Department of Orthopaedic Surgery, Meir Medical Center, Tel-Aviv University, Kfar-Saba, Israel.
Int Orthop. 2013 Mar;37(3):447-50. doi: 10.1007/s00264-012-1745-9. Epub 2013 Jan 17.
Anatomical reduction and fixation of unstable ankle fractures is necessary to prevent post-traumatic arthritis. Malunion of the distal fibula in unstable ankle fractures can lead to late degenerative changes of the ankle. Late reconstruction of the ankle can improve its function and postpone the need for ankle fusion or replacement.
We discuss three patients who presented with fibular malunion. All developed medial gutter opening, syndesmotic widening, and lateral shift and/or talar tilt. Surgery involved an anteromedial approach to clean the medial gutter, an anterolateral approach to clean the syndesmotic interval, elongation of the fibula by six to eight millimetres and stabilisation with a cervical spine cage and a locked plate.
After one year, all patients had radiologically demonstrated reduction of the talus in the mortise. Improved function was recorded at final follow up. The cage provides several advantages over other fixation methods, including osteoconductive properties, avoiding bone graft donor site morbidity, and the range of sizes allows the surgeon to adjust the amount of elongation.
Using spinal cages to treat malunited fibula fractures has several advantages compared to bone graft and good results can be expected.
为了预防创伤后关节炎，不稳定踝关节骨折需要进行解剖复位和固定。不稳定踝关节骨折中腓骨的愈合不良会导致晚期踝关节退行性改变。晚期踝关节重建可以改善其功能，推迟踝关节融合或置换的需要。
我们讨论了 3 例出现腓骨愈合不良的患者。所有患者均出现内踝间隙增宽、下胫腓联合增宽、外移和/或距骨倾斜。手术采用前内侧入路清理内踝间隙，前外侧入路清理下胫腓联合间隙，腓骨延长 6-8 毫米，用颈椎 cage 和锁定板固定。
1 年后，所有患者的距骨在跗骨中均显示出放射学上的复位。最终随访时记录到功能改善。与其他固定方法相比，cage 具有几个优势，包括骨诱导特性、避免供骨区并发症，并且有多种尺寸可供选择，允许外科医生调整延长量。
与植骨相比，使用脊柱 cage 治疗愈合不良的腓骨骨折具有几个优势，并且可以预期良好的效果。
