Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Orthop Trauma. 2012 Aug;26(8):e115-22. doi: 10.1097/BOT.0b013e31823bc320.
Long-term evaluation protocolled treatment of pronation external rotation (PER) type III-IV (OTA type C) ankle fractures.
Level III retrospective cohort study.
Level I trauma center.
A consecutive series of 98 patients with PER III-IV ankle fractures between 1985 and 1990.
Stable fractures with tibiotalar congruity were treated conservatively, whereas osteosynthesis was performed in unstable and displaced fractures to restore tibiotalar congruity.
Outcome parameters were (1) functional outcome questionnaire (Olerud score), (2) physical evaluation (loaded dorsal range of motion), (3) functional impairment (AMA Guides, 5th ed.), and (4) radiographic evaluation (Cedell score, medial clear space widening, and osteoarthritis).
After a median of 22 years, follow-up was achieved in 95% (n = 60) of living patients. Four patients had a true PER III injury, 5 patients had an unclear injury (between PER III and IV), and 51 patients (85%) sustained a PER IV injury. Excellent or good results were found in 90% of patients (Olerud score). Functional impairment, expressed as percentage of Whole Person Impairment, varied between 0% and 3%. Patients treated operatively and conservatively had statistically equivalent scores.
The long-term result of surgical treatment of PER ankle fractures is "good" or "excellent" in the majority of patients.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
对旋前外旋（PER）Ⅲ-Ⅳ型（OTA 分型 C）踝关节骨折进行长期随访评估。
Ⅲ级回顾性队列研究。
Ⅰ级创伤中心。
1985 年至 1990 年连续收治的 98 例 PER Ⅲ-Ⅳ型踝关节骨折患者。
对具有距骨胫腓关节一致性的稳定性骨折采用保守治疗，而对不稳定和移位骨折进行骨合成以恢复距骨胫腓关节的一致性。
（1）功能结果问卷（Olerud 评分），（2）体格评估（负重背屈活动范围），（3）功能障碍（AMA 指南，第 5 版），（4）影像学评估（Cedell 评分、内侧间隙增宽和骨关节炎）。
95%（n=60）的存活患者中位随访 22 年。4 例患者为真正的 PER Ⅲ型损伤，5 例患者损伤不明确（介于 PER Ⅲ和 PER Ⅳ之间），51 例（85%）患者为 PER Ⅳ型损伤。90%的患者（Olerud 评分）结果为优或良。功能障碍，以全人损伤百分比表示，在 0%至 3%之间。手术治疗和保守治疗的患者的评分具有统计学等效性。
手术治疗 PER 踝关节骨折的长期结果在大多数患者中为“良好”或“优秀”。
治疗性 IV 级。有关证据水平的完整描述，请参见作者须知。
