Panchbhavi Vinod K, Mody Milan G, Mason William T
University of Texas Medical Branch, 301 University Blvd., Rt. 0165, Galveston, TX 77555-0165, USA.
Foot Ankle Int. 2005 Jul;26(7):510-5. doi: 10.1177/107110070502600702.
Internal fixation of osteoporotic ankle fractures is technically difficult and may fail because of unreliable purchase. This study was undertaken to determine if a combination of a hook plate and tibial pro-fibular screws can provide secure fixation until fracture union.
Thirty-one patients between the ages of 55 and 90 years had open reduction and internal fixation of ankle fractures between April, 2001, and April, 2003. Sixteen patients with an average age of 71.4 years had ankle fracture fixation with a combination of hook plate and tibial pro-fibular screws for the distal fibular fracture, and 15 patients with an average age of 71.9 years had fixation of their ankle fractures with standard fixation technique using AO/ASIF principles but no tibial pro-fibular screws. All patients were followed with clinical and radiologic assessment at 2 weeks, 6 weeks, and 12 weeks postoperatively. At an average of 15.8 months after injury, patients also completed a mailed questionnaire with the Olerud-Molander ankle score and the AOFAS ankle-hindfoot score for preoperative and postoperative status.
All patients who had tibial pro-fibular screw fixation had fracture union without hardware failure or complications. In the standard fixation group two patients had wound breakdown and one had a valgus malunion with screw pull out. The AOFAS and Olerud-Molander scores for the standard open reduction and internal fixation were 57.3 and 82.8 before injury and 37 and 43.8 postoperatively, respectively. The AOFAS and Olerud-Molander scores for the hook plate and tibial pro-fibular fixation group were 55.9 and 81.3 before injury and 42.4 and 50.3 postoperatively, respectively.
The combination of hook plate and tibial pro-fibular screws in osteoporotic ankle fractures in a series of patients has not been reported before. This novel technique provides stable fixation for osteoporotic ankle fractures in elderly patients until union is achieved with good clinical scores.
骨质疏松性踝关节骨折的内固定技术难度大，且由于固定不可靠可能失败。本研究旨在确定钩钢板与胫腓联合螺钉联合使用能否提供可靠固定直至骨折愈合。
2001年4月至2003年4月期间，对31例年龄在55至90岁之间的患者进行了踝关节骨折切开复位内固定术。16例平均年龄71.4岁的患者采用钩钢板与胫腓联合螺钉联合固定治疗腓骨远端骨折，15例平均年龄71.9岁的患者采用AO/ASIF标准固定技术但未使用胫腓联合螺钉固定踝关节骨折。所有患者在术后2周、6周和12周进行临床和影像学评估。受伤后平均15.8个月，患者还通过邮寄问卷完成了Olerud-Molander踝关节评分和AOFAS踝-后足评分，以评估术前和术后状况。
所有采用胫腓联合螺钉固定的患者均实现骨折愈合，未出现内固定失败或并发症。在标准固定组中，有2例患者伤口裂开，1例出现外翻畸形愈合且螺钉拔出。标准切开复位内固定组受伤前的AOFAS和Olerud-Molander评分分别为57.3和82.8，术后分别为37和43.8。钩钢板与胫腓联合固定组受伤前的AOFAS和Olerud-Molander评分分别为55.9和81.3，术后分别为42.4和50.3。
此前尚未有关于一系列患者中钩钢板与胫腓联合螺钉联合用于骨质疏松性踝关节骨折的报道。这种新技术为老年骨质疏松性踝关节骨折提供了稳定固定，直至骨折愈合，且临床评分良好。
