Department of Orthopedics and Trauma Surgery, University of Verona, Italy.
Department of Orthopedics and Trauma Surgery, University of Verona, Italy.
Foot Ankle Surg. 2022 Jan;28(1):126-133. doi: 10.1016/j.fas.2021.02.009. Epub 2021 Feb 23.
Ankle fractures account for 4% of all fractures and treatment of those involving the Posterior Malleolus remains controversial. Clinical and radiological outcomes in a cohort of patients with Posterior Malleolus fractures conservatively treated were retrospectively evaluated; furthermore, a treatment algorithm was suggested.
Patients were divided according to Bartoníček classification. The clinical evaluation was made with OMAS/AOFAS scores; the radiological evaluation with Van Dijk classification for post-traumatic arthritis.
Clinical outcome worsened with the severity of Bartoníček classification, but early degenerative changes were not correlated neither to the clinical outcome nor to the injury pattern. Clinical and radiological outcomes depended on the damage of the syndesmosis as articular step-offs and tibio-fibular notch involvement.
We recommend conservative treatment for Bartoníček type I, type II and type III fractures, the latter when undisplaced and without tibial plafond depression. We suggest surgical treatment for type IV and displaced type III fractures.
踝关节骨折占所有骨折的 4%，后踝骨折的治疗仍存在争议。本研究回顾性评估了一组保守治疗的后踝骨折患者的临床和放射学结果，并提出了治疗方案。
根据 Bartoníček 分类对患者进行分组。临床评估采用 OMAS/AOFAS 评分；放射学评估采用 Van Dijk 分类评估创伤后关节炎。
临床结果随 Bartoníček 分类的严重程度而恶化，但早期退行性改变与临床结果和损伤类型均无相关性。临床和放射学结果取决于下胫腓联合的损伤程度，如关节台阶和胫腓骨切迹的受累。
我们建议对 Bartoníček Ⅰ型、Ⅱ型和Ⅲ型骨折采用保守治疗，对于无移位且无胫骨平台塌陷的Ⅲ型后踝骨折也建议采用保守治疗。我们建议对Ⅳ型和移位的Ⅲ型骨折采用手术治疗。
