Department of Orthopedic Surgery, Guizhou Provincial People's Hospital, Guiyang, China; Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an, China.
Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an, China.
Ann Palliat Med. 2021 Jul;10(7):7802-7812. doi: 10.21037/apm-21-1505.
The purpose of the current study was to retrospectively clarify the anatomic character and evaluate the mid-term operative outcomes for vertical medial malleolar fractures (MMFs).
A total of 53 patients with supination adduction (SAD) type II MMFs treated with open reduction and internal fixation (ORIF) between March 2009 and June 2013 were included. We reviewed the patients' preoperative X-ray and computed tomography (CT) to determine the pathoanatomic characteristics of medial malleolus fractures. Buttress plate lag screws fixation had been applied. Complications and treatment failures were recorded; the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes.
For the 53 patients, only 39.6% cases with simple vertical MMFs. The mean distal tibial articular surface (DTAS) involvement in the MMF was 16.5%±11.6% (range, 0-47%). The mean follow up time was 62.4±14.1 [44-91] months. There were 7 cases of traumatic osteoarthritis (TOA), and 3 cases of failure were reported in the screw fixation group. The mean AOFAS score was 80.6±15.8 points, and the mean VAS score was 2.1±1.7 points, with a good to excellent rate (GTE) of 81.1%. No significant difference was found in comparing the AOFAS, VAS, GTE, incision relative complication rate, infection rate, loss of reduction (LoR) rate, and TOA rate between groups (P>0.05). The participants in the buttress plate group reached a shorter mean full weight-bearing (FWB) time (P=0.04).
More than 60% vertical MMFs are with one or more characteristics of medial cortex comminuted fractures, or die-punch fragments, or medial joint compression. And patients with die-punch fragment, medial joint compression, LoR, large DTAS involvement and small fracture line angle (FLA) were positively correlated with the fair to poor results. Lag screw fixation should be cautiously used in vertical MMF patients with comminuted medial cortex.
本研究旨在回顾性阐明垂直内踝骨折（MMF）的解剖学特征，并评估中期手术结果。
纳入 2009 年 3 月至 2013 年 6 月采用切开复位内固定（ORIF）治疗的旋前内收（SAD）Ⅱ型内踝骨折患者 53 例。我们回顾了患者术前 X 线和计算机断层扫描（CT），以确定内踝骨折的病理解剖特征。采用支撑钢板拉力螺钉固定。记录并发症和治疗失败情况；采用美国矫形足踝协会（AOFAS）踝-后足评分和视觉模拟评分（VAS）评估功能结果。
53 例患者中，单纯垂直 MMF 仅占 39.6%。MMF 累及下胫腓关节面（DTAS）的平均比例为 16.5%±11.6%（范围，0-47%）。平均随访时间为 62.4±14.1[44-91]个月。创伤性关节炎（TOA）7 例，螺钉固定组失败 3 例。AOFAS 评分为 80.6±15.8 分，VAS 评分为 2.1±1.7 分，优良率（GTE）为 81.1%。两组间 AOFAS、VAS、GTE、切口相关并发症发生率、感染率、复位丢失率（LoR）、TOA 发生率差异均无统计学意义（P>0.05）。支撑钢板组患者达到完全负重（FWB）时间较短（P=0.04）。
超过 60%的垂直 MMF 具有一个或多个内侧皮质粉碎骨折、冲孔样骨折块或内侧关节压缩的特征。冲孔样骨折块、内侧关节压缩、复位丢失、较大的 DTAS 累及和较小的骨折线角度（FLA）与较差的结果呈正相关。对于粉碎性内侧皮质的垂直 MMF 患者，应谨慎使用拉力螺钉固定。
