Yuce A, Dedeoglu S S, Imren Y, Yerli M, Gurbuz H
Department of Orthopaedic and Traumatology, Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey.
Department of Orthopaedic and Traumatology, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey.
Malays Orthop J. 2020 Nov;14(3):90-97. doi: 10.5704/MOJ.2011.014.
The selection of the stage where fibular plate was performed in two-stage surgery of the intra-articular distal tibiofibular fractures with soft tissue injury is still controversial. The aim of the study was to compare the complications, radiological and functional outcomes between the patients who had fibular plate at initial or second phase during surgical management of such fractures.
In this study, medical records of 47 patients who underwent a two-stage surgical procedure for intra-articular distal tibia fractures accompanying soft tissue injury were retrospectively examined. Delta frame was applied in all cases within 24 hours following admission to the emergency department in accordance with AO principles. Those cases where fibular plate was applied during the initial stage and the second stage were classified as Group 1 and Group 2 in order to compare recorded data between the two groups.
According to the results of the study, there were 25 cases in Group 1 and 22 cases in Group 2 in which fibular plate was applied at the first stage and the second stage, respectively. The mean follow-up was found as 27.7±7.0 months in Group 1 and 28.2±6.2 months in Group 2 (p=0.778). No difference was found between the two groups in terms of the age, sex, hospital stay, the time between two surgical procedures, tibiofibular angle and AOFAS scoring (p>0.05).These two groups were also similar in mechanism of injury, Denise-Weber or AO classification, rates of tibiofibular malalignment on post-operative CT, fibular rotation, intra-articular tibial step-off, tibial varus-valgus duration of union, rate of infection, fibular angulation and the presence of the flap/graft/debridement (p>0.05).
In conclusion, two-stage surgical procedure in intra-articular distal tibiofibular fractures may be an effective method decreasing soft tissue complications. The timing of the open reduction and internal fixation of the fibula at different stages may not necessarily have an impact on the success of the post-operative tibial reduction, the total duration of surgery, syndesmosis malalignment or soft tissue complications.
在伴有软组织损伤的关节内胫腓骨远端骨折的两阶段手术中，腓骨钢板固定阶段的选择仍存在争议。本研究的目的是比较在此类骨折手术治疗过程中，在初始阶段或第二阶段进行腓骨钢板固定的患者之间的并发症、影像学和功能结果。
在本研究中，对47例行两阶段手术治疗伴有软组织损伤的关节内胫腓骨远端骨折患者的病历进行回顾性检查。根据AO原则，在所有病例入院急诊科后24小时内应用Delta架。将在初始阶段和第二阶段应用腓骨钢板的病例分别分为第1组和第2组，以便比较两组之间记录的数据。
根据研究结果，第1组有25例，第2组有22例，分别在第一阶段和第二阶段应用了腓骨钢板。第1组的平均随访时间为27.7±7.0个月，第2组为28.2±6.2个月（p = 0.778）。两组在年龄、性别、住院时间、两次手术之间的时间、胫腓骨角度和AOFAS评分方面均无差异（p>0.05）。这两组在损伤机制、Denise-Weber或AO分类、术后CT上胫腓骨排列不齐的发生率、腓骨旋转、关节内胫骨台阶移位、胫骨内翻-外翻愈合持续时间、感染率、腓骨成角以及皮瓣/移植物/清创术的存在方面也相似（p>0.05）。
总之，关节内胫腓骨远端骨折的两阶段手术可能是一种减少软组织并发症的有效方法。在不同阶段进行腓骨切开复位内固定的时机不一定会影响术后胫骨复位的成功率、手术总时长、下胫腓联合排列不齐或软组织并发症。
