Kukkonen Juha, Heikkilä Jouni T, Kyyrönen Timo, Mattila Kimmo, Gullichsen Eero
Department of Traumatology, Turku University Central Hospital, Finland.
J Trauma. 2006 May;60(5):1058-60. doi: 10.1097/01.ta.0000196700.74272.10.
It is known that posterior malleolar fracture is often associated with tibial diaphyseal fractures. However, in literature there are very few studies on tibial shaft fractures with respect to posterior malleolus fragment. We hypothesized that the incidence of posterior malleolar fracture is higher than in previous studies.
A total of 74 closed tibial shaft fractures were treated with intramedullary nailing in Turku University Central Hospital between January 1994 and December 1998. There were 55 men and 19 women, with a mean age of 39 years (range, 16 to 58 years). Two cases were excluded and 72 tibial shaft fractures were analyzed retrospectively.
Posterior malleolar fracture was observed in 18 cases (25.0%). Only 10 were observed preoperatively in plain films, seven were detected postoperatively and one was not detected at all during the treatment. Retrospectively, all 18 posterior malleolar fractures were detectable in preoperative plain films.
A fracture of the posterior malleolus was involved in every fourth tibial diaphyseal fracture. The fractures of the posterior malleolus were always detected in preoperative plain films and should be suspected, especially in cases of low-energy spiral distal tibial diaphyseal fractures. We recommend additional plain films to be taken at the ankle region to better visualize these fractures.
已知后踝骨折常与胫骨干骨折相关。然而，关于胫骨干骨折伴后踝骨折块的文献研究非常少。我们推测后踝骨折的发生率高于以往研究。
1994年1月至1998年12月期间，图尔库大学中心医院共对74例闭合性胫骨干骨折行髓内钉固定治疗。其中男性55例，女性19例，平均年龄39岁（范围16至58岁）。排除2例，对72例胫骨干骨折进行回顾性分析。
18例（25.0%）观察到后踝骨折。术前X线平片仅观察到10例，术后发现7例，治疗期间1例完全未被发现。回顾性分析显示，术前X线平片可发现所有18例后踝骨折。
每四例胫骨干骨折中就有一例合并后踝骨折。后踝骨折在术前X线平片中总能被发现，应予以怀疑，尤其是低能量螺旋型胫骨干远端骨折。我们建议在踝关节区域加拍X线平片以更好地显示这些骨折。
