Wang Xu, Zhang Chao, Yin Jian-Wen, Wang Chen, Huang Jia-Zhang, Ma Xin, Wang Cheng-Wei, Wang Xue
Department of Orthopaedic Surgery, Huashan Hospital of Fudan University, Shanghai, China.
Department of Orthopaedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Orthop Surg. 2017 Feb;9(1):42-48. doi: 10.1111/os.12318. Epub 2017 Mar 10.
To investigate the effect of internal fixation on postoperative ankle function in patients with supination-external rotation type IV ankle fractures, including medial malleolus fractures and deltoid ligament injury.
Between January 2012 and June 2014, patients with medial structure injuries were enrolled in this study and assigned to the medial malleolus fracture group or the deltoid ligament group. The surgical procedures for the two groups were documented. The follow-up endpoint was the time point when the steel plate or screw was removed from the lateral ankle. The Olerud-Molander ankle scoring system was used to assess ankle function.
A total of 84 patients with supination-external rotation type IV ankle fractures had complete medical records and were included in this study. The average age of the patients was 44.16 years (range, 15-75). The patient sample included 39 males and 45 females. Overall, 49 patients (19 males and 30 females) suffered a medial malleolus fracture. The average age of these patients was 40.20 years (range, 15-75). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 81.6% (40 patients) of these patients. Overall, 35 patients (20 males and 15 females) experienced a deltoid ligament injury. The average age of these patients was 44.21 years (range, 17-73). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 11.5% (four patients) of these patients. Open reduction was performed in patients with medial malleolus fractures, and two 4.0-mm cannulated screws were used to fixate the posterior malleolus and the medial malleolus. The suture-anchor technique was used to repair the ligaments in patients with deltoid ligament injuries. The follow-up endpoint was the time point when the steel plate and screws were removed from the lateral ankle in patients. The average follow-up period was 13.4 months (range, 11-17). The Olerud-Molander ankle scoring system was used to assess postoperative ankle function. The average score for the patients in the medial malleolus fracture group was 90.3 points (range, 85-95). The average score for the patients in the deltoid ligament injury group was 87.7 points (range, 80-95). No significant differences were found in the scores between the two groups.
Medial malleolus fracture and deltoid ligament injury are two different presentations of supination-external rotation type IV ankle fractures. Anatomic reduction of the articular surface concurrent with restoration of ankle stability can achieve favorable results for these two injuries.
探讨内固定对旋后-外旋IV型踝关节骨折患者术后踝关节功能的影响，此类骨折包括内踝骨折和三角韧带损伤。
2012年1月至2014年6月，纳入有内侧结构损伤的患者并分为内踝骨折组或三角韧带组。记录两组的手术过程。随访终点为从外踝取出钢板或螺钉的时间点。采用Olerud-Molander踝关节评分系统评估踝关节功能。
共有84例旋后-外旋IV型踝关节骨折患者有完整病历并纳入本研究。患者平均年龄44.16岁（范围15 - 75岁）。患者样本包括39例男性和45例女性。总体而言，49例患者（19例男性和30例女性）发生内踝骨折。这些患者的平均年龄为40.20岁（范围15 - 75岁）。后踝骨折块大于关节面25%的患者占这些患者的81.6%（40例）。总体而言，35例患者（20例男性和15例女性）发生三角韧带损伤。这些患者的平均年龄为44.21岁（范围17 - 73岁）。后踝骨折块大于关节面25%的患者占这些患者的11.5%（4例）。内踝骨折患者行切开复位，使用两枚4.0毫米空心螺钉固定后踝和内踝。三角韧带损伤患者采用缝线锚钉技术修复韧带。随访终点为患者从外踝取出钢板和螺钉的时间点。平均随访期为13.4个月（范围11 - 17个月）。采用Olerud-Molander踝关节评分系统评估术后踝关节功能。内踝骨折组患者的平均评分为90.3分（范围85 - 95分）。三角韧带损伤组患者的平均评分为87.7分（范围80 - 95分）。两组评分无显著差异。
内踝骨折和三角韧带损伤是旋后-外旋IV型踝关节骨折的两种不同表现形式。关节面解剖复位并同时恢复踝关节稳定性对这两种损伤均可取得良好效果。
