Franke Jochen, von Recum Jan, Suda Arnold J, Vetter Sven, Grützner Paul Alfred, Wendl Klaus
BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany.
Foot Ankle Int. 2014 Dec;35(12):1323-8. doi: 10.1177/1071100714549047. Epub 2014 Sep 8.
In about 25% of cases, reduction of acute unstable syndesmotic injuries and stabilization with syndesmotic screws leads to an inadequate reduction. Conventional fluoroscopy does not provide reliable information about the reduction outcome. However, use of intraoperative 3D imaging can be more accurate. The purpose of this study was to identify predictors of inadequate reduction so that the need for intra- or postoperative 3D imaging could be assessed. Our hypothesis was that complex injuries of the syndesmosis present a higher risk of malreduction than simpler ankle fractures.
From August 2001 to February 2011, 251 unstable syndesmotic injuries were treated from a total of 2286 ankle fractures. In 61 of these cases, malreduction of the fibula into the fibular notch was detected by intraoperative 3D imaging. The influence of all possible concomitant and combination injuries of the ankle joint, surgeon's experience, and potential implant-related effects was analyzed.
Thirty-seven Weber C fractures (60.7%), 13 Maisonneuve fractures (21.3%), 10 Weber B fractures (16.4%), and 1 syndesmotic injury without fracture (1.6%) were included. In 14 cases (23%) there was involvement of the posterior malleolus, in 10 cases of the medial malleolus (16.4%), and in 12 cases both (19.7%). The Weber C fractures included 10 bimalleolar fractures with involvement of the posterior malleolus. In neither this combination nor in any other possible injury configuration was it possible to identify a statistically significant correlation with malreduction of the fibula into the fibular notch. The surgeon's experience or an implant-related effect had no detectable influence either.
Based on the factors studied, it is not possible to conclude whether a patient has an increased risk of malreduction. Therefore we still recommend verifying all reduction outcomes by intraoperative 3D imaging or postoperative computed tomography.
Level III, retrospective comparative study.
在约25%的病例中，急性不稳定型下胫腓联合损伤的复位及下胫腓螺钉固定会导致复位不充分。传统的荧光透视检查无法提供关于复位结果的可靠信息。然而，术中使用三维成像可能会更准确。本研究的目的是确定复位不充分的预测因素，以便评估术中或术后使用三维成像的必要性。我们的假设是，与单纯的踝关节骨折相比，下胫腓联合的复杂损伤出现复位不良的风险更高。
从2001年8月至2011年2月，在总共2286例踝关节骨折中，治疗了251例不稳定型下胫腓联合损伤。在其中61例病例中，通过术中三维成像检测到腓骨在腓骨切迹内复位不良。分析了踝关节所有可能的合并伤和复合伤、外科医生的经验以及潜在的植入物相关影响。
纳入了37例Weber C型骨折（60.7%）、13例 Maisonneuve骨折（21.3%）、10例Weber B型骨折（16.4%）和1例无骨折的下胫腓联合损伤（1.6%）。14例（23%）有后踝损伤，10例（16.4%）有内踝损伤，12例（19.7%）两者均有损伤。Weber C型骨折包括10例伴有后踝损伤的双踝骨折。在这种组合或任何其他可能的损伤类型中，均未发现与腓骨在腓骨切迹内复位不良存在统计学上的显著相关性。外科医生的经验或植入物相关影响也未发现有可检测到的影响。
基于所研究的因素，无法得出患者复位不良风险是否增加的结论。因此，我们仍然建议通过术中三维成像或术后计算机断层扫描来验证所有复位结果。
III级，回顾性比较研究。
