Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jingan District, Shanghai, China.
Biomed Res Int. 2020 Jul 29;2020:2903537. doi: 10.1155/2020/2903537. eCollection 2020.
The aim of this study was to investigate the respective correlation between the height () of a posterior malleolar fracture (PMF) and the involved area () of an articular surface and the presence of "die-punch."
Patients with closed posterior malleolar fractures admitted to our hospital from January 2015 to December 2017 were selected, with complete X-ray and 3D reconstruction CT imaging data. The gender, age, injured side, and surgical fixation methods of the patients were recorded. A preoperative ankle CT scan was performed, and the images were viewed through the PACS (Picture Archiving and Communication Systems). Simultaneously, the involved joint surface area () by the posterior malleolar fracture was measured, as well as the proportion of the fracture area to the total ankle joint area. On the sagittal reconstruction CT images, the height () of the posterior malleolar fracture was measured to compare the correlation between the height of the fracture and the area of the fracture, as well as the area ratio. Besides, according to the presence or absence of "die-punch," patients were divided into two groups: A and B. And each group was further divided into three subgroups according to age (16-39 years old, 40-59 years old, and ≥60 years old). The statistical differences in the height of fracture between the subgroups were compared.
A total of 48 patients, aged 16-82 years, with an average age of 48.9 years, were included in this study, including 13 males and 35 females. There were 20 cases of left ankle injury and 28 cases of right ankle injury. The average height of the posterior malleolar fractures was 18.19 mm, the average area of the fracture was 202.28 mm, and the average ratio of the fracture area to the total articular surface area was 17.84%. Besides, die-punch was seen in 27 cases and not in 21 cases. The average height of fractures was 21.33 ± 5.38 mm in group A1, 14.38 ± 9.01 mm in group B1, 18.30 ± 7.95 mm in group A2, 14.48 ± 5.37 mm in group B2, 26.26 ± 6.73 mm in group A3, and 12.77 ± 3.07 mm in group B3.
The height () of the posterior malleolar fractures is positively correlated with the fracture area () and the fracture area ratio (FAR). The posterior malleolar fractures with "die-punch" tend to have a greater average height than that without "die-punch." In clinical work, orthopedic surgeons should not only pay attention to the size of the posterior malleolus fracture but also value its height, which hopefully could provide insight into the treatment and prognosis of PMF patients.
本研究旨在探讨后踝骨折（PMF）的高度（）与关节面受累面积（）以及“压痕”的关系。
选取 2015 年 1 月至 2017 年 12 月我院收治的闭合性后踝骨折患者，记录患者的性别、年龄、受伤侧别及手术固定方式。术前行踝关节 CT 扫描，通过 PACS（影像归档和通信系统）观察图像。同时测量后踝骨折累及的关节面面积（）和骨折面积占整个踝关节面积的比例。在矢状位 CT 重建图像上测量后踝骨折的高度（），比较骨折高度与骨折面积及面积比的相关性。此外，根据是否存在“压痕”，将患者分为 A、B 两组。每组再根据年龄（16-39 岁、40-59 岁和≥60 岁）分为三个亚组。比较亚组间骨折高度的统计学差异。
共纳入 48 例患者，年龄 16-82 岁，平均年龄 48.9 岁，其中男 13 例，女 35 例；左踝关节损伤 20 例，右踝关节损伤 28 例；后踝骨折平均高度为 18.19mm，骨折平均面积为 202.28mm，骨折面积占整个关节面面积的平均比例为 17.84%；27 例见“压痕”，21 例未见“压痕”。A1 组骨折平均高度为 21.33±5.38mm，B1 组为 14.38±9.01mm，A2 组为 18.30±7.95mm，B2 组为 14.48±5.37mm，A3 组为 26.26±6.73mm，B3 组为 12.77±3.07mm。
后踝骨折的高度（）与骨折面积（）和骨折面积比（FAR）呈正相关。有“压痕”的后踝骨折平均高度大于无“压痕”的后踝骨折。在临床工作中，骨科医生不仅要注意后踝骨折的大小，还要重视其高度，这有望为 PMF 患者的治疗和预后提供参考。
