Department of Orthopedics and Traumatology Service, Şişli Hamidiye Etfal Research and Training Hospital, Şişli/Istanbul, Turkey.
Acta Chir Orthop Traumatol Cech. 2021;88(3):204-210.
PURPOSE OF THE STUDY The purpose of this study was to evaluate if the fixation method of a posterior fragment in trimalleolar ankle fractures affects the surgical outcomes. MATERIAL AND METHODS A retrospective evaluation was made of all the cases of trimalleolar fractures over a 9-year period in a trauma center. Patients aged 18 - 70 years were enrolled in the study. Patients were separated into 2 groups according to the fixation method (A - P percutaneous screw, and posterior open reduction - internal fixation). The fractures were classified according to the AO classification system and the Haraguchi posterior malleolar fracture classification system. The FAOS and SF-36 scores, postoperative reduction quality, arthritis scores and minor - major complications were evaluated. RESULTS 86 patients were found to eligible for the study. The PMF was fixed using anteroposterior percutaneous screw in 50 (58.1 %) patients and with posterior open reduction-internal fixation in 36 (41.9 %) patients. AO 44 B type fracture was determined in 89.5 % of the patients, AO 44 C type was seen in 10.5 %. There were 27 patients (31.4 %) with Haraguchi type 1 fracture and 59 patients (68.6 %) with type 2 fracture. The mean step-off of the articular surface was statistically greater in Group 1 than in Group 2. No statistically significant difference was determined between the two groups in respect of syndesmosis malreduction. The mean arthritis score was higher in Group 1 than in Group 2. Mean scores of the SF-36 and FAOS questionnaire was statistically significantly improved in the patients with open reduction and internal fixation. DISCUSSION Although there is no consensus on the treatment of posterior malleolar fractures, the indication for surgery is mainly based on posterior fragment size in the literature. The anatomic articular reduction has been emphasized recently. In this study, it was determined that the anatomic articular reduction was correlated with better surgical outcomes. CONCLUSIONS The study results demonstrated that better functional and radiological outcomes was observed with direct open reduction and fixation of the posterior fragment than indirect reduction and percutaneous fixation in the patients with trimalleolar fracture. The arthritis risk and patient satisfaction were seen to be correlated with the anatomic reduction of the articular surface. Key words: trimalleolar fracture, posterior malleolar fracture, percutaneous screw, open reduction and fixation, ankle fracture.
目的 本研究旨在评估三踝骨折中后踝骨块的固定方式是否影响手术结果。
材料与方法 对创伤中心 9 年间的所有三踝骨折病例进行回顾性评估。纳入研究的患者年龄为 18-70 岁。根据固定方式（A-经皮螺钉固定，B-后外侧切开复位内固定）将患者分为 2 组。骨折根据 AO 分类系统和 Haraguchi 后踝骨折分类系统进行分类。评估 FAOS 和 SF-36 评分、术后复位质量、关节炎评分和轻微-严重并发症。
结果 共发现 86 例符合研究条件的患者。50 例（58.1%）患者采用经皮前后螺钉固定后踝骨块，36 例（41.9%）患者采用后外侧切开复位内固定。患者中 89.5%为 AO 44B 型骨折，10.5%为 AO 44C 型骨折。27 例（31.4%）为 Haraguchi 1 型骨折，59 例（68.6%）为 2 型骨折。关节面台阶距在 A 组的统计学上大于 B 组。两组在下胫腓联合复位不良方面无统计学差异。A 组关节炎评分高于 B 组。开放复位内固定组的 SF-36 和 FAOS 问卷评分均有统计学显著改善。
讨论 尽管对于后踝骨折的治疗尚无共识，但文献中手术的适应证主要基于后踝骨块的大小。最近强调了解剖关节面的复位。本研究确定解剖关节面的复位与更好的手术结果相关。
结论 研究结果表明，与间接复位和经皮固定相比，直接开放复位和固定后踝骨块可获得更好的功能和影像学结果。关节炎风险和患者满意度与关节面的解剖复位相关。
三踝骨折、后踝骨折、经皮螺钉、切开复位内固定、踝关节骨折。
