Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
Foot Ankle Int. 2013 Aug;34(8):1128-33. doi: 10.1177/1071100713481457. Epub 2013 Mar 7.
The management of an ossicle or avulsion fragment of the fibular tip in chronic lateral ankle instability is an open question. Some authors maintain the necessity of osteosynthesis for reconstruction of the lateral ligamentous structure if the fragment is large. We hypothesized that the modified Broström procedure with resection of the ossicle would result in good outcomes compared to that of the same procedure for chronic lateral instability patients without ossicle.
Between December 2004 and December 2010, 102 patients underwent the modified Broström procedure for chronic lateral instability. Of these, 82 patients (86 ankles) were available for this study. Forty ankles had ossicles at the fibular tip (group O), 46 had no ossicle (group N). The average follow-up period was 33 months in group O and 37 months in group N. Irrespective of size, if there were ossicles we resected all fragments and performed the modified Broström procedure. To analyze the surgical outcome, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot pain and function scales and Karlsson scores were compared between the 2 groups preoperatively and postoperatively.
Preoperative scores in the 2 groups showed no significant difference, except for AOFAS pain score. There was no significant difference in postoperative AOFAS pain and function score between the groups. Postoperative Karlsson score was significantly higher in group O than in group N (P = .001). Group O was divided into 2 subgroups by the largest diameter of the ossicle (< 10 mm and ≥ 10 mm); there was no significant difference in surgical outcomes.
In the treatment of chronic lateral instability of ankle, if there are ossicles on the fibular tip, osteosynthesis of the ossicles may not be necessary, even if the size is considerable. Modified Broström procedure after resection of the ossicle was successful.
Level III, retrospective case series.
在慢性外侧踝关节不稳定中，对于腓骨末端的小骨或撕脱碎片的处理仍存在争议。一些作者认为，如果碎片较大，为了重建外侧韧带结构，有必要进行骨固定。我们假设，如果存在小骨，采用改良 Broström 手术切除小骨的方法，其结果优于不切除小骨的慢性外侧不稳定患者的相同手术方法。
2004 年 12 月至 2010 年 12 月，102 例慢性外侧踝关节不稳定患者接受了改良 Broström 手术。其中 82 例（86 个踝关节）符合本研究标准。40 个踝关节（组 O）存在腓骨末端小骨，46 个踝关节（组 N）不存在小骨。组 O 的平均随访时间为 33 个月，组 N 的平均随访时间为 37 个月。无论大小如何，如果存在小骨，我们都会切除所有碎片并进行改良 Broström 手术。为了分析手术结果，比较了两组患者术前和术后美国矫形足踝协会（AOFAS）踝-后足疼痛和功能评分及 Karlsson 评分。
两组患者的术前评分除 AOFAS 疼痛评分外，其余均无统计学差异。两组患者的术后 AOFAS 疼痛和功能评分无统计学差异。组 O 的术后 Karlsson 评分明显高于组 N（P =.001）。根据小骨的最大直径（< 10mm 和≥ 10mm），将组 O 进一步分为 2 个亚组，手术结果无统计学差异。
在治疗慢性外侧踝关节不稳定时，如果腓骨末端有小骨，即使小骨较大，也不一定需要进行骨固定。切除小骨后行改良 Broström 手术是成功的。
III 级，回顾性病例系列研究。
