胫骨平台骨折中的下胫腓联合和下胫腓联合类似损伤。

Syndesmosis and Syndesmotic Equivalent Injuries in Tibial Plafond Fractures.

机构信息

Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT.

Department of Orthopedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA.

出版信息

J Orthop Trauma. 2019 Mar;33(3):e74-e78. doi: 10.1097/BOT.0000000000001363.

DOI:10.1097/BOT.0000000000001363

PMID:30768532

Abstract

OBJECTIVES

To identify the incidence and fracture characteristics associated with syndesmotic injury in tibial plafond fractures and report the incidence of posttraumatic osteoarthrosis (PTOA).

DESIGN

Retrospective comparative study.

SETTING

Two level-1 academic trauma centers.

PATIENTS/PARTICIPANTS: Of the 735 tibial plafond fractures (OTA/AO 43-B3 and 43-C) treated from January 2006 through December 2015, 108 patients (108/735, 15%) were identified with syndesmosis injury.

INTERVENTION

Either acute or missed syndesmotic injury.

MAIN OUTCOME MEASUREMENT

PTOA.

RESULTS

Fourteen fractures (14/735, 2%) had missed syndesmotic injury. Volkmann fragment of ≤10 mm (P = 0.04) and fibular avulsion fracture (P = 0.05) were significantly more common in missed syndesmosis. Ninety fractures (14/14 missed, 76/94 acute) had greater than 12-month follow-up (mean, 26 months; range, 12-102 months). Nearly all patients with missed syndesmosis injury developed arthrosis (13/14, 93%), and 45% (34/76 fractures) of plafond fractures with acute syndesmosis injury developed arthrosis (P < 0.001). Although controlling for malreduction, patients with missed syndesmosis had significantly more PTOA development (P = 0.018). Controlling for malreduction, patients with syndesmotic fixation and a ≤10-mm Chaput or Volkmann fragment or fibular avulsion fracture (8/31, 26%) were less likely to develop PTOA than if they had a similar fracture pattern without syndesmotic fixation (9/10, 90%) (P = 0.011).

CONCLUSIONS

Fifteen percent of tibia plafond fractures have a syndesmosis or syndesmotic equivalent injury. Missed syndesmosis injury has a high rate of PTOA development. Patients with a ≤10-mm Chaput or Volkmann fragment and/or fibular avulsion fracture benefit from syndesmotic fixation.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

确定与胫骨平台骨折相关的下胫腓联合损伤的发生率和骨折特征，并报告创伤后骨关节炎（PTOA）的发生率。

设计

回顾性比较研究。

地点

两个 1 级学术创伤中心。

患者/参与者：2006 年 1 月至 2015 年 12 月，共治疗了 735 例胫骨平台骨折（OTA/AO 43-B3 和 43-C），其中 108 例（108/735，15%）被确定为下胫腓联合损伤。

干预

无论是急性还是漏诊的下胫腓联合损伤。

主要观察指标

PTOA。

结果

14 例（735 例中的 14 例，2%）存在漏诊的下胫腓联合损伤。Volkmann 片段小于或等于 10mm（P=0.04）和腓骨撕脱骨折（P=0.05）在下胫腓联合漏诊中更为常见。90 例（14 例漏诊，94 例急性）骨折获得超过 12 个月的随访（平均 26 个月；范围 12-102 个月）。几乎所有漏诊下胫腓联合损伤的患者都发生了关节炎（13/14，93%），76 例（94 例急性）中只有 45%（34 例）发生了平台骨折关节炎（P<0.001）。尽管控制了复位不良，漏诊下胫腓联合损伤的患者发生 PTOA 的几率明显更高（P=0.018）。在控制复位不良的情况下，下胫腓联合固定且Chaput 或 Volkmann 片段≤10mm或腓骨撕脱骨折的患者（31 例中的 8 例，26%）发生 PTOA 的可能性低于未固定且具有类似骨折模式的患者（10 例中的 9 例，90%）（P=0.011）。