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Background There is still some controversy about the augmentation of the inferior extensor retinaculum after arthroscopic anterior talofibular ligament repair. The aim of this study was to evaluate the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques for chronic lateral ankle instability. Methods Thirty-four cases with grade-2 or grade-3 chronic anterior talofibular ligament lesions who underwent the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques were assessed retrospectively. A total of 30 cases (30 ankles) were followed up for a mean of 26.67 ± 4.19 months (range, 24—36 months). four cases were excluded due to insufficient medical records or loss of follow-up reports. The Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were evaluated before surgery and at the final follow-up time. Also, the results of stress fluoroscopic tests and complications were recorded. Results At the final follow-up, the average of the Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were 86.63 ± 6.69 (range, 77—100), 90.17 ± 4.64 (range, 85—100) and 0.53 ± 0.63 (range, 0—2), respectively. Moreover, the results of stress fluoroscopic tests were improved significantly after surgery. Mild keloid formation and/or knot irritation were observed in four cases. No wound infections, nerve injuries and recurrent instability were recorded. Also, no stiffness or arthritis of the subtalar joint was encountered. Conclusions The arthro-Broström procedure combined with endoscopic retinaculum augmentation using all-inside lasso-loop techniques is reliable and safe due to the advantage of direct endoscopic visualization.

Purposes The aim of surgical treatment for ZoneⅡsacral fractures is to rebuild the stability of the pelvis and prevent complications. Iliosacral screw and minimally invasive percutaneous plate all can used in ZoneⅡsacral fractures. Screw fixation under 3D navigation was increasingly adopted to improve surgical accuracy and safety. 3D Navigation is more accurate, has shorter surgical time, and has less radiation exposure than conventional X-ray in sacral fractures fixation. Therefore, this study aimed to compare the efficacy of percutaneous iliosacral screw fixation under 3D navigation with minimally invasive percutaneous plate fixation in the treatment of ZoneⅡsacral fractures.Methods Records of patients with ZoneⅡsacral fractures were extracted from the case system. Patients with 3D-navigation-guided percutaneous screw fixation (A fixation group) and minimally invasive percutaneous plate (B fixation group) were included. Patients' injury severity score (ISS), operative time, intra-operative blood loss, length of hospital stay, follow-up time, time to weight bearing, time to clinical healing, and complications were recorded. Matta criteria were used to assess fracture reduction outcomes. Functional outcomes were assessed using the Majeed grading system. X-rays were used to assess fracture displacement and healing. Results Thirty-five patients in group A and twenty-nine patients in group B were included in this study. Operative time, intra-operative blood loss, length of hospital stay were lower in the A fixation group than in the B fixation group. No significant differences were found between the two groups in ISS, time from admission to operation, time to weight bearing, time to clinical healing, Matta scores, or Majeed scores at follow-up.Conclusions Based on the results of this study, we conclude that these two methods can achieve satisfactory clinical results in the treatment of ZoneⅡsacral fractures. 3D-navigation-guided percutaneous screw fixation has a faster operative time, less blood loss, and shorter hospital stay. In clinical work, we suggest a good option for the treatment of ZoneⅡsacral fractures with percutaneous iliosacral screws under 3D-navigation. It is also suitable for patients with vertical displacement and dysmorphic sacral, with careful and adequate preoperative evaluation preplanning.

Background Because of the peculiar anatomy and complex geometry of this region, surgical treatment of acetabular fractures involving quadrilateral plate is a challenge to orthopaedic surgeons. Many scholars consider that quadrilateral plate exist a absolute “dangerous zone” for screw placement and have designed a variety of buttress plates to control medial displacement of the quadrilateral surface. In order to achieve the safe and effective fixation in quadrilateral plate, we have developed a novel fixation technique using a special shaped reconstruction plate combined with several buttress screws of quadrilateral plate which was called Dynamic Anterior Plate-Screw System for Quadrilateral plate (DAPSQ) since 2005(RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, a set of anatomical titanium plate(ATP group) of DAPSQ have been designed and applied for the treatment of quadrilateral plate fractures. The aim of this study was to compare the efficacy of anatomical titanium plate versus the reconstruction plate in the treatment of quadrilateral plate fractures. Methods We led a propensity-matched cohort study of quadrilateral plate fractures, and twenty-two patients were treated with anatomical titanium plate of DAPSQ in the inclusion period(2016-2018), and were matched to 22 cases in our database of RP group(2008-2016). The primary outcome measures were quality of reduction and functional outcome. Intraoperative conditions included surgical time, bleeding, and blood transfusion and the postoperative complications were also compared. Results Of these 22 consecutive patients in ATP group, the mean age was 46.7 years and the most common fracture pattern was a both-column fracture(12cases, 54.5%) according to Letournel-Judet classification. The mean follow up period was 23.1 months (range 12-37). There was no significant differences between the two groups with regards the quality of reduction using the Matta radiological criteria and functional outcomes evaluated by the modified Merle d’Aubigné score(P>0.05). Compared with the RP group, the ATP group has a short operation time(245.1 minutes vs. 286.8 minutes, P = 0.020), less intraoperative blood loss(1136.4 mL vs. 1777.3mL, P = 0.014) and transfusion(780.9 vs. 1256.8mL, P = 0.035). The complication rate was 22.7% in ATP group, and there was no significantly difference compared with the RP group(54.5%)(P>0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure. Conclusions The fixation of anatomical titanium plate in quadrilateral plate fractures showed similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. But the utility of anatomical titanium plate had the advantages of shorter operation time, less bleeding and transfusion which is worthy to recommend.