Mohammed R, Syed S, Metikala S, Ali Sa
Department of Trauma & Orthopedics, Hywel Dda NHS Trust, Carmarthen, United Kingdom.
Indian J Orthop. 2011 Sep;45(5):454-8. doi: 10.4103/0019-5413.83953.
With the length of the fibula restored and the syndesmosis reduced anatomically, internal fixation using a plating device may not be necessary for supra-syndesmotic fibular fractures combined with diastasis of inferior tibio-fibular joint. A retrospective observational study was performed in patients who had this injury pattern treated with syndesmosis-only fixation.
12 patients who had Weber type-C injury pattern were treated with syndesmosis only fixation. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomically reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient had a single tricortical screw fixation across the syndesmosis. Patients were kept non-weight-bearing for 6 weeks, followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective ankle scoring system (Olerud and Molander scale) and by radiographic assessment of the ankle mortise.
At a mean follow-up of 13 months, the functional outcome score was 75. Excellent to good outcomes were noted in 83% of the patients. Ankle mortise was reduced in all cases, and all but one fibular fracture united without loss of fixation. Six patients had more than one malleolar injury, needing either screw or anchor fixations. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of the fibula. This was probably due to early screw removal, before union of the fibular fracture had occurred.
We recommend syndesmosis-only fixation as an effective treatment option for a combination of syndesmosis disruption and Weber type-C lateral malleolar fractures.
随着腓骨长度得以恢复且下胫腓联合解剖复位，对于合并下胫腓关节分离的胫腓联合上方腓骨骨折，使用钢板装置进行内固定可能并非必要。对采用单纯下胫腓联合固定治疗的此类损伤模式患者进行了一项回顾性观察研究。
12例Weber C型损伤模式患者接受了单纯下胫腓联合固定治疗。仅在腓骨长度能够恢复且下胫腓联合能够解剖复位时才遵循该治疗方案。通过经皮或小切口复位并钳夹稳定下胫腓联合，除1例患者外，所有患者均通过单枚三皮质螺钉固定下胫腓联合。患者保持6周不负重，平均8周后取出螺钉。使用客观的踝关节评分系统（Olerud和Molander量表）以及踝关节榫眼的影像学评估来评估结果。
平均随访13个月时，功能结果评分为75分。83%的患者结果为优至良。所有病例的踝关节榫眼均复位，除1例患者外，所有腓骨骨折均愈合且未出现内固定失败。6例患者有多处踝关节损伤，需要螺钉或锚钉固定。1例患者在取出下胫腓联合螺钉后出现晚期分离，并接受了腓骨植骨翻修手术。这可能是由于在腓骨骨折愈合之前过早取出螺钉所致。
我们推荐单纯下胫腓联合固定作为治疗下胫腓联合损伤合并Weber C型外踝骨折的一种有效治疗选择。
