Jaskulka R A, Ittner G, Schedl R
2nd Clinic of Trauma Surgery, University of Vienna, Austria.
J Trauma. 1989 Nov;29(11):1565-70. doi: 10.1097/00005373-198911000-00018.
One hundred forty-two patients with malleolar fractures were followed up for an average of 5.7 years postoperatively. In 80 cases (56.4%) we found no lesion of the distal articular surface of the tibia; 62 patients (43.6%) had a fracture of the posterior tibial margin. Both groups were closely matched with regard to fractures of the lateral and medial malleolus. The long-term results were significantly poorer when a fracture of the posterior tibial margin was additionally present, even in cases with a small marginal fragment of the lip of the tibia. Further, we found a clear relationship between the articular involvement and the incidence of post-traumatic osteoarthrosis in cases with no additional osteosynthesis of the fragment. In cases of larger fragments, the long-term results after anatomic reduction and additional osteosynthesis were on the whole far better than in cases treated conservatively.
142例踝关节骨折患者术后平均随访5.7年。80例（56.4%）患者未发现胫骨远端关节面损伤；62例（43.6%）患者存在胫骨后缘骨折。两组在内外踝骨折方面匹配良好。即使存在胫骨唇小边缘骨折块，当合并胫骨后缘骨折时，长期结果明显更差。此外，在未对骨折块进行额外内固定的病例中，我们发现关节受累与创伤后骨关节炎的发生率之间存在明确关系。对于较大骨折块的病例，解剖复位及额外内固定后的长期结果总体上远优于保守治疗的病例。
