Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for M.B. Berkes:
J Bone Joint Surg Am. 2013 Oct 2;95(19):1769-75. doi: 10.2106/JBJS.L.00949.
With regard to supination-external rotation type-IV (SER IV) ankle fractures, there is no consensus regarding which patient, injury, and treatment variables most strongly influence clinical outcome. The purpose of this investigation was to examine the impact of articular surface congruity on the functional outcomes of operatively treatment of SER IV ankle fractures.
A prospectively generated database consisting of operatively treated SER IV ankle fractures was reviewed. Postoperative computed tomography (CT) scans were used to assess ankle joint congruity. Ankles were considered incongruent in the presence of >2 mm of articular step-off, intra-articular loose bodies, or an articular surface gap of >2 mm (despite an otherwise anatomic reduction) due to joint impaction and comminution. Patients with at least one year of clinical follow-up were eligible for analysis. The primary and secondary outcome measures were the Foot and Ankle Outcome Score (FAOS) and ankle motion.
One hundred and eight SER IV fractures met our inclusion criteria. The average duration of follow-up was twenty-one months. Seventy-two patients (67%) had a congruent ankle joint, and thirty-six (33%) had elements of articular surface incongruity on postoperative CT scanning. These two groups were similar with regard to comorbidities and injury and treatment variables. At the time of the final follow-up, the group with articular incongruity had a significantly worse FAOS with regard to symptoms (p = 0.012), pain (p = 0.004), and activities of daily living (p = 0.038). Those with articular incongruity had worse average scores in the FAOS sport domain as well. No significant differences in ankle motion were found between the two groups.
In this population of patients with an operatively treated SER IV ankle fracture, the presence of postoperative articular incongruity correlated with inferior early clinical outcomes. Orthopaedic surgeons should scrutinize ankle fracture reductions and strive for perfection to allow for the best possible clinical outcome.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
对于旋后外旋型 IV 度（SER IV）踝关节骨折，目前对于哪些患者、损伤和治疗变量对临床结果影响最大尚无共识。本研究旨在探讨关节面吻合度对手术治疗 SER IV 踝关节骨折的功能结果的影响。
对接受手术治疗的 SER IV 踝关节骨折的前瞻性生成数据库进行了回顾。术后 CT 扫描用于评估踝关节关节吻合度。如果存在>2mm 的关节台阶、关节内游离体或>2mm 的关节面间隙（尽管解剖复位），则认为踝关节不吻合，这是由于关节挤压和粉碎导致的。有至少一年临床随访的患者符合分析条件。主要和次要结局测量指标是足踝结果评分（FAOS）和踝关节活动度。
符合纳入标准的 SER IV 骨折共有 108 例。平均随访时间为 21 个月。72 例（67%）患者踝关节吻合，36 例（33%）患者术后 CT 扫描显示存在关节面不吻合的因素。这两组在合并症和损伤及治疗变量方面相似。在最终随访时，关节不吻合组 FAOS 的症状（p=0.012）、疼痛（p=0.004）和日常生活活动（p=0.038）方面明显更差。关节不吻合组 FAOS 运动域的平均评分也较差。两组踝关节活动度无显著差异。
在这组接受手术治疗的 SER IV 踝关节骨折患者中，术后存在关节不吻合与早期临床结果较差相关。矫形外科医生应仔细检查踝关节骨折复位情况，并努力追求完美，以获得最佳的临床结果。
治疗性 IV 级。请参阅作者说明，以获取完整的证据水平描述。
