BACKGROUND: The treatment for displaced Salter-Harris II (S-H II) distal tibia fractures remains controversial. The purpose of this study was to review S-H II distal tibia fractures and evaluate the rate of premature physeal closure (PPC) treated by open reduction and internal fixation (ORIF).
METHODS: We reviewed the charts and radiographs of S-H II fractures of the distal tibia with displacement > 3 mm between 2012 and 2019 treated by ORIF. Patients were followed up for a minimum of 6 months. CT scans of injured side or contralateral ankle radiograph were obtained if there was any evidence of PPC. Any angular deformity or shortening of the involved leg was documented. Multivariable logistic regression was performed to identify risk factors for the occurrence of PPC.
RESULTS: A total of 65 patients with a mean age of 11.8 years were included in this study. The mean initial displacement was 8.0 mm. All patients but one were treated within 7 days after injury and the mean interval was 3.7 days. Supination-external rotation injuries occurred in 50 patients, pronation-eversion external rotation in 13, and supination-plantar flexion in two. The residual gap was less than 1 mm in all patients following ORIF and all fractures healed within 4-6 weeks. Superficial skin infection developed in one patient. Ten patients complained of the cosmetic scar. The rate of PPC was 29.2% and two patients with PPC developed a varus deformity of the ankle. Patients with associated fibular fracture had 7 times greater odds of developing PPC. Age, gender, injured side, mechanism of injury, amount of initial displacement, interval from injury to surgery, or energy of injury did not significantly affect the rate of PPC.
CONCLUSIONS: ORIF was an effective choice of treatment for S-H II distal tibia fractures with displacement > 3 mm to obtain a satisfactory reduction. PPC is a common complication following ORIF. The presence of concomitant fibula fracture was associated with PPC.

Ankle fractures are common injuries. If an ankle fracture is combined with tibiofibular syndesmosis separation, then tibiofibular transfixation should be used to stabilize the syndesmosis; in such cases, flexible (suture-button) fixation is an option. We surgically treated a male patient\'s unstable ankle fracture with internal fixation devices, including a suture-button fixator, and observed the development of a flexor hallucis longus checkrein deformity in the postoperative period. The aim of this report is to describe this rare postoperative complication associated with the use of suture-button transfixation of the tibiofibular syndesmosis.

Foot-binding was a widespread custom in China for hundreds of years, though the severity and type of binding varied considerably over time and space. To examine the morphological consequences of extremely severe foot-binding, this paper uses 35 sets of bound and 33 sets of unbound foot bones, from the remains of women excavated from the Xinzhi cemetery in northern Shandong Province. Based on macroscopic observation, CT slices, and measurements of bound foot bones, multiple distinctive consequences of foot-binding were identified. Compared with normal bones, bound foot bones have severely reduced overall size and weight. The density of trabecular mesh was reduced and its structure was altered in all tarsal bones. While the talus and navicular bones of bound feet retained all major groups of trabeculae, the calcaneus experienced massive trabecular loss, suggesting that in a bound foot the calcaneus lost its weight bearing function and its role in plantarflexion. The severity of changes was greater in the laterally positioned foot bones, i.e. the lateral cuneiform, the cuboid, and 4th and 5th metatarsals, than in the medial ones, showing that most of the body weight in the bound foot was transmitted along the first ray. Degenerative osteoarthritic changes affected articular surfaces of the foot bones, even in young individuals. These changes suggest that the biomechanics of bipedal locomotion were considerably affected in all females with severely bound feet.

Total calcaneus and talus loss in the hindfoot is an unusual but severe condition encountered in clinical settings. This condition affects lower-extremity function and poses a significant challenge to limb salvage. We present a case of a 43-year-old man with total calcaneus and talus loss in the right foot treated by Ilizarov technique. A staged treatment protocol was planned to reconstruct and optimize the heel for weightbearing and walking. During the 15-month postoperative follow-up, the patient reported no significant discomfort in the targeted foot and regained satisfactory function, including shoe wearing, walking, driving, and climbing stairs. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 71, which was an improvement from a preoperative score of 40. This case is the first reported on the functional reconstruction by Ilizarov technique of hindfoot with total calcaneus and talus loss. This treatment protocol provides an effective approach to reconstructing the hindfoot with massive bone loss, although the long-term outcome remains unknown.

