Background: The clinical superiority of surgical treatment for acromioclavicular (AC) joint dislocation remains controversial. The aim of this study was to compare the clinical and radiological outcomes of the modified Phemister procedure with CC ligament augmentation using Mersilene tape to those of hook plate fixation for acute AC joint dislocation. Methods: In this study, patients who received modified Phemister surgery with CC ligament augmentation using Mersilene tape (PM group) or hook plate fixation (HK group) for acute unstable AC joint dislocation with a minimum 5-year follow-up period were retrospectively reviewed. The clinical outcomes were evaluated according to blood loss during surgery, surgical duration, visual analogue scale (VAS), Constant-Murley score (CMS), University of California at Los Angeles (UCLA) shoulder rating scale, and the occurrence of complications. Radiological outcomes were assessed from radiographs according to multiple parameters, including CC distance maintenance, acromion osteolysis, and the presence of distal clavicle osteolysis. Results: A total of 35 patients completed follow-up for more than 5 years and were analyzed in this study (mean = 74.08 months). There were 18 patients in the PM group and 17 in the HK group. The PM group exhibited similar improvement in functional outcome to the HK group. Regarding radiological outcomes, the HK group had a superior performance in terms of CC distance maintenance, of statistical significance (CCDR: 94.29 ± 7.01% versus 111.00 ± 7.69%, p < 0.001) after a one-year follow-up period. However, there were 4 cases of acromion osteolysis and 2 cases of distal clavicle osteolysis in the HK group. Conclusion: Hook plate fixation was found to be superior to the modified Phemister technique with CC ligament augmentation using Mersilene tape in terms of CC distance maintenance, but there was no significant difference in the functional outcome after 5 years of follow-up. Both surgical methods are reliable options for the treatment of acute AC joint dislocation. Modified Phemister surgery with CC ligament augmentation using Mersilene tape is a relatively lower-cost option for acute AC joint dislocation without the need of a second surgery for implant removal.

The optimal surgical treatment approach for calcaneal fractures remains controversial. This retrospective comparative study aimed to compare the clinical and radiological outcomes of minimally invasive locking plate fixation with those of screw fixation for displaced intra-articular calcaneus fractures (DIACFs) treated via the sinus tarsi approach (STA). A total of 38 patients and 40 feet with DIACFs from 2015 to 2020 were retrospectively reviewed with a minimum of 3 years of follow-up. Patients were divided into two groups based on fixation method: minimally invasive locking plate fixation (MIP group) versus screw fixation (SW group) (17 vs 23, respectively). The clinical outcomes were evaluated by the Visual Analogue Scale (VAS), Maryland Foot Score (MFS), Olerud-Molander (OM) ankle score, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and occurrence of complications. Radiological outcomes were assessed by radiographs for multiple parameters, including calcaneal height, length, width, and Böhler’s angle. The patients were followed up for an average of 63.37 months. There was no significant difference in the final VAS score, MFS, OM score, AOFAS score, and the total incidence of complications between the two groups (P>0.05). Regarding the radiological outcome, there was also no significant difference in the reduction loss of calcaneal height, length, width, and Böhler’s angle (P>0.05) after a one-year follow-up period. However, the rate of implant removal in the MIP group was significantly greater than that in the SW group (P< 0.05). Minimally invasive locking plate fixation versus screw fixation of DIACFs via sinus tarsi approach may yield comparable radiological and functional outcomes. The screw fixation group suggested a shorter surgical time and lower implant removal rate. Both surgical methods are viable options for DIACFs. However, further large-scale prospective studies are warranted to confirm these results.

Rationale: Blue rubber bleb nevus syndrome (BRBNS) is a rare condition with characteristic vascular malformations of the skin, most frequently lesions of the gastrointestinal tract and central nervous system, and less often, the musculoskeletal system. We report a 5-year case of BRBNS complicated with pathological femoral fracture that was successfully treated with sirolimus. Patient concerns: We report the case of a 1-week-old girl with a diagnosis of BRBNS who had multiple venous malformations over her body. She also presented with right lower-limb swelling and complicated with a pathological femoral fracture. Diagnoses: BRBNS with the complication of pathological femoral fracture. Interventions: Treatment with low-dose sirolimus as an antiangiogenic agent was administered, combined with hip spica protection. Outcomes: The vascular lesion was reduced after about 6 months and the fracture site had healed around 2.5 years after initiation of sirolimus therapy. There were no drug adverse effects at the 5-year follow-up point. The patient showed excellent spirit and no obvious sequelae were found. Lessons: To the best of our knowledge, this is the first report of the successful use of sirolimus in a patient with a pathological femoral fracture related to BRBNS complications.

Rationale: Open talus fracture with extrusion is a rare condition of trauma. We report a 5-year follow-up of an open talus fracture with extrusion associated with a tri-malleolar fracture that was successfully treated with reimplantation and fixation. Patient concerns: We report the case of a 73-year-old female with a diagnosis of left foot open talus fracture with extrusion. She also presented with an ipsilateral ankle tri-malleolar fracture. Diagnoses: Open talus fracture with extrusion and associated with a tri-malleolar fracture. Interventions: Surgery with reimplantation and fixation. Outcomes: The extruded talus was reduced, and the fracture healed approximately 9 months after the operation. There were no adverse effects at the 5-year follow-up point. The patient showed excellent performance, and no obvious sequelae were found. Lessons: To the best of our knowledge, this is the first report of an open talus fracture with extrusion associated with a tri-malleolar fracture.