| Trimalleolar fracture is one kind of intraarticular fracture that belongs to common injury. There are many complications in operative treatment. If it is healed by plaster or small splint, the poor stability usually makes displacement occur frequently and the result could not reach excellent extent. The patient's quality of life and work ability become worse.There was a theory that making utensil for the diaplasis in 1748 in our nation The kind of science ideology of healing fiactures is a principle about diaplasis and fixation It is emphasized that diaplasis is the basic of treating fiacture. The usage of new appliance for fixation can make the treatment perfect.Since intermediate stage of 1970s, the clinical and scientific researchers of our nation have designed external fixator device for different fractures. The achievement is based on the fiacture treatment achievement of Traditional Chinese Medicine and the theory of modern medicine. The curative effect is satisfying. Threading needles per cutem away from wound and fixing by bracket are the treatment's advantages. No injury of surrounding soft tissue, no destroy of marrow, but good for the treatment of compound fracture. The intension of fiacture fixation can be adjusted in different stages. There are so many distinct advantages. But few intraarticular fiactures can be healed by external fixation device by now.My advisor Wenjianmin healed many bone fractures for several decades. An independent classification of trimalleolar fractures (ICTF) is introduced through a retrospective study. It is on the basis of the experience my advisor has owned that ankle fixation and reposition device (AFRD) is worked out in the end. AFRD is designed according to displacement peculiarity and fixation requirement. Based on the clinical application and biomechanics investigation, the configuration of AFRD is established. A new treatment prescription of trimalleolar fiactures by AFRD and manipulation is established. The mechanism of AFRD is elucidated by biomechanics research. Clinical application is well guided by the results.The independent classification of trimalleolar fractures, advanced development of clinical application of AFRD and biomechanics are concretely studied andresearched in the articles.1. Classification research of trimalleolar fractures1.1 Materials and methodsRadiographs of 42 trimalleolar fractures were studied, and a classification of trimalleolar fractures is concluded according to dislocation of talus and diastasis of distal tibiofibular syndesmosis. Fisher exact test of SAS system is used to compare it with the traditional main classifications. Devise design is cross-sectional study means.1.2 ResultsIn this study, there are 12 trimalleolar fracture cases without dislocation of talus and 30 cases with dislocation of talus. In those with dislocation of talus, 16 with Lateral-Dislocation of Talus; 8 with Lateral-Posterior-Dislocation of Talus; 6 with Posterior-Dislocation of Talus.Trimalleolar fracture can be classified into stable and unstable types. Three sub-types in the unstable types. The details of classification is below: Stable type: without dislocation of talus; without diastasis of distal tibiofibularsyndesmosisUnstable type: with dislocation of talus Type I Lateral-Dislocation of TalusType I a: without diastasis of distal tibiofibular syndesmosis Type I h diastasis of distal tibiofibular syndesmosis Type II Lateral-Posterior-Dislocation of TalusType II a: without diastasis of distal tibiofibular syndesmosis Type lib: diastasis of distal tibiofibular syndesmosis Type III Posterior-Dislocation of TalusType Ella: without diastasis of distal tibiofibular syndesmosis Type II3b: diastasis of distal tibiofibular syndesmosis 1.3Discussion(1) InDanis-Weber Classification, trimalleolar fracture belongs to type B and type C. In Lauge-Hansen Classification, trimalleolar fractures belong to Stage 4 of Supination-External (Eversion) Rotation type, Stage 3 of Pronation-Abduction type(with avulsion fracture of ventral condyle) and Stage 4 of Pronation-Eversion type. In AO classification, trimalleolar fracture belongs to type B3.2, type B3.3, type C1.3 and type C2.3. Cotton fracture actually is trimalleolar fracture with Posterior-Dislocation of Talus. In those traditional classifications, there is not the one only for trimalleolar fracture. No one can tell us dislocation of talus and diastasis of distal tibiofibular syndesmosis.(2)Compared with traditional ankle fracture classification, the independent classification of trimalleolar fractures make diagnosis easy by X-ray films. It is consistent with biomechanics mechanism. As a brief and concise classification, it is mastered easily and useful in the clinical application.(3)The independent classification of trimalleolar fracture can be used in the choice of treatment plan and operation sequence, treatment of diastasis of distal tibiofibular syndesmosis and external fixation device application.(4)Trimalleolar fracture dislocation and displacement rule: After the independent classification of trimalleolar fracture is analyzed, it is found that Unstable type trimalleolar fracture's characteristic is dislocation of Talus. To emphasize the characteristic, Trimalleolar fracture dislocation is denominated especially for it specifically?Displacement rules are:Medial malleolus fracture occurs separating, anterior and interior direction displacement The fibular fracture moves to lateral and posterior direction, with cnspation and external rotation displacement. Posterior malleolus fracture goes upwards and backwards. The talus displacement exits three kind of condition. They are lateral, lateral-posterior and posterior three directions. Diastasis of distal tibiofibular syndesmosis can occur in every trimalleolar fracture dislocation type.