Pires Robinson Esteves Santos, Mauffrey Cyril, de Andrade Marco Antônio Percope, Figueiredo Leonardo Brandão, Giordano Vincenzo, Belloti João Carlos, dos Reis Fernando Baldy
Department of Orthopaedic Surgery, Federal University of Minas Gerais and Felício Rocho Hospital, Belo Horizonte, MG, Brazil,
Eur J Orthop Surg Traumatol. 2014 Oct;24(7):1297-303. doi: 10.1007/s00590-013-1295-x. Epub 2013 Aug 20.
The gold standard for the surgical management of ankle fractures is through open reduction and internal fixation. The rate of wound problems has been reported to be as high as 18%, especially in patients with poor vascular supply or in diabetics. Minimally invasive percutaneous plate osteosynthesis (MIPPO) has been described as a potential solution for these patients.
This is a prospective observational cohort study. From October 2009 to February 2010, and following ethical approval of our research, adult patients admitted at our level I trauma center with a closed lateral malleolar displaced unstable fracture (Lauge-Hansen supination-external rotation) with or without a medial-sided injury and patients with an undisplaced fracture associated with medial clear space opening on external rotation stress radiographs were recruited and managed using MIPPO technique. All patients were followed up for a minimum of 12 months post-surgery (12-20 with a mean of 16.5 months). Trauma mechanism, comorbidities, classifications, trauma-surgery interval, image intensifier duration, surgery duration, complications, and function American Orthopaedic Foot and Ankle Society (AOFAS) were analyzed.
Thirty-two patients were recruited of which 20 fulfilled the inclusion criteria (16 females, 4 males) and were available for follow-up. Ten fractures (50%) were classified as 44-B1, 7 fractures (35%) as 44-B2, and 3 fractures (15%) as 44-B3 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification (100% were supination-external rotation injuries). At 8 weeks post-surgery, all fractures had healed. The duration of surgery ranged between 15 and 73 min (average 32.8) from skin incision to closure. There were 2 complications (1 malunion and 1 skin necrosis requiring implant removal). At 12-month follow-up, AOFAS average was 88.3 (72-100 standard deviation of 6.8 points).
MIPPO technique proved to be a viable option for lateral malleolar fracture treatment with a low complication rate and high functional outcome at 1 year. It is particularly useful in patients with a high risk of wound complication.
踝关节骨折手术治疗的金标准是切开复位内固定。据报道，伤口问题发生率高达18%，尤其是在血供较差的患者或糖尿病患者中。微创经皮钢板接骨术（MIPPO）已被描述为这些患者的一种潜在解决方案。
这是一项前瞻性观察队列研究。2009年10月至2010年2月，在我们的研究获得伦理批准后，我们一级创伤中心收治的成年患者，若患有闭合性外踝移位不稳定骨折（Lauge-Hansen旋后-外旋型），伴或不伴有内侧损伤，以及在应力位X线片上发现与内侧间隙增宽相关的无移位骨折，则采用MIPPO技术进行招募和治疗。所有患者术后至少随访12个月（12 - 20个月，平均16.5个月）。分析创伤机制、合并症、分类、创伤至手术间隔时间、影像增强器使用时间、手术时间、并发症以及美国矫形足踝协会（AOFAS）功能评分。
共招募32例患者，其中20例符合纳入标准（16例女性，4例男性）并可供随访。根据 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association分类，10例骨折（50%）为44 - B1型，7例骨折（35%）为44 - B2型，3例骨折（15%）为44 - B3型（100%为旋后-外旋型损伤）。术后8周时，所有骨折均愈合。从皮肤切开到缝合，手术时间为15至73分钟（平均32.8分钟）。出现2例并发症（1例畸形愈合和1例皮肤坏死需取出内固定物）。在12个月随访时，AOFAS平均评分为88.3（72 - 100，标准差为6.8分）。
MIPPO技术被证明是治疗外踝骨折的一种可行选择，并发症发生率低，1年时功能预后良好。它对伤口并发症风险高的患者尤其有用。
