Wijendra Asanka, Alwe Rupali, Lamyman Michael, Grammatopoulos George A, Kambouroglou Gregoris
Trauma Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom.
Trauma Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom.
Injury. 2017 Mar;48(3):763-769. doi: 10.1016/j.injury.2016.11.014. Epub 2016 Dec 10.
With an aging but still active population, open ankle fractures are increasingly presenting as low energy fragility injuries, sharing many characteristics with that of hip fractures. Yet, there is little in the literature on the management and outcome of these fractures. The primary aim of this study was to describe the outcome following open, ankle fragility fracture. Our secondary aim was to identify potential factors that improved outcome.
All consecutive, low energy open ankle fractures treated at a Level I Trauma Centre over a five-year period were included. The method of fracture fixation, soft tissue closure, patient demographics, complications and mortality were recorded. Functional outcome was assessed using the Enneking Scoring system.
The cohort comprised 61 patients with a mean age of 73 years (range 27-100); 50 (82%) were females and all patients requiring operative intervention. The overall rate of complication was 24.5% (n=15), with reoperation due to loss of reduction, non-union, infection or amputation required in 7 cases (11.5%). The one-year mortality was 23%. The mean Enneking score, measuring functional outcome, was 36 out of 40 (SD: 6, range: 16-40). It was significantly higher for those treated with internal fixation (37, SD: 5 range: 16-40) than those with external fixation (31, SD: 6 range: 21-38) (p=0.01). Similarly, definitive wound closure - primary closure (37, SD: 5) or flap with split thickness skin graft (SSG) (36, SD: 6) - led to better outcomes than non-definitive closure (31, SD: 8).
The high morbidity associated with low energy ankle fractures is likely to reflect the hosts' reserves and is comparable to other fractures seen in the elderly. It is evident that definitive fracture fixation providing absolute, rather than relative stability; and definitive wound cover, with either primary closure or flap and SSG, enable early mobilization and shorter hospital stays with improved overall functional outcomes.
随着人口老龄化但仍保持活跃，开放性踝关节骨折越来越多地表现为低能量脆性损伤，与髋部骨折有许多共同特征。然而，关于这些骨折的治疗和结果的文献很少。本研究的主要目的是描述开放性踝关节脆性骨折后的结果。我们的次要目的是确定改善结果的潜在因素。
纳入在一级创伤中心接受治疗的连续五年内所有低能量开放性踝关节骨折患者。记录骨折固定方法、软组织闭合情况、患者人口统计学特征、并发症和死亡率。使用Enneking评分系统评估功能结果。
该队列包括61例患者，平均年龄73岁（范围27 - 100岁）；50例（82%）为女性，所有患者均需要手术干预。总体并发症发生率为24.5%（n = 15），7例（11.5%）因复位丢失、骨不连、感染或截肢需要再次手术。一年死亡率为23%。衡量功能结果的平均Enneking评分为40分中的36分（标准差：6，范围：16 - 40）。接受内固定治疗的患者（37分，标准差：5，范围：16 - 40）的评分显著高于接受外固定治疗的患者（31分，标准差：6，范围：21 - 38）（p = 0.01）。同样，确定性伤口闭合——一期闭合（37分，标准差：5）或带分层皮片移植（SSG）的皮瓣（36分，标准差：6）——比非确定性闭合（31分，标准差：8）导致更好的结果。
低能量踝关节骨折相关的高发病率可能反映了宿主的储备能力，与老年人中看到的其他骨折相当。显然，提供绝对而非相对稳定性的确定性骨折固定；以及采用一期闭合或皮瓣和SSG的确定性伤口覆盖，能够实现早期活动并缩短住院时间，同时改善整体功能结果。
