Haaglanden Medical Centre, The Hague, the Netherlands.
Haaglanden Medical Centre, The Hague, the Netherlands.
Injury. 2019 Dec;50(12):2318-2323. doi: 10.1016/j.injury.2019.10.006. Epub 2019 Oct 4.
Type B fibula fractures are the most common type of ankle fractures. Generally, surgical repair is advised for unstable fractures and non-operative treatment for stable fractures. However, evidence on long-term functional outcome of both treatment regimens is lacking. Aim of this study is to compare the long-term outcome in function and pain between patients with an isolated type B fibula fracture treated non-operatively and surgically.
MATERIAL & METHODS: In this retrospective cohort study, all consecutive patients aged between 18 and 75 years, treated non-operatively or surgically between January 2008 and December 2015 for a distal fibula fracture at the level of the syndesmosis without an additional medial or posterior fracture and with a medial clear space ≤6 mm were included. All eligible patients received a questionnaire, composed of the Olerud-Molander Ankle Score (OMAS), the American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS), the Euroqol-5D (EQ-5D) for quality of life and the Visual Analogue Scale (VAS) for pain sensation. With a mean follow-up of 5.3 years, 229 patients were included. For all aspects of the questionnaire, there was no significant difference between non-operative and operative treatment in outcome of function and pain: the EQ-5D score was respectively 0.8 vs. 0.9 (p = 0.72), mean VAS score 0.8 vs. 1.3 (p = 0.09), OMA score 84 vs. 84 (p = 0.98) and for the AOFAS 93 vs. 90 (p = 0.28). 33% of the patients who had surgery had revision surgery for implant removal because of persistent pain complaints. In 3% of the surgically treated patients, a wound infection required intravenous antibiotic treatment. In the non-operatively treated cohort, one patient developed a deep venous thrombosis in the fractured leg.
According to results of this study, in adult patients with an isolated distal fibula and medial clear space ≤6 mm, without proven instability these fractures can safely be treated non-operatively, while avoiding risks and costs of surgery and preserving good long-term outcome in terms of pain and function.
B 型腓骨骨折是最常见的踝关节骨折类型。一般来说，不稳定骨折建议手术修复，稳定骨折建议非手术治疗。然而，这两种治疗方案的长期功能结果的证据都缺乏。本研究的目的是比较非手术和手术治疗单纯 B 型腓骨骨折患者的长期功能和疼痛结果。
在这项回顾性队列研究中，纳入了 2008 年 1 月至 2015 年 12 月期间因下胫腓联合水平无附加内侧或后侧骨折且内侧间隙≤6mm 的单纯腓骨远端骨折接受非手术或手术治疗的连续患者，年龄在 18 至 75 岁之间。所有合格的患者都接受了问卷调查，问卷包括 Olerud-Molander 踝关节评分（OMAS）、美国矫形足踝协会踝关节-后足评分（AOFAS）、欧洲五维健康量表（EQ-5D）生活质量和视觉模拟评分（VAS）疼痛感觉。平均随访 5.3 年后，纳入了 229 名患者。在问卷的所有方面，非手术和手术治疗在功能和疼痛结果方面没有显著差异：EQ-5D 评分分别为 0.8 与 0.9（p=0.72），平均 VAS 评分分别为 0.8 与 1.3（p=0.09），OMAS 评分分别为 84 与 84（p=0.98），AOFAS 评分分别为 93 与 90（p=0.28）。因持续疼痛抱怨而接受植入物取出的翻修手术的患者中，有 33%接受了手术治疗。在接受手术治疗的患者中，有 3%的患者因伤口感染需要静脉抗生素治疗。在非手术治疗组中，有 1 例患者发生骨折腿深静脉血栓形成。
根据这项研究的结果，对于成人孤立性腓骨远端骨折且内侧间隙≤6mm、无明确不稳定的患者，这些骨折可以安全地进行非手术治疗，同时避免手术风险和成本，并保持良好的长期疼痛和功能结果。
