J Am Podiatr Med Assoc. 2021 Mar 1;111(2). doi: 10.7547/20-100.
We aimed to evaluate radiologic and clinical outcomes of ankle fractures involving posterior fragments that were fixed with a posterior plate by the posterolateral approach.
Sixty-five patients who were followed for at least 12 months and were older than 18 years were included. The posterior malleolus fractures were classified according to the Haraguchi classification system with computed tomography (CT). The posterior malleolus fragments were fixed with a plate through a posterolateral approach. Intra-articular step-off, reduction of the posterior malleolar fragment, and fibular position in the incisura were evaluated by early postoperative CT. American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale pain score were used for clinical assessment.
The posterior malleolus fractures were classified as Haraguchi type 1 in 45 patients (69.2%), Haraguchi type 2 in 12 patients (18.5%), and Haraguchi type 3 in eight patients (12.3%). No patients showed signs of instability or loss of reduction on direct radiographs during follow-up. Postoperative CT showed no loss of reduction in the posterior malleolus and tibiofibular alignment. On evaluation, there was no intra-articular step-off (<1) in any of the patients. The mean AOFAS score was calculated to be 91.6. The mean visual analog scale score was 1.2.
We conclude that direct posterior fixation with the posterolateral approach can be a good option for ankle fractures involving posterior malleolar fragments.
我们旨在评估通过后外侧入路固定后钢板治疗涉及后踝骨折块的影像学和临床结果。
共纳入 65 例随访时间至少 12 个月且年龄大于 18 岁的患者。后踝骨折根据 CT 扫描的 Haraguchi 分类系统进行分类。通过后外侧入路用钢板固定后踝骨折块。术后早期 CT 评估关节面台阶、后踝骨折块复位情况及腓骨在切迹中的位置。采用美国矫形足踝协会（AOFAS）评分和视觉模拟评分（VAS）进行临床评估。
45 例（69.2%）患者后踝骨折为 Haraguchi 1 型，12 例（18.5%）为 Haraguchi 2 型，8 例（12.3%）为 Haraguchi 3 型。随访过程中，直接 X 线片未见不稳定或复位丢失的迹象。术后 CT 显示后踝无复位丢失，胫腓骨对线良好。评估时，所有患者关节面台阶均<1。AOFAS 评分平均为 91.6，VAS 评分平均为 1.2。
我们认为，直接后外侧固定是治疗涉及后踝骨折块的踝关节骨折的一种较好选择。
