Orthopedic and traumatology resident, Hospital de São Francisco Xavier, CHLO, Lisboa, Portugal, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal.
Orthopedic and traumatology resident, Hospital de São Francisco Xavier, CHLO, Lisboa, Portugal, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal.
Injury. 2021 Mar;52(3):633-637. doi: 10.1016/j.injury.2020.10.021. Epub 2020 Oct 6.
This study aimed to evaluate the clinical outcomes and the trans-syndesmotic screw frequency after trimalleolar ankle fractures with a posterior malleolus fracture involving <25% of the articular surface.
Retrospective comparative study. Patients with trimalleolar ankle fracture who underwent surgery between January 2011 and January 2018 were identified within the departments' fracture database. General demographics, treatment details, and fracture specific details (CT-scans) were assessed. Patients were grouped per the posterior malleolus fragment treatment: osteosynthesis (group 1) and non-osteosynthesis (group 2).
64 patients, 58.6 ± 17.8 years (range: 23-75), 68.8% female were eligible and follow up time was 43.1 ± 22.2 (range 24-96) months. The mean size of the posterior malleolus fragment was 14.7 ± 5.3% (range: 5-24). Posterior malleolus fragment treatment distribution: osteosynthesis (group 1) 31.2% and non- osteosynthesis (group 2) 68.8%. Group 1 showed significantly better clinical outcomes (p<0.05), AOOS (93.9 ± 5.79 (range: 73-99), AOFAS (91.5 ± 6.22 (range: 72-100) and VAS (0.8 ± 1.22 (range: 0-5) compared to Group 2, AOOS (84.25±8.34 (range: 63-100); AOFAS (84.75±8.05 (range: 58-100) and VAS (1.7 ± 1.38 (range: 0-6). Osteosynthesis of the posterior malleolus fragment significantly reduced the frequency of trans-syndesmotic screw (0%) compared to non-osteosynthesis posterior malleolus fragment (15.9%) (p < 0.05). The EQ-5D score was better in group 1 (1.08±0.27 (range: 1-2.2) compared to group 2 (1.27 ± 0.27 (range: 1-2.4) but with no statistical significance (p> 0.15).
Posterior malleolus fragments (<25% of the articular surface) have significantly better clinical outcomes and significant decrease in trans-syndesmotic screw need following osteosynthesis.
本研究旨在评估累及关节面<25%后踝骨折伴后踝骨折的临床结果和经踝螺钉的使用频率。
回顾性比较研究。在骨折数据库中确定了 2011 年 1 月至 2018 年 1 月期间接受手术的三踝骨折患者。评估一般人口统计学、治疗细节和骨折特定细节（CT 扫描）。根据后踝骨折块的治疗方法将患者分为两组：骨愈合（组 1）和非骨愈合（组 2）。
64 例患者，58.6±17.8 岁（范围：23-75），68.8%为女性，随访时间为 43.1±22.2 个月（范围 24-96）。后踝骨折块的平均大小为 14.7±5.3%（范围：5-24）。后踝骨折块的治疗分布：骨愈合（组 1）31.2%和非骨愈合（组 2）68.8%。组 1 显示出明显更好的临床结果（p<0.05），AOOS（93.9±5.79（范围：73-99），AOFAS（91.5±6.22（范围：72-100）和 VAS（0.8±1.22（范围：0-5）与组 2相比，AOOS（84.25±8.34（范围：63-100）；AOFAS（84.75±8.05（范围：58-100）和 VAS（1.7±1.38（范围：0-6）。与非骨愈合后踝骨折块（15.9%）相比，后踝骨折块的骨愈合显著降低了经踝螺钉的使用频率（0%）（p < 0.05）。组 1 的 EQ-5D 评分（1.08±0.27（范围：1-2.2）优于组 2（1.27±0.27（范围：1-2.4），但无统计学意义（p>0.15）。
累及关节面<25%的后踝骨折块行骨愈合治疗后具有更好的临床结果，且经踝螺钉的使用需求显著降低。
