Testa Gianluca, Ganci Marco, Amico Mirko, Papotto Giacomo, Giardina Serena Maria Chiara, Sessa Giuseppe, Pavone Vito
Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico - Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy.
Eur J Orthop Surg Traumatol. 2019 Aug;29(6):1325-1330. doi: 10.1007/s00590-019-02430-6. Epub 2019 Apr 9.
Trimalleolar fractures are a common injury of the ankle that require surgical treatment to obtain an anatomic reduction of both malleoli and stabilization of the syndesmosis. This study aims to report the outcomes of surgical treatment for trimalleolar fractures, identifying the risk factors determining a worse result.
Between January 2013 and December 2016, 48 patients with trimalleolar fracture treated with open reduction and internal fixation were retrospectively analyzed. The mean age was 44.69 years, and average body mass index (BMI) was 29.04. According to the Danis-Weber classification, 30 (62.5%) fractures were type B and 18 (37.5%) were type C. Clinical and radiographic evaluations at 3, 6, and 12 months were assessed. The functional results of Visual Analogue Staircases and Olerud-Molander (O&M) ankle score were reported.
No significant difference was found among the size of the PM in patients with and without ankle dislocation (p = 0.364). Therefore, there is no correlation between the size of the posterior fragment and the ankle dislocation and the size of the posterior malleolus and syndesmosis stability (p = 0.328). Age over 61 years, BMI > 40, ASA > 1, type C fracture, and fracture dislocation were considered as negative prognostic fractures.
Surgical treatment for trimalleolar fractures needs accurate preoperative planning. Age over 61 years, BMI > 40, ASA > 1, type C fracture, and fracture dislocation were considered as negative prognostic fractures.
三踝骨折是常见的踝关节损伤，需要手术治疗以实现双踝的解剖复位和下胫腓联合的稳定。本研究旨在报告三踝骨折的手术治疗结果，确定导致较差结果的危险因素。
回顾性分析2013年1月至2016年12月间48例行切开复位内固定治疗的三踝骨折患者。平均年龄为44.69岁，平均体重指数（BMI）为29.04。根据Danis-Weber分类，30例（62.5%）骨折为B型，18例（37.5%）为C型。评估了术后3、6和12个月的临床及影像学表现。报告了视觉模拟阶梯评分和奥勒鲁德-莫兰德（O&M）踝关节评分的功能结果。
有或无踝关节脱位患者的后踝骨折块大小无显著差异（p = 0.364）。因此，后踝骨折块大小与踝关节脱位及后踝大小和下胫腓联合稳定性之间无相关性（p = 0.328）。年龄超过61岁、BMI > 40、美国麻醉医师协会（ASA）分级> 1、C型骨折及骨折脱位被视为预后不良的骨折。
三踝骨折的手术治疗需要精确的术前规划。年龄超过61岁、BMI > 40、ASA分级> 1、C型骨折及骨折脱位被视为预后不良的骨折。
