Service d'orthopédie, pôle ostéoarticulaire, CHU Hôtel Dieu, 11, rue Joseph-Caille, 44000 Nantes, France.
Clinique mutualiste Catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France.
Orthop Traumatol Surg Res. 2018 Jun;104(4):507-510. doi: 10.1016/j.otsr.2018.03.008. Epub 2018 Apr 11.
Retrograde transplantar intramedullary nailing (TIMN) is a recently described option for ankle fracture in elderly patients with multiple comorbidity contraindicating classical internal fixation. The main objective of the present study was to assess mobility after TIMN for ankle fracture in the elderly. The secondary objective was to assess complications.
Retrograde TIMN provides reliable fixation of ankle fracture in the elderly, enabling early resumption of walking.
Fourteen patients, with a mean age of 79.6years (range: 65-99years), with fracture of the ankle or tibial pilon treated by retrograde TIMN, were prospectively included over a 1-year period (2014-2016). Full weight-bearing with walking cast boot was authorized as of day 1. Mobility was assessed on Parker score in consultation at 6, 12, 24 and 48 weeks.
Ten patients were followed up. Mean Parker score was 3.6 (range: 1-5) preoperatively, and 2.4 (range: 1-5) and 2.7 (range: 1-5) at 24 and 48 weeks, respectively: i.e., not significantly different from preoperative values (p=0.057 and p=0.054, respectively). There were no decubitus-related complications. Two patients (20%) showed other complications, including 1 deep infection requiring material ablation. Consolidation was systematic, without hindfoot malunion.
Retrograde TIMN appeared to be a useful option for ankle fracture in elderly patients for whom classical internal fixation was contraindicated. It allowed immediate resumption of weight-bearing and early rehabilitation, with no increased morbidity or mortality.
IV.
逆行髓内钉固定（TIMN）是一种最近描述的治疗老年患者伴多种合并症的踝关节骨折的方法，这些合并症禁忌进行传统内固定。本研究的主要目的是评估老年踝关节骨折行 TIMN 后的活动能力。次要目标是评估并发症。
逆行 TIMN 为老年踝关节骨折提供可靠的固定，可早期恢复行走。
在 1 年期间（2014-2016 年），前瞻性纳入了 14 名平均年龄为 79.6 岁（范围：65-99 岁）的患者，这些患者的踝关节或胫骨 pilon 骨折采用逆行 TIMN 治疗。从第 1 天开始，就可以使用负重步行靴进行完全负重。在第 6、12、24 和 48 周时，通过帕克评分进行咨询以评估活动能力。
10 名患者得到了随访。术前平均帕克评分为 3.6（范围：1-5），24 周和 48 周时分别为 2.4（范围：1-5）和 2.7（范围：1-5），与术前值无显著差异（p=0.057 和 p=0.054）。没有褥疮相关的并发症。2 名患者（20%）出现了其他并发症，包括 1 例需要材料切除的深部感染。所有患者均实现了系统性的愈合，没有后足畸形愈合。
逆行 TIMN 似乎是一种治疗禁忌行传统内固定的老年踝关节骨折患者的有用方法。它允许立即恢复负重和早期康复，而不会增加发病率或死亡率。
IV。
