不稳定踝关节骨折中内踝的选择性固定。

Selective fixation of the medial malleolus in unstable ankle fractures.

机构信息

Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.

出版信息

Injury. 2019 Apr;50(4):983-989. doi: 10.1016/j.injury.2019.03.010. Epub 2019 Mar 11.

DOI:10.1016/j.injury.2019.03.010

PMID:30879641

Abstract

BACKGROUND

Whilst the lateral malleolus appears to be crucial in controlling anatomical reduction of the talus, the role of the medial malleolus is less clear. Medial sided complications including infection, damage to local structures and symptomatic hardware are not without morbidity. This study compares the outcomes of patients with bimalleolar or trimalleolar ankle fractures who underwent fibular nail stabilisation with or without medial malleolar fixation.

METHODS

From a prospective single-centre trauma database, we identified 342 patients over a nine-year period who underwent fibular nail insertion to stabilise a bimalleolar or trimalleolar ankle fracture. Isolated lateral malleolar fractures were excluded. Demographic data, clinical outcomes, radiographic evaluation, return to work and sport, and patient reported outcomes, including Olerud-Molander Ankle Score (OMAS), EuroQol-5D (EQ-5D) and Manchester-Oxford Foot Questionnaire (MOXFQ) were collected.

RESULTS

This study included 247 patients with a mean age of 66.7 years (range, 25-96 years), of whom 200 were female (81%). Medial malleolar fixation was not performed in 54 cases (22%). There was no significant difference between groups with respect to failure of fixation (p = 0.634) or loss of talar reduction (p = 0.157). No patient required surgery for a symptomatic medial malleolar non-union. Medial sided complications occurred in 32 (16%) of the fixation group, of whom 20 (10%) required further surgery. At a mean mid-term follow-up of 4.8 years (range, 8 months - 9 years) there was no significant difference between the non-fixation and fixation groups with respect to the median OMAS (85 vs 80; p = 0.885) or median EQ-5D (0.80 vs 0.81; p = 0.846). Patient satisfaction was not significantly different between the two groups (85/100 vs 87/100; p = 0.410).

CONCLUSION

Non-operative management of the medial malleolar component of an unstable ankle fracture treated with a fibular nail may reduce the rate of post-operative complications without compromising the patient reported outcome.

摘要

背景

虽然外踝似乎对控制距骨的解剖复位至关重要，但内踝的作用则不太明确。内侧并发症包括感染、局部结构损伤和有症状的内固定物等，并非没有发病率。本研究比较了接受腓骨钉固定治疗双踝或三踝骨折患者中，行或不行内踝固定的治疗结果。

方法

从一个前瞻性的单中心创伤数据库中，我们在 9 年期间确定了 342 例接受腓骨钉插入以稳定双踝或三踝骨折的患者。排除了单纯的外踝骨折。收集了人口统计学数据、临床结果、影像学评估、重返工作和运动以及患者报告的结果，包括 Olerud-Molander 踝关节评分（OMAS）、EuroQol-5D（EQ-5D）和曼彻斯特-牛津足部问卷（MOXFQ）。

结果

本研究包括 247 例患者，平均年龄 66.7 岁（范围 25-96 岁），其中 200 例为女性（81%）。54 例（22%）未行内踝固定。两组在固定失败（p=0.634）或距骨复位丢失（p=0.157）方面无显著差异。无患者因有症状的内踝骨不连而需要手术。固定组有 32 例（16%）发生内侧并发症，其中 20 例（10%）需要进一步手术。在平均中期随访 4.8 年（范围 8 个月至 9 年）时，非固定组和固定组在 OMAS 中位数（85 与 80；p=0.885）或 EQ-5D 中位数（0.80 与 0.81；p=0.846）方面无显著差异。两组患者满意度无显著差异（85/100 与 87/100；p=0.410）。