UNASSIGNED: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA.
UNASSIGNED: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet).
UNASSIGNED: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and -6.6% ± 4.8% and -8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064.
UNASSIGNED: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination.
UNASSIGNED: Level II, prospective comparative study.

BACKGROUND: Acute compartment syndrome occurs when pressure within a compartment increases and affects the function of the muscle and tissues after an injury. Compartment syndrome is most common in lower leg and may lead to permanent injury to the muscle and nerves if left untreated.
METHODS: 46 patients with acute compartment syndrome were enrolled, including 8 cases with serious complications, between January 2008 and December 2012. The protocols combining early management and the correction of deformities were adjusted in order to attempt to enable full recovery of all patients.
RESULTS: All patients had necrotic muscles and nerves, damaged vascular, and severe foot deformities. In the early stage, each patient received systemic support and wound debridement to promote wound healing. For patients with serious complications, a number of medical measures, including installation of Ilizarov external frames, arthrodesis, osteotomy fusion, arthroplasty, or tendon lengthening surgery, were performed to achieve satisfactory clinical outcomes. All the patients resumed weight-bearing walking and daily exercises.
CONCLUSIONS: Acute compartment syndrome and sequential complications could be managed using a number of medical procedures.

Macrodactylism or macrodactyly is referred to as congenital deformity of fingers or toes, and the corresponding incidence rate is relatively low. In this article, we describe a young male with macrodactylism of the second toe of his right foot. He was suffering from persistent pain, overgrowth, and hyperhidrosis ofthe involved toe. Radiographic examination of the right foot showed a small translucent area surrounded by hyperplasia and sclerotic bone in the second distal phalanx, in addition to increased soft tissue density and volume. Surgical resection of the bone lesion and reduction of the soft tissue bulk were performed. Pathological findings showed osteoblast hyperplasia, which was diagnosed as osteoid osteoma, and noabnormal findings were seen in the skin. Symptoms of pain and hyperhidrosis disappeared postsurgery and did not recur over the subsequent 2-year follow-up. As far as we know, this was a rare case of osteoid osteoma occurring in the toe that resulted in macrodactylism, which was also associated with localized hyperhidrosis.

BACKGROUND: The purpose of this article was to introduce calcaneal lengthening for partial traumatic loss of the calcaneus. Effectiveness with the use of the technique was also assessed.
METHODS: From January 2013 to May 2016, calcaneal lengthening was performed in 15 patients who sustained a partial traumatic loss of the tuberosity portion of calcaneus. There were 13 men and 2 women with an average age of 36 years (range, 19-53 years). Combined Achilles tendon rupture was noted in 7 patients, and the tendon was reinserted to the calcaneus before calcaneal lengthening. Calcaneal lengthening was performed using an Ilizarov frame. Clinical outcome was assessed based on the American Orthopedic Foot and Ankle score.
RESULTS: The mean loss of calcaneus was 27% (range, 19%-35%). Calcaneal lengthening (mean total time is157 days; range, 111-226 days) included three periods, i.e., latency (mean 7 days; range, 7-9 days), distraction (mean 43 days; range, 32-57 days), and consolidation (mean 108 days; range, 84-162 days). The mean amount of lengthening was 28% (range, 19%-38%). The mean follow-up duration was 25 months (range, 24-27 months). Based on the American Orthopaedic Foot and Ankle, there were 8 excellent, 6 good, and 1 fair result.
CONCLUSIONS: For the treatment of partial traumatic loss of the calcaneus, calcaneal lengthening using an Ilizarov frame is a preferable technique to restore the length of calcaneus and foot function.

