume surgeon should be considered to prevent or reduce the complications.

Objective To introduce a combined operation for treating chronical peroneal tendon dislocation and to evaluate the clinical outcomes of patients.Methods Data of 12 ankles in 12 patients (male 9,female 3) with chronical peroneal tendon dislocation who underwent the fibular groove deepening procedure with transposition of the peroneal longus muscle from June 2006 to August 2013 were retrospectively analyzed.The mean age was 24.6±4.3 years (range,18-34 years),and there were 3 cases on left side,9 on right side.The mechanism of peroneal tendon injury consisted of sports injuries in 8 and sprains in 4.There were 8 cases of flat fibula sulcus and 4 cases of convex.All patients met the inclusion criteria of a painful snapping or popping sensation or palpable clicking and positive provocation maneuver and without fracture and were treated with peroneal sulcus deepening and peroneal longus tendon transposition.The duration of preoperative popping and pain symptoms ranged from 12 to 23 weeks,with an average of 16.9±4.0 weeks.All cases were treated conservatively 3-4 weeks before operation and were not effective.The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale,visual anologue scale (VAS).Results Twelve patients were followed up with an average period of 37.3± 7.0 (range,25-50)months.The mean VAS scale score of all patients reduced from 5.6±0.9 to 0.5±0.7 at the latest follow-up.The mean AOFAS scale score improved from 61.4±5.6 to 92.6±4.2 at the latest follow-up.The difference between preoperative and postoperative was statistically significant.(t=16.250,-18.475;P=0.000).According to the evaluation of symptom and function scoring system,10 cases were excellent and 2 cases were good,with an excellent rate of 100％.The mean postoperative return-sport time was 26.42±3.06 weeks (range,23-32 weeks).All patients healed primarily and no infection,skin necrosis and residual redislocation occurred.The osteotomy healed completely without displacement,which was confirmed by imaging examination in three months postoperation.No patients had intractable pain after surgery,and they were able to perform daily activities at 3 months and physical exercise at 6 months after surgery.No slip occurred in all patients at the latest follow-up.Conclusion The fibular groove deepening procedure with transposition of the peroneal longus muscle can effectively treat chronical peroneal tendon dislocation and obtain good medium-term results.

Objective To compare and analyze the epidemiological features of Colles fractures in the elderly between Northern and Eastern areas of China from January 2010 to December 2011. Methods Data of Colles fractures treated between January 2010 to December 2011 in 39 hospitals in northern and eastern China were collected through the PACS system and case reports checking system. Data of 18 hospitals in northern China were classified as group northern, while data of 21 hospitals in eastern China were classified as group eastern. Gender, age and side between two groups were compared. Results A total of 2,610 Colles fractures in the elderly were divided into group northern (1,777 cases) and group eastern (833 cases). There were 466 males (17.85%) and 2,144 females (82.15%), with a male/female ratio of 1:4.60 and a median age of 70 years. Left fractures (1,372 cases, 52.57%) were more than the right side (1,238 cases, 47.43%). There were 349 males and 1,428 females in group northern (M/F=1:4.09), and 117 males and 716 females in group eastern (M/F=1:6.12, χ2=12.102, P=0.001). The median age of the two groups were 69 years and 71 years, respectively, with a statistically significant difference (Z=-4.372, P<0.001). The predominant age group in two groups was from 60 to 65 years, accounting for 35.34% (628/1,777) and 29.05% (242/833), respectively. The age distribution had significant differences in patients aged 60-65 years, 81-85 years and ≥86 years between the two groups (χ2=10.094, χ2=5.028, χ2=24.885, P<0.05). There were no significant differences of other age groups between group northern and group eastern. There were more left fractures than right side in group northern and group eastern. Conclusions Colles fractures in elderly were most seen in females and left side. The predominant age group was from 60 to 65 years, accounting for about 1/3 of all injuries. Compared with eastern China, the patients were younger. The male/female ratio and proportion of 60 to 65 years were higher, while the proportion of 81-85 years and ≥86 years was lower. Key words: Aged; Colles'fracture; Radius fractures; Epidemiology; Sex distribution