Lehtola Ristomatti, Leskelä Hannu-Ville, Flinkkilä Tapio E, Pakarinen Harri J, Niinimäki Jaakko L, Ohtonen Pasi P, Kortekangas Tero H
Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Kajaanintie 50, P.O. Box 21, FI 90029 OYS Oulu, Finland; Medical Research Center Oulu, University of Oulu, Pentti Kaiteran Katu 1, P.O. Box 8000, FI-90014 Oulu, Finland.
Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Kajaanintie 50, P.O. Box 21, FI 90029 OYS Oulu, Finland.
Foot Ankle Surg. 2022 Feb;28(2):229-234. doi: 10.1016/j.fas.2021.03.014. Epub 2021 Apr 4.
The clinical relevance and treatment of syndesmosis injury in supination-external rotation (SER) ankle fractures are controversial.
After malleolar fixation 24 SER 4 ankle fracture patients with unstable syndesmosis in external rotation stress test were randomised to syndesmosis transfixation with a screw (13 patients) or no fixation (11 patients). Mean follow-up time was 9.7 years (range, 8.9-11.0). The primary outcome measure was the Olerud-Molander Ankle Outcome Score (OMAS). Secondary outcome measures included ankle mortise congruity and degenerative osteoarthritis, 100-mm visual analogue scale for function and pain, RAND 36-Item Health Survey, and range of motion.
Mean OMAS in the syndesmosis transfixation group was 87.3 (SD 15.5) and in the no-syndesmosis-fixation group 89.0 (SD 16.0) (difference between means 1.8, 95% CI -10.4-14.0, P = 0.76). There were no differences between the two groups in secondary outcome measures.
With the numbers available, SER 4 ankle fractures with unstable syndesmosis can be treated with malleolar fixation only, with good to excellent long-term functional outcome.
旋后-外旋型（SER）踝关节骨折中胫腓下联合损伤的临床相关性及治疗存在争议。
24例接受外旋应力试验时胫腓下联合不稳定的SER 4型踝关节骨折患者在固定外踝后，被随机分为两组，一组用螺钉固定胫腓下联合（13例患者），另一组不进行固定（11例患者）。平均随访时间为9.7年（范围8.9 - 11.0年）。主要结局指标为奥勒鲁德-莫兰德踝关节结局评分（OMAS）。次要结局指标包括踝关节 mortise 关节面的一致性和退行性骨关节炎、100毫米功能和疼痛视觉模拟量表、兰德36项健康调查以及活动范围。
胫腓下联合固定组的平均OMAS为87.3（标准差15.5），未固定胫腓下联合组为89.0（标准差16.0）（均值差异为1.8，95%置信区间为-10.4至14.0，P = 0.76）。两组在次要结局指标方面无差异。
就现有数据而言，伴有不稳定胫腓下联合的SER 4型踝关节骨折仅行外踝固定即可获得良好至极佳的长期功能结局。
