Spiral fractures of the distal tibia commonly have an associated occult posterior malleolus fracture. Even the careful radiographic examination of the ankle joint, that is mandatory before surgery, may not detect this injury. CT scan or MRI may be a compensative method to detect these injuries. CT scan should be routinely performed in clinical practice.

This minimal invasive procedure featured percutaneous leverage, manual compression, and the application of the anatomic plates and compression bolts through lateral approach is proved to be an effective treatment for displaced intra-articular calcaneal fracture, offering the combination of fewer soft tissue complications and good reduction. With < 3-mm displacement of the posterior facet after reduction, the restoration of the calcaneal width and height can be very important to achieve satisfactory radiologic and functional outcomes.

Objective: To investigate the role of the calcar femorale in stress distribution in the proximal femur.Methods: Twenty-five specimens of proximal femurs were fixed to simulate single-limb stance. Strain gauges were applied to record the strain under different loads. Strain values of 27 selected sites in the proximal femur were recorded and analyzed at the level of 100 N, 200 N, 300 N, 400 N, 500 N, 600 N and 700 N, respectively before and after disruption of the calcar femorale.Results: When a normal load was being borne, strain values measured in the posterior and medial aspects of the proximal femur were greater than those measured in the anterior and lateral aspects, no matter whether the calcar femorale was disrupted or not. However after disruption of the calcar femorale, strain values in the posterior and medial aspects of the proximal femur increased significantly, whereas those of the anterior and lateral aspects decreased significantly. Conclusion:The calcar femorale redistributes stress in the proximal femur by decreasing the load in the posterior and medial aspects and increasing the load in the anterior and lateral aspects.

Pelvic fractures are an uncommon injury in pediatric trauma patients, but the morbidity and mortality associated with these injuries can be profound. Of the posterior pelvic ring disruptions, the posterior dislocation of sacroiliac joint, which is the traditional dislocation of the sacroiliac joint, occurs in most incidences of pediatric trauma patients. There are few reports, however, on the "anterior" dislocation of sacroiliac joint, in which the ilium dislocates anterior to the sacrum and often combines with symphyseal diastasis and fractures of pubic rami and ilia. The distinct fracture-dislocation of sacroiliac joint is a subtype of completed posterior pelvic fracture. Literature review contains little information about such type of dislocation. We present four cases of pediatric trauma patients with the "anterior" dislocation of sacroiliac joint. After a thorough literature review of existing classification of pelvic fractures, we name it as the anterior dislocation of sacroiliac joint.

The sacral pedicel axial view projection is a optimal radiographic technique for percutaneous placement of iliosacral screws in clinical practice. We can get the limpid axial view of pedicel of S1 to applicate this project method, which provides a speedier method with less radiation exposure for percutaneous placement of iliosacral screws.

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We have used magnetic resonance imaging to determine safe drilling directions and depth for plate-screw fixation of the clavicle. On confirmation, these findings could be used in the clinical setting to reduce the risk of inadvertent iatrogenic subclavian neurovascular bundle injury during surgical clavicle fracture repair.