Schiffman Eric D, McCarthy Joseph C, Kwon John Y
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
Orthopedics. 2012 Aug 1;35(8):e1290-2. doi: 10.3928/01477447-20120725-38.
This article describes a case of an ankle fracture following hip arthroscopy. A 58-year-old woman underwent hip arthroscopy for a labral tear. She was placed in a lateral decubitus position with her foot in a padded boot. Traction was maintained for approximately 30 minutes. She was instructed to bear weight as tolerated with crutches postoperatively. At 2-week follow-up, she reported ipsilateral ankle pain. Radiographs revealed a minimally displaced medial malleolus fracture. She was treated with a cast followed by a cam walker boot and successfully went on to complete union and resolution of her symptoms. The following risk factors exist for ankle fracture after hip arthroscopy: history of ankle sprains, ligamentous laxity (more common in women), and small feet with large calves (more likely to become plantarflexed during traction). Distraction performed with the ankle rotated is also likely to place added stress on the medial or lateral ligamentous structures. It is important to counsel patients preoperatively about the risk of ankle pain after hip arthroscopy, to be aware of the possibility of ankle pathology postoperatively, and to have a low threshold for ordering radiographs. Radiographs are warranted if patients continue to have ankle pain after 72 hours postoperatively.
本文描述了一例髋关节镜检查后发生踝关节骨折的病例。一名58岁女性因髋臼唇撕裂接受了髋关节镜检查。她被置于侧卧位，足部置于有衬垫的靴子里。持续牵引约30分钟。术后她被指示在能耐受的情况下使用拐杖负重。在术后2周的随访中，她报告同侧踝关节疼痛。X线片显示内踝骨折，移位极小。她接受了石膏固定治疗，随后使用了行走靴，最终成功实现骨折愈合且症状消失。髋关节镜检查后发生踝关节骨折存在以下风险因素：踝关节扭伤史、韧带松弛（在女性中更常见）以及小腿粗壮而足部较小（在牵引过程中更易发生跖屈）。在踝关节旋转的情况下进行牵引也可能会给内侧或外侧韧带结构增加额外压力。术前向患者告知髋关节镜检查后发生踝关节疼痛的风险、术后意识到踝关节病变的可能性并保持较低的X线片检查门槛非常重要。如果患者术后72小时后仍持续存在踝关节疼痛，则有必要进行X线片检查。
