Mitchell W G, Shaftan G W, Sclafani S J
J Trauma. 1979 Aug;19(8):602-15.
"Satisfactory reduction" is insufficient in discussing ankle fractures; only perfect anatomic reduction will suffice. Fractures extending into joint surfaces carry a higher incidence of disability than those involving the metaphysis and/or diaphysis. The end result is further adversely affected when such fractures occur in weight-bearing joints with resulting disability from persistent pain and stiffness. It is our belief that anatomic reduction of displaced ankle fractures, especially the restoration of fibular length, is almost impossible by closed reduction. Closed reduction may require frequent manipulation and plaster changes as the swelling subsides, and the fragments become displaced. This encourages ankle and subtalar stiffness. For these reasons mandatory open reduction and rigid internal fixation of these fractures are recommended. A review of 300 nonconsecutive cases of open and closed displaced ankle fractures treated by open reduction had an overall infection rate of 1% and an incidence of degenerative arthritis of 3%.
在讨论踝关节骨折时，“满意复位”是不够的；只有完美的解剖复位才足够。延伸至关节面的骨折比累及干骺端和/或骨干的骨折导致残疾的发生率更高。当此类骨折发生在负重关节时，最终结果会受到进一步不利影响，导致持续疼痛和僵硬而致残。我们认为，对于移位的踝关节骨折进行解剖复位，尤其是恢复腓骨长度，通过闭合复位几乎是不可能的。随着肿胀消退且骨折块发生移位，闭合复位可能需要频繁手法操作和更换石膏。这会导致踝关节和距下关节僵硬。基于这些原因，建议对这些骨折进行强制性切开复位和坚强内固定。对300例采用切开复位治疗的非连续性开放性和闭合性移位踝关节骨折病例的回顾显示，总体感染率为1%，退行性关节炎发生率为3%。