(5)Anatomy and mechanics: In trimalleolar fractures, the powerful posterior talofibular ligament makes fibular fracture move to lateral and posterior direction. Distal tibiofibular posterior syndesmosis is more powerful than anterior syndesmosis, so crispation and external rotation occurs frequently. Achilles tendon and talus impact makes posterior malleolus fracture go upwards and backwards. Traction from thedeltoid ligament and tibial spur anterior ligament makes medial malleolus fracture depart and move to anterior and interior direction.While trimalleolar fracture dislocation occurs, talus and fibular fracture move to lateral easily as an entirety. The conjunction of talus and fibular fracture is tightly, so easily move as an entirety. It can be regarded as an Anatomy module. The space and condition of their serious dislocation are usually offered by diastasis of distal tibiofibular syndesmosis and m lateral ovement of fibular fracture.(6)Independent classification of trimalleolar fractures and prognosis: The independent classification of trimalleolar fracture owns special advantages in it's prognosis, but needs more study and research.1.4ConclusionsAn independent classification of trimalleolar fracture exists in trimalleolar fractures objectively. The independent classification of trimalleolar fracture is more useful for clinic and research The independent classification of trimalleolar fractures is simpler and more useful man the old system.2. Advanced development of AFRD2.1 Fixation requirement of AFRD(DVersatility and dexterity;(2)Ad-libitum of threading needles;(3)Adjustability of rigidity;(4)Controllability of space between limbs and AFRD;(5)Independence of groupware.2.2MaterialsofAFRDStainless steel and carbon fibers can be selectable. Stainless steel is used widespread for it's cost reason.2JComponents of AFRDStainless steel rings(circular bases), telescopic linkage rods(struts), heightening stakes, fasten-needle utensils, fasten-needle utensil connectors, T -shape fasten- needle utensil connectors, screw holders, universal joints (globular joints), female screws and threaded bars.2.4Configurations of AFRDAnkle fixation device (AFD—Configuration I ): The main body structure is made up of two stainless steel 1/2 rings connected with three struts. Two heightening-stakes are fixed on the proximal 1/2 ring. Two heighten-stakes and fasten-needle utensil connectors are fixed on distal 1/2 ring.Ankle fixation and reposition device (AFRD—Configuration II ): Proximal end stainless steel 1/2 ring is replaced by one stainless steel full ring. Three-shape fasten-needle utensil connectors are also fixed on it.2.5 Clinical research procedure of AFRD2.6 Function of AFRDAnkle fixation device (Configuration I ) can make ankle fixed well for the treatment of serious ankle fracture and dislocation. Ankle fixation deviceCConfiguration I ) is also used for fusion of joint.Closed reduction and perfect fixation of ankle can be gained by AFRD. Three T-shape fasten-needle utensil connector on ankle fixation and reposition device (Configuration II) can be used as direction targeting. It is convenience for threading needles and fixing. The six needles can fix the fractures well. Distal tibiofibular syndesmosis can be fixed well by olive pine that is connected on the AFRD. 3.CIinic research of treating trimalleolar fracture dislocation by AFRD3.1 Materials and methods36 patients with trimalleolar fracture dislocation fail to be treated by plaster or splint were treated with AFRD. After closed reduction and threading needles, the ankle is fixed by AFRD.Reduction process: Entirety reduction, local reduction and aid of apparatus.Threading needles and fixation methods: entirety reduction transfixation, transfixation for distal tibiofibular syndesmosis, transfixation for fibular fracture, transfixation for Posterior malleolus fracture, transfixation for medial malleolus fracture and sequence of Threading needles.3.2 ResultsAccording to the Leeds classification, the total percentage of excellent and goodclinical outcome is 91.7%, no infection of pinhole* no disunion and mal-union. The advantage of curative effect is obvious by literature contrast.3 JDiscussion and conclusionsCompared with traditional ankle fracture classification, the independent classification of trimalleolar fractures make the cognition of injury mechanism and the displacement rule more deeply. It is full of practicability and pertinency for the treatment.There are many advantages of this method such as reliability of fixation, union swiftness, little injury and good functional recovery.Needles threaded through tibial tubercle, calcaneal tubercle and metatarsal bone, AFRD is installed The ankle is fixed at dorsiflexion neutral position. By the aid of six half needle and olive pine, the good replacement and fixation come true for trimalleolar fracture dislocation. The methods tally with biology fixation principle. Replacement of ankle mortise and talus is also thought of highly.4. Biomechanks investigation of AFRD treatment for trimalleolar fracture dislocation4.1Experiment objectiveSeek the best fixation position for the treatment of trimalleolar fracture.4.2Experiment conditionsCadaver sample, testing experiment machine, deformeter, flake for deformeter, surgical instruments and AFRD.4^Experiment methodTypical model; Lateral-Dislocation of Talus type (Type la ) without diastasisof distal tibiofibular syndesmosis (Stage 4 of Supination-External (Eversion) Rotation type of Lague-Hansen classification). Making model by operation. AFRD is installed and six half needle are used for the good replacement and fixation of trimalleolar fracture dislocatioa Stick straining flake on very down surface of half needle. It is at axial direction and 2.5cm far from fasten-needle utensil. Then guide wire is connected-Ankle joint position is adjusted by AFRD at 9 different positions. They are dorsiflexion-neutral position, dorsiflexion-anastrophe position, dorsiflexion-ecstrophy...
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