Mason Lyndon William, Kaye Angus, Widnall James, Redfern James, Molloy Andrew
Trauma and Orthopaedic Department, Aintree University Hospital, Liverpool, United Kingdom.
JB JS Open Access. 2019 Jun 7;4(2):e0058. doi: 10.2106/JBJS.OA.18.00058. eCollection 2019 Apr-Jun.
There is increasing acceptance that the clinical outcomes following posterior malleolar fractures are less than satisfactory. We report our results of posterior malleolar fracture management based on the classification by Mason and Molloy.
All fractures were classified on the basis of computed tomographic (CT) scans obtained preoperatively. This dictated the treatment algorithm. Type-1 fractures underwent syndesmotic fixation. Type-2A fractures underwent open reduction and internal fixation through a posterolateral incision, type-2B fractures underwent open reduction and internal fixation through either a posteromedial incision or a combination of a posterolateral with a medial-posteromedial incision, and type-3 fractures underwent open reduction and internal fixation through a posteromedial incision.
Patient-related outcome measures were obtained in 50 patients with at least 1-year follow-up. According to the Mason and Molloy classification, there were 17 type-1 fractures, 12 type-2A fractures, 10 type-2B fractures, and 11 type-3 fractures. The mean Olerud-Molander Ankle Score was 75.9 points (95% confidence interval [CI], 66.4 to 85.3 points) for patients with type-1 fractures, 75.0 points (95% CI, 61.5 to 88.5 points) for patients with type-2A fractures, 74.0 points (95% CI, 64.2 to 83.8 points) for patients with type-2B fractures, and 70.5 points (95% CI, 59.0 to 81.9 points) for patients with type-3 fractures.
We have been able to demonstrate an improvement in the Olerud-Molander Ankle Score for all posterior malleolar fractures with the treatment algorithm applied using the Mason and Molloy classification. Mason classification type-3 fractures have marginally poorer outcomes, which correlates with a more severe injury; however, this did not reach significance.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
后踝骨折后的临床结果不尽人意，这一点越来越被人们所接受。我们报告了基于梅森（Mason）和莫洛伊（Molloy）分类法的后踝骨折治疗结果。
所有骨折均根据术前获得的计算机断层扫描（CT）进行分类。这决定了治疗方案。1型骨折行下胫腓联合固定。2A型骨折通过后外侧切口进行切开复位内固定，2B型骨折通过后内侧切口或后外侧与后内侧联合切口进行切开复位内固定，3型骨折通过后内侧切口进行切开复位内固定。
对50例至少随访1年的患者进行了与患者相关的预后评估。根据梅森和莫洛伊分类法，有17例1型骨折、12例2A型骨折、10例2B型骨折和11例3型骨折。1型骨折患者的平均奥勒鲁德-莫兰德踝关节评分（Olerud-Molander Ankle Score）为75.9分（95%置信区间[CI]，66.4至85.3分），2A型骨折患者为75.0分（95%CI，61.5至88.5分），2B型骨折患者为74.0分（95%CI，64.2至83.8分），3型骨折患者为70.5分（95%CI，59.0至81.9分）。
我们已经证明，使用梅森和莫洛伊分类法应用治疗方案后，所有后踝骨折患者的奥勒鲁德-莫兰德踝关节评分均有所改善。梅森分类3型骨折的预后略差，这与更严重的损伤相关；然而，这并不具有统计学意义。
治疗性IV级。有关证据水平的完整描述，请参阅作者须知。
