Martin Kevin D, Tripp Courtney T, Huh Jeannie
Department of Orthopaedic Surgery, Evans Army Community Hospital, Fort Carson, CO, USA.
Department of Radiology, Evans Army Community Hospital, Fort Carson, CO, USA.
Foot Ankle Int. 2021 Feb;42(2):157-165. doi: 10.1177/1071100720955149. Epub 2020 Oct 3.
Posterior malleolar fractures within a trimalleolar ankle fracture pattern are challenging to manage. Posterior ankle arthroscopy provides a means to assess the intra-articular and syndesmotic reductions, while removing loose bodies. The purpose of this study was to determine the radiographic and patient reported outcomes of posterior arthroscopic reduction and internal fixation (PARIF) in trimalleolar ankle fractures.
From November 2015 to March 2019, we prospectively enrolled consecutive trimalleolar ankle fractures that underwent PARIF by a single surgeon. Preoperative and postoperative computed tomography (CT) scans were interpreted by 2 blinded musculoskeletal radiologists for articular reduction, syndesmosis congruity, and presence of ossific loose bodies. Patient outcomes were assessed using the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS) ankle score, Olerud-Molander Ankle Score (OMAS), and visual analog scale (VAS). A total of 28 trimalleolar ankle fractures were treated with PARIF. Mean patient age was 36 years (range, 19-69).
Preoperative CT identified 18 intra-articular loose bodies (range, 0-4) in 36% of ankles and 75% (n = 21) syndesmosis incongruity. Postoperative CT scans demonstrated anatomic intra-articular reduction in all fractures, 41.7% (5/12) syndesmosis incongruity without fixation, and 0% (0/9) with suture-button fixation. At mean 2-year follow-up, the results were good to excellent with mean VAS score 1 (range, 0-4), AOFAS score 84 (range, 63-100), FADI 85 (range, 59-100), and OMAS 76 (range, 40-100).
The PARIF technique for displaced posterior malleolar fractures was effective in achieving anatomic intra-articular reduction, syndesmosis congruity, and intra-articular loose body removal, while safely preserving the soft tissues.
Level IV, prospective case series.
三踝骨折模式中的后踝骨折治疗具有挑战性。后踝关节镜检查提供了一种评估关节内和下胫腓联合复位情况的方法，同时可清除游离体。本研究的目的是确定三踝骨折行后关节镜下复位内固定（PARIF）后的影像学和患者报告结局。
2015年11月至2019年3月，我们前瞻性纳入了由单一外科医生进行PARIF的连续三踝骨折患者。术前和术后计算机断层扫描（CT）由2名盲法肌肉骨骼放射科医生解读，以评估关节复位、下胫腓联合的一致性和骨化游离体的存在情况。使用足踝残疾指数（FADI）、美国矫形足踝协会（AOFAS）踝评分、奥勒鲁德-莫兰德踝评分（OMAS）和视觉模拟量表（VAS）评估患者结局。共有28例三踝骨折接受了PARIF治疗。患者平均年龄为36岁（范围19 - 69岁）。
术前CT显示36%的踝关节存在18个关节内游离体（范围0 - 4个），75%（n = 21）存在下胫腓联合不一致。术后CT扫描显示所有骨折均实现了解剖学关节内复位，41.7%（5/12）未固定的下胫腓联合不一致，采用缝线纽扣固定的为0%（0/9）。平均随访2年时，结果良好至优秀，平均VAS评分为1分（范围0 - 4分），AOFAS评分为84分（范围63 - 100分），FADI为85分（范围59 - 100分），OMAS为76分（范围40 - 100分）。
PARIF技术用于移位后踝骨折，在实现解剖学关节内复位、下胫腓联合一致性和清除关节内游离体方面有效，同时能安全地保留软组织。
IV级，前瞻性病例系列。
