Gloucester Royal Hospital, Gloucester, Gloucestershire, UK.
Injury. 2013 Jul;44(7):994-7. doi: 10.1016/j.injury.2012.11.008. Epub 2012 Dec 11.
Fragility fractures of the ankle are increasing in incidence. Such fractures typically occur from low-energy injuries but lead to disproportionately high levels of morbidity. Ankle fractures in this age group are managed conservatively in plaster or by open reduction and internal fixation. Both modalities have shown high rates of failure in terms of delayed union or mal-union together with perioperative complications such as implant failure and wound breakdown. The optimal treatment of these patients remains controversial.
We aimed to review the functional outcome of patients with ankle fragility fractures primarily managed using a tibio-talar-calcaneal nail (TTC).
We retrospectively reviewed 31 consecutive patients primarily managed with a TCC nail for osteoporotic fragility fractures about the ankle. Data were collected via case notes, radiographic reviews and by clinical reviews at the outpatient clinic or a telephone follow-up. Information regarding patient characteristics, indication for operation, Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture classification, operative and postoperative complications, time to radiographic union and current clinical state including Olerud and Molander scores were recorded (as a measure of ankle function).
Nine of 31 patients had died by the time of follow-up. Mean preoperative and postoperative Olerud and Molander scores were 56 and 45, respectively. There were no postoperative wound complications. Twenty-nine of 31 patients returned to the same level of mobility as pre-injury. There were three peri-prosthetic fractures managed successfully with nail removal and replacement or plaster cast. There were two nail failures, both in patients who mobilised using only a stick, which were managed by nail removal. Ten of 31 patients were not followed up radiographically due to either infirmity or death. Thirteen of 21 followed up radiographically had evidence of union and 8/21 had none. None, however, had clinical evidence of fracture nonunion.
The TTC nail can successfully be used to manage fragility fractures about the ankle in the elderly. Much like fractured neck of femur patients, who also have a high rate of mortality, this allows immediate mobilisation with minimal risk of wound complications. However, careful assessment must be made of each patient's mobility, as there is a significant incidence of device failure in the more active patient.
踝关节脆性骨折的发病率正在上升。此类骨折通常由低能量损伤引起，但会导致发病率异常高。该年龄段的踝关节骨折通过石膏或切开复位内固定保守治疗。这两种方法在延迟愈合或畸形愈合方面的失败率都很高，同时还伴有围手术期并发症，如植入物失败和伤口破裂。这些患者的最佳治疗方法仍存在争议。
我们旨在回顾主要采用胫距跟骨钉（TTC）治疗的踝关节脆性骨折患者的功能结果。
我们回顾性分析了 31 例连续患者，他们主要采用 TCC 钉治疗踝关节骨质疏松性脆性骨折。数据通过病历、影像学检查以及门诊或电话随访的临床检查收集。记录患者特征、手术指征、 Arbeitsgemeinschaft für Osteosynthesefragen（AO）骨折分类、手术和术后并发症、影像学愈合时间以及目前的临床状态（包括 Olerud 和 Molander 评分）（作为踝关节功能的衡量标准）。
随访时，31 例患者中有 9 例死亡。术前和术后平均 Olerud 和 Molander 评分分别为 56 分和 45 分。无术后伤口并发症。31 例患者中有 29 例恢复到与受伤前相同的活动水平。有 3 例假体周围骨折，通过去除并更换钉或石膏固定成功治疗。有 2 例钉失败，均发生在仅使用手杖活动的患者中，通过去除钉治疗。由于体弱或死亡，31 例患者中有 10 例未进行影像学随访。21 例中有 13 例影像学显示有愈合迹象，8 例没有。然而，没有一例有骨折不愈合的临床证据。
TTC 钉可成功用于治疗老年踝关节脆性骨折。与股骨颈骨折患者非常相似，后者的死亡率也很高，这种方法允许在最小化伤口并发症风险的情况下立即活动。然而，必须仔细评估每位患者的活动能力，因为在活动能力较强的患者中，设备失败的发生率较高。
