UniversitätsCentrum für Orthopädie und Unfallchirurgie (OUC), Universitätsklinikum Carl Gustav Carus, Dresden.
Z Orthop Unfall. 2021 Jun;159(3):323-331. doi: 10.1055/a-1079-6476. Epub 2020 Feb 10.
Even minor residual fragment malpositioning after internal fixation of ankle fractures is associated with a worse prognosis. Frequent causes for non-anatomical reduction are fibular shortening due to comminuted fractures or poor bone quality, translational or rotational malpositioning of the distal fibula within the tibial incisura with unstable syndesmosis injuries, and inadequately addressed bony avulsions of the tibiofibular syndesmosis. After operative treatment of fracture dislocations with syndesmotic fixation, in case of complex fracture pathoanatomy, and with suspected non-anatomic reduction in postoperative radiographs, computed tomography imaging of both ankles should be performed. Correction of relevant malreductions should be performed as early as possible in order to speed up rehabilitation and to avoid late sequelae due to a load shift or instability in a weight-bearing joint.
即使踝关节骨折内固定后有轻微的残余骨折块位置不良，也与预后较差有关。导致解剖复位不佳的常见原因包括：粉碎性骨折或骨质量差导致腓骨短缩，下胫腓联合不稳定损伤时腓骨远端在胫骨切迹内发生平移或旋转错位，以及下胫腓联合骨撕脱未得到充分处理。对于下胫腓联合固定治疗的骨折脱位，在复杂的骨折病理解剖和术后 X 线片怀疑解剖复位不佳的情况下，应同时对双侧踝关节进行 CT 成像。对于相关的复位不良，应尽早进行矫正，以便加快康复，并避免因承重关节负荷转移或不稳定而导致的晚期后遗症。