OBJECTIVE: To evaluate the short-term effectiveness of Hyprocure subtalar stabilization for adolescent flexible flatfoot.
METHODS: Between December 2013 and September 2015, 14 cases (26 feet) of adolescent flexible flatfoot were treated with Hyprocure subtalar stabilization. There were 10 males (18 feet) and 4 females (8 feet) with the average age of 14.5 years (range, 12-18 years). There were 12 cases (24 feet) of congenital flatfoot and 2 cases (2 feet) of flatfoot caused by neurological diseases. The preoperative pain visual analogue scale (VAS) was 4.2±0.4; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot function score was 72.2±12.3. Simple Hyprocure subtalar stabilization was used in 8 feet, and a combination of minimally invasive percutaneous Achilles tendon lengthening or gastrocnemius lysis, preposing of posterior tibial tendon and spring ligament tightening surgery, or open dorsal medial cuneiform osteotomy and bone graft in 18 feet. The VAS score and AOFAS ankle and foot function score were used to evaluate the effectiveness. The talus-the first metatarsal angle (T1MT), the talus-the second metatarsal angle (T2MT), and talonavicular coverage angle (TCA) were measured on the anteroposterior X-ray film; the Meary\'s angle, calcaneal inclination angle (CI), and the talar declination (TD) were measured on the lateral X-ray film.
RESULTS: All incisions healed well. Two cases (2 feet) had tarsal sinus pain, which was cured after symptomatic treatment. All patients were followed up 5-24 months (mean, 14.5 months). Pain was obviously relieved. At last follow-up, VAS score was significantly decreased to 1.4±0.3 (t=27.676, P=0.000). AOFAS ankle and foot function score was significantly increased to 94.5±10.8 (t=7.765, P=0.000). The postoperative X-ray film showed that medial arch was elevated after the Hyprocure subtalar stabilization was placed in tarsal sinus. At last follow-up, the T1MT, T2MT, TCA, Meary\'s angle, and TD were significantly improved when compared with preoperative ones (P<0.05); CI has no significant improvement (t=0.109, P=0.598).
CONCLUSIONS: Hyprocure subtalar stabilization is simple, effective for adolescent flexible flatfoot, the short-term effectiveness is good. But the indications should be strictly controlled, treatment should be individualized, corresponding auxiliary soft tissue and bone surgery is needed. The long-term effectiveness needs further follow-up.
UNASSIGNED: 探讨应用Hyprocure距下关节稳定器治疗青少年柔韧性平足症的近期疗效。.
UNASSIGNED: 2013年12月-2015年9月，收治青少年柔韧性平足症14例（26足）。男10例（18足），女4例（8足）；年龄12～18岁，平均14.5岁。先天性平足症12例（24足），神经疾病导致平足症2例（2足）。术前疼痛视觉模拟评分（VAS）为（4.2±0.4）分，美国矫形足踝协会（AOFAS）踝与后足功能评分为（72.2±12.3）分。8足单纯应用Hyprocure距下关节稳定器治疗，18足联合经皮微创跟腱延长术或腓肠肌松解术、胫后肌腱前置及弹簧韧带紧缩术或内侧楔骨背侧开放截骨植骨术。采用VAS及AOFAS踝与后足功能评分评价临床疗效，于X线片测量距骨-第1跖骨角、距骨-第2跖骨角、距舟覆盖角、Meary\'s角、跟骨倾斜角及距骨倾斜角。.
UNASSIGNED: 术后患者切口均Ⅰ期愈合。2例（2足）出现跗骨窦区疼痛，经对症处理后疼痛消失。患者均获随访，随访时间5～24个月，平均14.5个月。患足穿鞋、行走时疼痛较术前明显缓解，末次随访时VAS评分为（1.4±0.3）分，与术前比较差异有统计学意义（t=27.676，P=0.000）。AOFAS踝与后足功能评分为（94.5±10.8）分，较术前显著提高（t=7.765，P=0.000）。X线片复查示，距下关节稳定器植入跗骨窦中，内侧足弓高度较术前抬高。末次随访时，距骨-第1跖骨角、距骨-第2跖骨角、距舟覆盖角、Meary\'s角、距骨倾斜角较术前明显改善（P＜0.05）；跟骨倾斜角改善不明显，与术前比较差异无统计学意义（t=0.109，P=0.598）。.
UNASSIGNED: 应用Hyprocure距下关节稳定器操作简便，可有效矫治青少年柔韧性平足症，近期疗效良好，但应严格把握适应证，必要时辅助软组织及骨性手术，远期疗效有待进一步随访。.

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