The Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, People's Republic of China.
The Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, People's Republic of China.
Injury. 2019 Nov;50(11):2108-2112. doi: 10.1016/j.injury.2019.07.006. Epub 2019 Jul 22.
To introduce a new method for intraoperative detection of rotational malreduction of the lateral malleolus using conventional fluoroscopy.
From January 2014 to December 2017, 56 Weber type C unstable lateral malleolar fractures with syndesmosis injury were identified. The fibular fracture patterns were simple oblique or transverse in 20, comminuted in 25, and Maisonneuve injury with fibular neck fractures in 11 cases. 47 cases were operated with ORIF, and 9 cases of Maisonneuve fractures were operated with CRIF. The mortise view of the contralateral uninjured ankle was used for intraoperative comparison. Two indexes were applied for fluoroscopic detection of distal fibula malrotation, i.e. the contour profile change in lateral malleolar shape, and the intrinsic structure appearance of lateral malleolar fossa cortex. Postoperative talofibular joint congruency was measured on axial CT scan to confirm the reduction quality.
Using the two radiographic parameters for intraoperative fluoroscopic evaluation, we finally achieved satisfying reduction and fixation of the lateral malleolus in all 56 cases. A more spoon-shaped fibula profile and disappearance of the lateral fossa cortex shadow indicates an internal rotation, while a more pointed blade-shaped fibula profile and disappearance of lateral fossa cortex shadow indicates an external rotation. Postoperative CT scanning identified distal fibular no rotation in 44 cases (78.6%), mild rotation less than 5° in 12 cases (21.4%), with 7 cases internal rotation (mean 3.1°) and 5 cases external rotation (mean 2.8°).
Using conventional intraoperative fluoroscopy on mortise view, new radiographic parameters can provide reliable method to detect rotational malreduction of the lateral malleolus.
介绍一种利用常规透视术中检测外踝旋转移位的新方法。
自 2014 年 1 月至 2017 年 12 月，共发现 56 例 Weber 分型 C 型不稳定外踝骨折合并下胫腓联合损伤。腓骨骨折模式简单斜行或横行 20 例，粉碎性骨折 25 例，Maisonneuve 损伤合并腓骨颈骨折 11 例。47 例采用切开复位内固定（ORIF）治疗，9 例 Maisonneuve 骨折采用经皮复位内固定（CRIF）治疗。术中比较对侧未受伤踝关节的跗骨间视图。应用两种影像学指标检测腓骨远端旋转不良，即外踝形态轮廓改变和外踝窝皮质固有结构外观。术后通过轴位 CT 扫描测量距下关节吻合度，以确定复位质量。
使用术中透视评估的两个影像学参数，最终我们成功地使所有 56 例患者的外踝都得到了满意的复位和固定。腓骨更呈匙形轮廓且外踝窝皮质阴影消失提示内旋，而更呈尖锐刀片形轮廓且外踝窝皮质阴影消失提示外旋。术后 CT 扫描发现 44 例（78.6%）无旋转移位，12 例（21.4%）轻度旋转移位小于 5°，7 例内旋（平均 3.1°），5 例外旋（平均 2.8°）。
利用常规术中跗骨间透视，新的影像学参数可以为检测外踝旋转移位提供可靠的方法。
