Rammelt S, Heim D, Hofbauer L C, Grass R, Zwipp H
Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
Unfallchirurg. 2011 Oct;114(10):847-60. doi: 10.1007/s00113-011-1978-x.
Ankle fractures are the most frequent injuries of a load-bearing joint. Their treatment belongs to the daily routine in trauma surgery. However, despite an increased understanding of the mechanism of injury and relatively straightforward fixation techniques, the medium- to long-term results are often less than satisfactory. The following article therefore explicitly focusses on unsolved problems and controversies in the treatment of ankle fractures in the light of the current literature. These include the therapeutic and prognostic relevance of frequently used classification systems, criteria for the indication for surgery, frequent hazards in internal fixation, the question of whether and how to fix the posterior malleolus, and the detection and treatment of syndesmotic instability. Furthermore, trauma surgeons face the increasing incidence of ankle fractures in the elderly. The presence of osteoporosis, diabetes mellitus and neuropathic osteoarthropathy represents a special challenge.
踝关节骨折是承重关节最常见的损伤。其治疗属于创伤外科的日常工作。然而，尽管对损伤机制的理解有所增加，且固定技术相对简单，但中长期结果往往不尽人意。因此，以下文章根据当前文献明确聚焦于踝关节骨折治疗中尚未解决的问题和争议。这些问题包括常用分类系统的治疗和预后相关性、手术指征标准、内固定常见风险、是否以及如何固定后踝的问题，以及下胫腓联合不稳的检测和治疗。此外，创伤外科医生面临着老年人踝关节骨折发病率不断上升的问题。骨质疏松症、糖尿病和神经性骨关节病的存在带来了特殊挑战。
