Department of Orthopaedic Surgery, University of Bologna, Instituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy.
Injury. 2010 Nov;41(11):1208-11. doi: 10.1016/j.injury.2010.09.017. Epub 2010 Oct 8.
Post-traumatic malalignment is evident in cases of malunion of ankle fractures. This condition predisposes to the development of chronic pain, functional impairment, and finally post-traumatic arthritis. The aim of this paper is to present a joint-saving surgical treatment of post-traumatic ankle malalignment. It is based on the review of a series of patients who developed fracture malunion and were treated with articular reconstruction. Twenty-two ankle fractures, which malunited and resulted into valgus deformity and fibular shortening are presented. Pre-reconstruction and mid-term follow-up evaluation included the AOFAS score and standard weight-bearing radiographs. Surgical treatment consisted in articular reconstruction with malleolar osteotomies. Post-operatively, the non-weight-bearing period extended to 6 weeks post-surgery, while full weight-bearing was allowed at 12 weeks on average. All osteotomies healed, while no intra-operative or early post-operative complications were reported. The average pre-operative AOFAS score was 45, while post-operatively climbed to 87. At the last follow-up, on average at 5-years post-surgery, 10 patients reported "excellent" function, 7 "good", 3 "fair" and 2 "poor" function. The correction of the malalignment was maintained in 20 cases. The two patients with poor function and loss of reduction underwent ankle fusion. Articular reconstruction with malleolar osteotomies is indicated for the treatment of ankle post-traumatic malalignment, offering reduction of pain, improvement of the ankle function, delaying the development of post-traumatic arthritis, and minimising the need of radical surgery such as ankle fusion or prosthetic replacement. Moreover, once a correct alignment of the joint is achieved, secondary surgery, if necessary, can be performed more easily, and with better results.
创伤后对线不良可见于踝关节骨折的愈合不良。这种情况易导致慢性疼痛、功能障碍，最终发展为创伤性关节炎。本文旨在介绍一种保留关节的创伤后踝关节对线不良的手术治疗方法。该方法基于对一系列因骨折愈合不良而导致关节面不平整和腓骨短缩的患者进行关节重建的回顾性研究。共纳入 22 例踝关节骨折患者，这些患者的骨折愈合不良导致了踝关节内翻畸形和腓骨短缩。术前和中期随访评估包括美国足踝外科协会（AOFAS）评分和标准负重位 X 线片。手术治疗包括踝关节切开复位和距骨截骨术。术后，非负重期延长至术后 6 周，平均 12 周后可完全负重。所有截骨均愈合，无术中或早期术后并发症。术前 AOFAS 评分为 45 分，术后平均提高至 87 分。末次随访时（平均术后 5 年），10 例患者报告“优”，7 例“良”，3 例“可”，2 例“差”。20 例患者对线不良得到了纠正。2 例功能差且复位丢失的患者行踝关节融合术。距骨截骨术关节重建适用于治疗创伤后踝关节对线不良，可减轻疼痛，改善踝关节功能，延缓创伤性关节炎的发展，并减少踝关节融合或假体置换等根治性手术的需要。此外，一旦关节对线得到纠正，如果需要，后续手术可以更轻松地进行，并且可以获得更好的结果。
