Wordie Sarah J, Carter Thomas H, MacDonald Deborah, Duckworth Andrew D, White Timothy O
Edinburgh Orthopaedics - Trauma; Royal Infirmary of Edinburgh, Edinburgh, UK; and.
Usher Institute, University of Edinburgh, Edinburgh, UK.
J Orthop Trauma. 2022 Apr 1;36(4):195-200. doi: 10.1097/BOT.0000000000002262.
To (1) describe the percutaneous technique used to reduce and fix a posterior malleolar fracture with anteroposterior screws in patients managed with a fibular intramedullary nail, (2) describe the selection of patients to whom this technique can be applied, and (3) report the clinical and patient reported outcome of this intervention.
Retrospective review.
Academic orthopaedic trauma center.
Thirty-two consecutive patients with a mean age of 65 years (range, 39-90) over a thirteen-year period identified from a prospective database.
Unstable ankle fractures managed surgically with a fibular nail and percutaneous fixation of the posterior malleolar component.
The primary short-term outcome was complications related to posterior malleolar fracture fixation. The primary mid-term outcome was the Olerud-Molander Ankle Score. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, EuroQol-5D, health, pain, and satisfaction.
Thirty of the 32 (94%) posterior malleolar fractures united uneventfully. Postoperative loss of talar reduction occurred in 2 patients (6.3%), which in 1 patient (3.1%) eventually required a hindfoot nail arthrodesis. There were no soft-tissue complications related to the anteroposterior screws or the fibular nail fixation. At a mean follow-up of 3.7 years (range, 1-8), the median Olerud-Molander Ankle Score, Manchester-Oxford Foot Questionnaire, EuroQol-5D, health, pain, and satisfaction scores were 80.0, 23.4, 0.85, 80.0, 85.0, and 87.5, respectively.
Percutaneous ankle fracture fixation with a fibular nail and posterior malleolar screws results in reliable fracture stabilization, good patient outcomes, and high treatment satisfaction.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
（1）描述在采用腓骨髓内钉治疗的患者中，使用前后位螺钉复位并固定后踝骨折的经皮技术；（2）描述可应用该技术的患者选择标准；（3）报告该干预措施的临床及患者报告结局。
回顾性研究。
学术性骨科创伤中心。
从前瞻性数据库中确定的连续32例患者，平均年龄65岁（范围39 - 90岁），随访时间为13年。
采用腓骨钉手术治疗不稳定踝关节骨折，并经皮固定后踝骨折块。
主要短期结局为与后踝骨折固定相关的并发症。主要中期结局为奥勒鲁德 - 莫兰德踝关节评分。次要结局包括曼彻斯特 - 牛津足部问卷、欧洲五维度健康量表、健康状况、疼痛及满意度。
32例患者中有30例（94%）后踝骨折顺利愈合。2例患者（6.3%）术后距骨复位丢失，其中1例患者（3.1%）最终需要行后足钉关节融合术。未发生与前后位螺钉或腓骨钉固定相关的软组织并发症。平均随访3.7年（范围1 - 8年）时，奥勒鲁德 - 莫兰德踝关节评分、曼彻斯特 - 牛津足部问卷、欧洲五维度健康量表、健康状况、疼痛及满意度评分的中位数分别为80.0、23.4、0.85、80.0、85.0和87.5。
采用腓骨钉和后踝螺钉经皮固定踝关节骨折可实现可靠的骨折稳定，患者预后良好，治疗满意度高。
治疗性四级证据。有关证据级别的完整描述，请参阅作者指南。
