University Hospitals Leuven, Department of Trauma Surgery, Herestraat 49, B-3000 Leuven, Belgium.
University Hospitals Leuven, Department of Trauma Surgery, Herestraat 49, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium.
Injury. 2020 Apr;51(4):1118-1124. doi: 10.1016/j.injury.2020.02.109. Epub 2020 Feb 25.
The necessity for reduction and fixation of posterior malleolus fractures remains under debate. Therefore, we assessed the functional outcome and quality after plate osteosynthesis of the posterior malleolus, identified the main drivers of outcome and aimed to determine which patient and fracture type are eligible for plate osteosynthesis of the posterior malleolus.
A prospective patient cohort of 50 patients with an ankle fracture including the posterior malleolus underwent plate osteosynthesis via a posterior approach, and was compared to a retrospective patient cohort of 85 consecutive patients who did not. Twenty-five demographic, operative and postoperative characteristics were assessed. Outcome was recorded using questionnaires: AOFAS, EQ-5D, EQ-5D-VAS, EQ-5D-TTO, sensory nerve-associated complications, and flexion deficit of the hallux.
Direct reduction and plate osteosynthesis of posterior malleolus fractures was inferior to non-operative treatment. Subanalysis of trimalleolar fractures revealed that the outcome of plate osteosynthesis was equal. Both fracture type and plate osteosynthesis were independent drivers of the outcome; Haraguchi type 3 posterior malleolus fractures were associated with the best functional outcome and quality of life scores. Comorbidity, age, postoperative complications and reintervention largely determined the outcome. Up to 30% of the patients reported (temporarily) flexion deficit of the hallux and 38% numbness at the lateral side of the foot.
There is no indication for routine plate osteosynthesis of all posterior malleolus fractures. Careful patient selection, less invasive surgery and modified postoperative rehabilitation seem mandatory to improve the outcome and prevent adverse effects.
后踝骨折是否需要复位和固定仍存在争议。因此，我们评估了后踝骨折钢板内固定的功能结果和质量，确定了结果的主要驱动因素，并旨在确定哪些患者和骨折类型适合行后踝钢板内固定术。
前瞻性患者队列包括 50 例踝关节骨折患者（其中包括后踝骨折），采用后入路行钢板内固定术，并与 85 例连续未行手术的患者进行回顾性比较。评估了 25 项人口统计学、手术和术后特征。采用 AOFAS、EQ-5D、EQ-5D-VAS、EQ-5D-TTO 量表评估结果，记录感觉神经相关并发症和踇趾活动度受限情况。
直接复位和后踝骨折钢板内固定术的效果不如非手术治疗。三踝骨折的亚组分析显示，钢板内固定术的结果相当。骨折类型和钢板内固定术都是结果的独立驱动因素；Haraguchi 3 型后踝骨折与最佳功能结果和生活质量评分相关。合并症、年龄、术后并发症和再次干预在很大程度上决定了结果。多达 30%的患者报告（暂时）出现踇趾活动受限，38%的患者出现足部外侧麻木。
并非所有后踝骨折都需要常规行钢板内固定术。需要仔细选择患者，采用微创手术，并进行改良的术后康复，以改善结果并预防不良影响。
