Zbeda Robert M, Friedel Steven Paul, Katchis Stuart D, Weiner Lon
Orthopedics. 2020 May 1;43(3):e166-e170. doi: 10.3928/01477447-20200213-01. Epub 2020 Feb 20.
Ankle fractures with a posterior malleolus component are complex injuries. The most commonly used operative methods include indirect reduction via a percutaneous anterior approach and direct reduction via a posterolateral approach. For large posterior malleolus fractures with medial extension, direct reduction via a posteromedial approach is an alternative operative option. The authors hypothesized that fixation of large posterior malleolus fractures via a posteromedial approach results in anatomic reduction and stable plate fixation. From 2008 to 2015, 22 (9.0%) of 244 consecutive operative ankle fractures were identified as posterior malleolus fractures treated using a posteromedial approach. Patient charts were retrospectively reviewed for demographics, operative details, follow-up time, and any postoperative complications. Postoperative radiographs were reviewed to ensure that anatomic reduction and stable fixation was maintained. Sixteen (72.7%) of 22 patients were female, and the average age at the time of surgery was 54.1 years (range, 26-86 years). The average follow-up time was 13.0 months (range, 2.0-41.4 months). Twenty-one (95.5%) of 22 patients healed on a radiographic and clinical basis. There was an 18.2% (4 of 22) postoperative complication rate: 1 patient had a nonunion, 1 patient had cellulitis, 1 patient had osteomyelitis involving the fibula, and 1 patient had symptomatic heterotopic ossification. Open reduction and internal fixation of posterior malleolus fractures via a posteromedial approach achieved anatomic reduction, stable plate fixation, and complete healing in all but 1 patient. This study demonstrates that the posteromedial approach is a reasonable alternative to other more commonly used methods for treating these fractures. [Orthopedics. 2020;43(3):e166-e170.].
伴有后踝骨折块的踝关节骨折是复杂损伤。最常用的手术方法包括经皮前路间接复位和后外侧入路直接复位。对于合并内侧延伸的大型后踝骨折，经后内侧入路直接复位是另一种手术选择。作者推测，经后内侧入路固定大型后踝骨折可实现解剖复位和钢板稳定固定。2008年至2015年期间，在244例连续接受手术的踝关节骨折患者中，有22例（9.0%）被确定为采用后内侧入路治疗的后踝骨折。对患者病历进行回顾性分析，记录患者人口统计学资料、手术细节、随访时间以及任何术后并发症。复查术后X线片，以确保维持解剖复位和稳定固定。22例患者中有16例（72.7%）为女性，手术时的平均年龄为54.1岁（范围26-86岁）。平均随访时间为13.0个月（范围2.0-41.4个月）。22例患者中有21例（95.5%）在影像学和临床检查中愈合。术后并发症发生率为18.2%（22例中有4例）：1例患者出现骨不连，1例患者发生蜂窝织炎，1例患者发生腓骨骨髓炎，1例患者出现有症状的异位骨化。除1例患者外，经后内侧入路切开复位内固定后踝骨折均实现了解剖复位、钢板稳定固定和完全愈合。本研究表明，后内侧入路是治疗这些骨折的一种合理替代方法，可替代其他更常用的方法。[《骨科》。2020；43(3):e166-e170。]
