Kheiran Amin, Roberts Veronica, Rana Balvinder, Mangwani Jitendra
Leicester Orthopaedics, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, LE1 5WW, UK.
Foot and ankle surgery unit, Max Hospitals, Gurgaon and Saket, New Delhi, India.
J Clin Orthop Trauma. 2020 May-Jun;11(3):422-425. doi: 10.1016/j.jcot.2020.03.022. Epub 2020 Apr 8.
Unstable ankle fractures are common, and majority requires open reduction and internal fixation (ORIF). There is emerging evidence that the rate of malreduction has remained high despite advances in surgical techniques and implants. Malreduced ankle is a prominent cause of post-traumatic ankle arthritis leading to poor patient reported outcome. The aim of this study was to investigate the quality of anatomical reduction and surgical fixation of ankle fractures and the impact of simple education intervention on the quality of reduction of these fractures.
An audit cycle was completed in two phases; retrospective review (phase 1) of 114 cases operated prior to an education intervention using infographic posters and then a prospective (phase 2) review of 96 consecutive cases operated after the education intervention. Data including age, fracture morphology, time to surgery, and the quality of reduction were assessed. The quality of anatomical reduction was evaluated using radiological parameters described by Pettrone. Paediatric, Weber A, pathological and open fractures were excluded. Education interventions included regional teaching and dissemination of infographic posters. Mann- Whitney test and Chi-squared test were used to compare continuous and categorical data between phase 1 and 2 respectively. P value < 0.05 was considered significant.
Phase one cohort showed malreduced fixation in 25% of cases. Inadequate restoration of fibular length was the most common type of malreduction. After implementation of education intervention, malreduction rate reduced to 9.4% in phase 2 (p = 0.015). There were no significant differences between age, gender, and time to surgery between phase one and two.
This study demonstrates that simple education intervention can lead to better understanding of fixation and decrease the rate of malreduction of these fractures. We recommend that using Pettrone's radiological criteria in correction of corresponding anatomy of ankle fracture is a useful tool to avoid malreduction.
不稳定型踝关节骨折很常见，大多数需要切开复位内固定（ORIF）。有新证据表明，尽管手术技术和植入物有所进步，但复位不良率仍然很高。踝关节复位不良是创伤后踝关节炎的一个突出原因，导致患者报告的预后较差。本研究的目的是调查踝关节骨折的解剖复位质量和手术固定情况，以及简单教育干预对这些骨折复位质量的影响。
一个审计周期分两个阶段完成；对114例在使用信息图表海报进行教育干预之前接受手术的病例进行回顾性审查（第1阶段），然后对96例在教育干预之后接受手术的连续病例进行前瞻性审查（第2阶段）。评估包括年龄、骨折形态、手术时间和复位质量等数据。使用Pettrone描述的放射学参数评估解剖复位质量。排除小儿、Weber A型、病理性和开放性骨折。教育干预包括区域教学和信息图表海报的传播。分别使用Mann-Whitney检验和卡方检验比较第1阶段和第2阶段的连续数据和分类数据。P值<0.05被认为具有统计学意义。
第1阶段队列显示25%的病例存在复位不良固定。腓骨长度恢复不足是最常见的复位不良类型。实施教育干预后，第2阶段复位不良率降至9.4%（p = 0.015）。第1阶段和第2阶段在年龄、性别和手术时间方面没有显著差异。
本研究表明，简单的教育干预可以提高对固定的理解，并降低这些骨折的复位不良率。我们建议在纠正踝关节骨折相应解剖结构时使用Pettrone的放射学标准是避免复位不良的有用工具。
