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Objective: To investigate clinical effects of minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate., Methods: From February 2016 to March 2017, 32 patients with mid-lateral 1/3 clavicle fractures treated by minimally-invasive internal fixation with distal clavicular anatomic locking plate, including 24 males and 8 females with an average of (42.3±12.7) years old (ranged from 22 to 68 years old). According to Robinson classification, 6 patients were type 2A2, 18 patients were type 2B1 and 8 patients were type 2B2. No vessel and nerve injury occurred before operation. The time from injury to operation ranged from 0 to 6 days with an average of (3.1±1.4) days. Length of bilateral clavicule were compared before and after operation to evaluate fracture reduction. Constant score at 6 months after operation was applied to assess recovery of shoulder function., Results: Thirty patients were followed up from 11 to 18 months with an average of (13.3±2.2 ) months. No vessel and nerve injury, implant failure, nonunion or delayed union occurred after operation, and facture wound healed at stage I, the time ranged from 8 to 12 weeks with an average of(10.2±1.1) weeks. Shortened length of clavicle decreased from(11.2±3.6) % before operation to (0.4±0.3)% after operation at 2 days. Ten patients removed internal fixation at 8 months after operation without re-fracture occurred after remove plate. Constant score increased from 23.53±5.21 before operation to 94.30±5.60 after operation at 6 months, and 26 patients got excellent results, and 4 good. Patients were satisfied aesthetic degree of scar and shoulder joint function., Conclusions: Minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate, which has advantages of less trauma, rapid recover, less scar, could receive good clinical effects and not effect beauty., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To explore surgical method and clinical effects of descending branch of the anterior lateral malleolar artery based anterograde island flap for repairing foot and ankle wounds., Methods: Nine patients with skin defects of foot and ankle repaired by descending branch of the anterior lateral malleolar artery based anterograde island flap were studied from June 2015 to January 2017, including 6 males and 3 females aged from 32 to 63 years old. The wound were located on foot and ankle and associated with exposure of bone, tendon, blood vessels or nerves. The surface of wound located on foot in 6 patients, and 3 patients in ankle joint. The area of defect ranged from 1.5 cm×2.0 cm to 6.0 cm×13.0 cm, and the area of flap ranged from 2.0 cm×3.0 cm to 7.0 cm×15.0 cm. The donor site was skin grafted with split-thickness skin from abdomen. Appearance, texture, condition of donor site of island flaps after operation were observed, satisfied degree of clinical effects were evaluated by ZHANG Hao's evaluation, and AOFAS score were used to evaluate function., Results: Circulations of flaps in 9 cases were stable without blockage, and healed well at 2 weeks after operation. All patients were followed up from 2 to 18 months with an average of(8.0±2.3) months. All flap were survived at stage I, pedicles looked smooth and tidy, no cat-ear formed, the texture of flap was soft with satisfied appearance, the color was near to surrounding skin. The surface of wound were tidy after skin graft of donor sites without scar hypertrophy. Nine patients got satisfied results according to ZHANG Hao's evaluation, and AOFAS score was excellent., Conclusions: Descending branch of the anterior lateral malleolar artery based anterograde island flap for repairing foot and ankle wounds, which has advantages of protect main vessel, thin flap, is a simple and effective method., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To explore the operation methods and clinical effects of transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament in treating complete acromioclavicular joint dislocation., Methods: From January 2006 to June 2012,26 patients with acute complete acromioclavicular joint dislocation underwent surgery. Transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament, additional clavical hoot plate and Kirschner wires fixation, were performed in all the patients. Among the patients, 18 patients were male and 8 patients were female, with an average age of 36.7 years old (ranged from 25 to 51 years). The duration from injury to operation was from 3 to 12 days with an average of 5 days. According to the Rockwood classification, 4 cases were grade III and 22 cases were grade V . Clinical manifestation included local swelling, tenderness with snapping, limitation of shoulder joint motion. In preoperative bilateral shoulder joint X-rays, the injured coracoclavicular distance was (16.2 ± 5.0) mm which was significantly wider than that of uninjured sides (7.6 ± 1.0) mm. Clinical results were evaluated according to X-rays and Constant-Murley score., Results: All incisions obtained primary healing after operation without complication of infection, internal fixation breakage, redislocation. All the patients were followed up from 12 to 30 months with an average of 18 months. Kirschner wires and internal fixation plate were removed at 1 month and 8-10 months after operation, respectively. At final follow-up, the motion of shoulder joint recovered to normal and a no pain joint was obtained. According to Constant-Murley score, 24 cases got excellent results and 2 cases good. There was no significant difference after operation between the injured coracoclavicular distance and the uninjured contralateral side [(7.7 ± 1.2) mm vs (7.6 ± 1.0) mm), P > 0.05]., Conclusion: Transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament, additional fixation using hook plate and Kirschner wires is the effective surgical method in treating complete acute acromioclavicular joint dislocation.

Objective: To investigate possible causes of micromotion in distal femoral prosthesis., Methods: Based on the assumption that the femur and prosthesis were considered as concentric cylinders with completely bonded interface, a theoretical model simulating the interfacial stress transfer was established. The distributions of the interfacial shear and radial stresses with the changing of z were obtained through mathematics and mechanics deducing., Results: The maximum interfacial shear stress occurred at the position of z=0, namely, the cross section of the femur neck. The interfacial shear stress sharply decreased with the increasing of z and came to nearly zero at the range of z> 0.1 m. While the interfacial radial stress increased with the increasing of z,at the range of z >0.05 m it was constant and reached the maximum., Conclusion: The micromotion in distal prosthesis is caused by the interfacial radial stress.