Department of Orthopaedics, Yantaishan Hospital, NO.91 Jiefang Road, Zhifu District, Yantai, 264001, Shandong Province, China.
J Orthop Surg Res. 2021 Feb 8;16(1):120. doi: 10.1186/s13018-021-02270-3.
Although efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures. Ankle fractures involving the distal tibial plafond frequently present a surgical challenge in choosing which incisions will be best for surgical treatment. Here, we present an innovative fibular notch approach for the treatment of some specific ankle fractures and present a series of patients with either functional or radiographic outcomes.
Twenty-two patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach in this retrospective study. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment.
All surgeries were successfully performed via the fibular notch approach as the primary approach with excellent intraoperative visualization. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis. All fractures healed with an average time of 17.3 ± 3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. The average AOFAS score was 88.8 at the last follow-up.
The fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.
尽管疗效与许多因素有关，但手术入路是治疗复杂踝关节骨折最重要的干预因素之一。涉及距骨下胫骨平台的踝关节骨折在选择哪种切口最适合手术治疗时经常具有挑战性。在这里，我们提出了一种创新的腓骨切迹入路治疗某些特定踝关节骨折，并介绍了一系列具有功能或影像学结果的患者。
在这项回顾性研究中，通过腓骨切迹入路治疗了 22 例伴有腓骨和下胫腓联合损伤的距骨下胫骨平台骨折患者。从手术记录中回顾了手术技术的细节。从病历中回顾了相关数据。使用 CT 扫描检查骨折和联合复位的质量，通过体格检查和应力射线照相评估踝关节的外侧稳定性。使用美国矫形足踝协会踝-后足量表（AOFAS）对临床功能进行评估。
所有手术均通过腓骨切迹入路成功完成，作为主要入路，术中可视化效果极佳。术后 X 线片显示所有骨折和联合均得到满意复位。所有骨折均在平均 17.3±3.6 周愈合。4 例患者存在轻度创伤后骨关节炎（PTOA）。末次随访时的平均 AOFAS 评分为 88.8。
腓骨切迹入路是治疗涉及距骨下胫骨平台的特定踝关节骨折的安全可靠方法。该入路提供了对骨折块和关节面的极佳直接可视化，而不会显著增加医源性损伤。观察到满意的影像学和临床结果，建议进一步进行临床和解剖学研究，以确定该方法在治疗复杂胫骨远端骨折中的可行性。
