Mahapatra Piyush, Rudge Ben, Whittingham-Jones Paul
Surgeon, Trauma and Orthopaedic Department, West Hertfordshire Hospital NHS Trust, Watford General Hospital, Watford, UK.
Surgeon, Trauma and Orthopaedic Department, West Hertfordshire Hospital NHS Trust, Watford General Hospital, Watford, UK.
J Foot Ankle Surg. 2018 Sep-Oct;57(5):1005-1009. doi: 10.1053/j.jfas.2017.11.037. Epub 2018 Mar 13.
The case we present suggests that it might be possible to overcompress the syndesmosis, causing subluxation of the talus within the ankle mortise. A 26-year-old female patient had had a Weber Type C ankle fracture internally fixed with a lateral plate and syndesmosis screws. Despite the fibula appearing well reduced and computed tomography imaging showing a well-aligned fibula within the fibular notch, anteromedial subluxation of the talus was present in the ankle mortise. Examination with the patient under anesthesia revealed a stable syndesmosis fixation; however, talar malpositioning was not affected by the foot position. The syndesmosis fixation was revised sequentially. As the fixation was relaxed sequentially, the talus appeared to reduce within the ankle mortise, with restoration of the previously obliterated medial clear space. The syndesmosis was stabilized with a single 3.5-mm cortical screw in a reduced position. The patient had made a full recovery at the 12-month follow-up examination, having undergone elective syndesmosis screw removal at 12 weeks postoperatively. Several studies have suggested that it might not be possible to overcompress the syndesmosis and have even advocated the use of a lag screw technique for syndesmosis fixation. Based on the present case, we would advise a degree of caution with this approach, because it might be possible to overcompress the syndesmosis and cause significant subluxation of the tibiotalar articulation.
我们所呈现的病例表明，可能会过度压缩下胫腓联合，导致距骨在踝关节 mortise 内半脱位。一名26岁女性患者因 Weber C 型踝关节骨折接受了外侧钢板和下胫腓联合螺钉内固定。尽管腓骨复位良好，计算机断层扫描成像显示腓骨在腓骨切迹内排列整齐，但踝关节 mortise 内仍存在距骨前内侧半脱位。在麻醉下对患者进行检查发现下胫腓联合固定稳定；然而，距骨的位置异常不受足部位置的影响。下胫腓联合固定依次进行了翻修。随着固定依次放松，距骨在踝关节 mortise 内似乎复位了，先前消失的内侧间隙也恢复了。在下胫腓联合复位的位置用一枚3.5毫米皮质骨螺钉进行了稳定固定。患者在术后12周进行了选择性下胫腓联合螺钉取出术，并在12个月的随访检查中完全康复。几项研究表明，可能无法过度压缩下胫腓联合，甚至主张使用拉力螺钉技术进行下胫腓联合固定。基于本病例，我们建议对此方法保持一定程度的谨慎态度，因为可能会过度压缩下胫腓联合并导致胫距关节明显半脱位。
