Panchbhavi Vinod K, Gurbani Barkha N, Mason Candace Bailey, Fischer Wayne
Professor and Chief, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX.
Resident, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX.
J Foot Ankle Surg. 2018 Jan-Feb;57(1):91-94. doi: 10.1053/j.jfas.2017.08.013.
Given the high prevalence of ankle fractures and morbidity of malalignment after fixation, an appropriate anatomic relationship between the distal fibula and adjacent tibia and talus is important. The tip of the lateral malleolus of the fibula has often been described to be at the level of the lateral talar process. However, no studies to date have examined the relationship of the distal fibular tip to the lateral process of the talus. We assessed 66 weightbearing mortise radiographs for variability of the distal fibular tip in relation to the lateral process of the talus. The subjects were all skeletally mature, with a mean age of 45.3 ± 14.6 years. We used a paired t test with a null hypothesis that the true mean difference in the distance from the distal fibula to the lateral process was equal to 0. The mean distance of the distal tip of the fibula was 0.257 ± 0.127 cm proximal to the tip of the lateral process of the talus. The 95% confidence interval was 0.226 to 0.288. Of the 66 subjects, 65 had the distal tip of the fibula proximal to the lateral process of the talus, corresponding to a negative fibular variance. In the remaining subject, the distal tip of the fibula was at the same level of the tip as the lateral process of the talus. The distal tip of the fibula is most commonly not at the level of the talus lateral process, as often described in published reports. Instead, it has a variance analogous to the relationship between the lengths of the ulna compared with the radius. The distal tip of the fibula in our study was more often proximal to the tip of the lateral process of the talus and can be described as a negative fibular variance, or "fibula minus."
鉴于踝关节骨折的高发病率以及固定后对线不良的发病率，腓骨远端与相邻胫骨和距骨之间适当的解剖关系很重要。腓骨外侧踝尖通常被描述为位于距骨外侧突的水平。然而，迄今为止尚无研究探讨腓骨远端尖与距骨外侧突的关系。我们评估了66张负重位踝关节正位X线片，以研究腓骨远端尖相对于距骨外侧突的变异性。受试者均为骨骼成熟者，平均年龄为45.3±14.6岁。我们使用配对t检验，原假设为腓骨远端到外侧突的距离的真实平均差等于0。腓骨远端尖的平均距离在距骨外侧突尖近端0.257±0.127cm处。95%置信区间为0.226至0.288。在66名受试者中，65名的腓骨远端尖位于距骨外侧突近端，对应于腓骨负变异。在其余一名受试者中，腓骨远端尖与距骨外侧突尖处于同一水平。腓骨远端尖最常见的情况并非如已发表报告中经常描述的那样与距骨外侧突处于同一水平。相反，它具有类似于尺骨与桡骨长度关系的变异。在我们的研究中，腓骨远端尖更常位于距骨外侧突尖的近端，可描述为腓骨负变异，即“腓骨短”。
