Gupta Sandeep, Virk Jagandeep Singh, Malhotra Anubhav, Garg Sudhir Kumar
Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India.
J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019842289. doi: 10.1177/2309499019842289.
Ankle fractures involving posterior malleolus are disabling injuries if not managed properly. Clinical and functional outcome of ankle fractures involving posterior tibial plafond is significantly worse. Although the surgical approach and techniques to reduce and fix this fracture are well described in the literature, there still seems to be divided consensus among orthopedic surgeons regarding the same.
In this case series of eight patients with trimalleolar fractures, a posterolateral approach was used for fixation of posterior malleolus in all the cases. A preoperative computed tomography scan formed an integral part of management of such injuries. The Olerud and Molendar scoring system was employed at 12 months of follow-up to assess the functional outcome. Weight-bearing X-rays were taken to assess for any ankle arthritis.
The average age of patients was 48.8 years. The most common mode of sustaining injury was twisting of the ankle joint ( n = 5). The average time to union and full weight-bearing was 12.8 weeks (range 10-16 weeks). An excellent functional outcome in four patients and a good outcome in the rest of the four patients were obtained at the end of 12 months of follow-up. No significant ankle arthritis or complications were encountered.
Appropriate preoperative imaging evaluation is an integral part of planning for these complex injuries. The posterolateral approach provides good exposure for appropriate visualization. Stable fixation of posterior malleolus in trimalleolar fractures plays a vital role in obtaining a positive clinical and functional outcome.
涉及后踝的踝关节骨折若处理不当会导致功能障碍。涉及胫骨后踝的踝关节骨折的临床和功能预后明显更差。尽管文献中对该骨折的手术入路及复位固定技术已有详尽描述，但骨科医生对此似乎仍存在不同观点。
在这个包含8例三踝骨折患者的病例系列中，所有病例均采用后外侧入路固定后踝。术前计算机断层扫描是此类损伤治疗的重要组成部分。随访12个月时采用奥勒鲁德和莫伦达尔评分系统评估功能预后。拍摄负重X线片以评估是否存在踝关节关节炎。
患者的平均年龄为48.8岁。最常见的受伤方式是踝关节扭伤（n = 5）。平均愈合时间和完全负重时间为12.8周（范围10 - 16周）。随访12个月结束时，4例患者功能预后极佳，其余4例患者预后良好。未出现明显的踝关节关节炎或并发症。
恰当的术前影像评估是这些复杂损伤治疗规划的重要组成部分。后外侧入路能提供良好的暴露以便进行合适的可视化操作。三踝骨折中后踝的稳定固定对获得良好的临床和功能预后起着至关重要的作用。
