Starkweather Michael P, Collman David R, Schuberth John M
Department of Orthopedic Surgery, Kaiser Foundation Hospital, French Campus, 450 6th Avenue, San Francisco, CA 94118, USA.
J Foot Ankle Surg. 2012 Sep-Oct;51(5):575-8. doi: 10.1053/j.jfas.2012.05.022. Epub 2012 Jul 20.
The present retrospective study assessed the complications and loss of reduction in 126 patients aged 16 years or older who bore weight in a short leg cast within 15 days after surgical repair of acute unilateral closed ankle fractures from January 1997 to December 2003. Fracture reduction was assessed on immediate postoperative and weightbearing digital radiographs at least 6 weeks after surgery. The medical records were reviewed for postoperative complications. Complete radiographs were available for 81 patients. The mean follow-up period was 171 (range 42 to 1275) days. The mean patient age was 50 years. Patients began walking an average of 8 days after surgery. From the medical record review, no cases of malunion or nonunion occurred. A total of 14 complications developed in 12 (9.5%) of 126 patients, including a delay in wound healing in 6, nerve paresthesia in 5, and hardware migration in 1. The patients aged 60 years or older had a slightly greater overall complication rate (6 of 38, p = .18). Patients who walked on postoperative day 1 had slightly more wound problems (2 of 19, p = .36). Of the 81 ankle fracture radiographs, 80 (98.8%) showed no displacement in fracture reduction on the final follow-up examination. One patient had a 2-mm loss of fracture reduction and was allowed to walk on postoperative day 1 (p = .09). These results support early protected weightbearing after operative treatment of closed isolated lateral malleolar and bimalleolar ankle fractures without syndesmotic involvement in patients of all ages.
本回顾性研究评估了1997年1月至2003年12月期间，126例16岁及以上急性单侧闭合性踝关节骨折手术修复后15天内接受短腿石膏固定并负重的患者的并发症及复位丢失情况。术后即刻以及术后至少6周负重时拍摄数字X线片评估骨折复位情况。查阅病历以了解术后并发症情况。81例患者有完整的X线片资料。平均随访期为171天（范围42至1275天）。患者平均年龄为50岁。患者术后平均8天开始行走。通过病历查阅，未发现骨不连或骨畸形愈合病例。126例患者中有12例（9.5%）共出现14种并发症，包括6例伤口愈合延迟、5例神经感觉异常和1例内固定物移位。60岁及以上患者的总体并发症发生率略高（38例中有6例，p = 0.18）。术后第1天开始行走的患者伤口问题略多（19例中有2例，p = 0.36）。在81张踝关节骨折X线片中，80张（98.8%）在最终随访检查时显示骨折复位无移位。1例患者骨折复位丢失2 mm，术后第1天即被允许行走（p = 0.09）。这些结果支持对所有年龄组无下胫腓联合损伤的闭合性单纯外踝和双踝踝关节骨折患者进行手术治疗后早期保护性负重。
