Department of Orthopaedics, Skåne University Hospital, Inga Marie Nilssons gata 22, 205 02 Malmö, Sweden; Faculty of Medicine, Lund University, Box 117, 221 00 Lund, Sweden.
Faculty of Medicine, Lund University, Box 117, 221 00 Lund, Sweden.
Injury. 2021 Jul;52(7):1999-2005. doi: 10.1016/j.injury.2021.04.008. Epub 2021 Apr 7.
Ankle fractures are commonly treated by open reduction and internal fixation with plate and screws. Unplanned return to theatre is common, in many cases to extract prominent osteosynthesis material from the lateral malleolus as swelling subsides. We hypothesised that patients operated with a posterolateral plate placement on the lateral malleolus would have fewer reoperations, and fewer complications, compared to patients with a lateral plate placement.
From a prospectively collected database of all orthopaedic surgery performed at our institution, we identified 664 ankle fractures undergoing plate fixation between 2008-01-01 and 2012-04-30. Radiographs were analysed to only include AO/OTA 44-B-fractures (n = 453), and to define study groups based on plate positioning. Hospital files were assessed to identify possible confounding factors, and any unplanned reoperation or complication. Complications were classified according to Dindo-Clavien.
The risk of reoperation was 13% after posterolateral plating, compared with 24% after lateral plating; absolute risk reduction 10% (95% CI: 2.5-18), p = 0.02. After adjusting for possible confounders, the odds ratio of undergoing reoperation after lateral plating was 2.2 (95% CI: 1.17-4.1), p = 0.01. The two surgical methods did not differ with regard to complication frequency: 31% vs 34%, p = 0.6, but complications following lateral plate fixation were more serious, p = 0.03. Plate positioning depended on surgeon preference.
The two studied methods are both considered standard treatment of ankle fractures, and relatively simple surgical procedures. High rates of secondary surgery after plate fixation have been reported, but no study comparing plate positioning has been previously published to our knowledge. AO Sweden has recently switched to teaching posterolateral plating in group exercises during the AO Basic Fracture Surgery course, based on the belief that it may be safer than lateral plating. Our findings support this change in practice.
Posterolateral plate positioning on the lateral malleolus in AO/OTA 44-B-fractures may be preferential to lateral plate positioning, due to a large difference in unplanned secondary surgery.
踝关节骨折通常采用切开复位内固定加钢板和螺钉治疗。术后计划外再次手术很常见，在许多情况下，随着肿胀消退，需要从外踝取出突出的骨固定材料。我们假设，与外侧钢板放置相比，用后外侧钢板放置在外侧踝上的患者手术再操作更少，并发症更少。
我们从我院前瞻性收集的所有骨科手术数据库中，确定了 2008 年 1 月 1 日至 2012 年 4 月 30 日期间进行的 664 例踝关节骨折钢板固定病例。对 X 线片进行分析，仅纳入 AO/OTA 44-B 型骨折（n=453），并根据钢板定位定义研究组。评估医院档案以确定可能的混杂因素，以及任何计划外再次手术或并发症。并发症根据 Dindo-Clavien 分类。
后外侧钢板固定的再手术风险为 13%，而外侧钢板固定的再手术风险为 24%；绝对风险降低 10%（95%CI：2.5-18），p=0.02。在调整了可能的混杂因素后，外侧钢板固定后再手术的优势比为 2.2（95%CI：1.17-4.1），p=0.01。两种手术方法在并发症发生率方面没有差异：31%比 34%，p=0.6，但外侧钢板固定后的并发症更严重，p=0.03。钢板定位取决于外科医生的偏好。
这两种研究方法都被认为是治疗踝关节骨折的标准方法，而且是相对简单的手术。已有报道称，钢板固定后二次手术的发生率较高，但据我们所知，以前没有研究比较过钢板定位。AO 瑞典公司最近在 AO 基础骨折手术课程的小组练习中转向教授后外侧钢板固定，基于这样一种信念，即它可能比外侧钢板固定更安全。我们的研究结果支持这种实践的改变。
在 AO/OTA 44-B 型骨折中，用后外侧钢板放置在外侧踝上可能优于外侧钢板放置，因为计划外二次手术的差异很大。
