Reduction Room of Orthopedics and Traumatology Department of Integrated Traditional Chinese and Western Medicine, Tianjin Hospital, Tianjin, China.
Imaging Department, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2021 Oct;13(7):2163-2169. doi: 10.1111/os.13115. Epub 2021 Sep 13.
To investigate the curative effect of closed reduction and external fixation in the treatment of grade IV supination-external rotation fractures of the ankle joint.
Fifty-six patients treated with closed reduction and external fixation from February 2016 to March 2020 were included in this retrospective study, all with sprains. After receiving nerve block anesthesia, the patient underwent closed reduction under C-arm fluoroscopy, and the ankle joint was fixed in a dorsiflexion-inversion position with casting and splints after the end of the fracture met the reduction standard by fluoroscopy. One week and four weeks after the reduction treatment, oblique axial and coronal MR scans of the ankle joint were performed to determine the degree of injury and healing of the inferior tibiofibular syndesmosis; anteroposterior and lateral X-rays of the ankle joint (including the ankle acupoints) were regularly reviewed to observe the fracture alignment and healing. Combined with the images and physical examination, the patients were instructed to undergo ankle weight-bearing rehabilitation training when they met the clinical healing standard, and at the last follow-up, the Mazur ankle evaluation and grading system were used for evaluation. After the reduction, the images were evaluated according to the Leeds standard. The image healing of fracture was evaluated by callus growth criteria.
The follow-up period of patients ranged from 11 to 58 months, with an average of 26.8 months. The clinical healing time was (8.51 ± 2.12) weeks. The excellent and good rating after reduction was 82.1%, and the excellent and good rating during clinical fracture healing was 73.2%, according to the Leeds imaging evaluation. According to the Mazur ankle evaluation and grading system, the excellent and good rating was 75.0%. Pairwise comparison of callus images at 4, 6 and 12 weeks showed statistically significant differences (P < 0.05), suggesting callus growth at different time periods. A total of 56 patients had anterior inferior tibial fibular ligament (AITFL) injuries (grade II-III), among which 11 patients had AITFL injuries combined with grade II injuries of the interosseous ligament (IOL) and 4 patients had AITFL injuries combined with grade III injuries of the IOL.
Most of the patients with grade IV supination-external rotation fracture of the ankle joint had good prognosis after closed reduction and plaster combined with splint fixation. For patients with IOL injury who had poor prognosis, open reduction and internal fixation therapy is appropriate.
探讨闭合复位外固定治疗旋后外旋Ⅳ度踝关节骨折的疗效。
回顾性分析 2016 年 2 月至 2020 年 3 月采用闭合复位外固定治疗的 56 例旋后外旋Ⅳ度踝关节骨折患者资料，均为扭伤所致。患者接受神经阻滞麻醉后，在 C 臂透视下进行闭合复位，骨折端达到透视复位标准后，踝关节置于背伸、外翻位，采用石膏和夹板固定。复位治疗后 1 周和 4 周，对踝关节行斜轴和冠状面 MRI 扫描，以确定下胫腓联合的损伤和愈合程度；定期复查踝关节正侧位 X 线片（包括踝穴位），观察骨折对线和愈合情况。结合图像和体格检查，当患者符合临床愈合标准时，指导其进行踝关节负重康复训练，末次随访时采用 Mazur 踝关节评分系统进行评估。复位后，根据 Leeds 标准对图像进行评估。根据骨痂生长标准评估骨折愈合的影像学表现。
患者的随访时间为 11～58 个月，平均 26.8 个月。临床愈合时间为（8.51±2.12）周。根据 Leeds 影像学评价，复位后优、良率为 82.1%，临床骨折愈合时优、良率为 73.2%。根据 Mazur 踝关节评分系统，优、良率为 75.0%。4、6、12 周时骨痂图像的两两比较差异均有统计学意义（P<0.05），提示不同时期骨痂生长情况不同。56 例患者均存在下胫腓前韧带（AITFL）损伤（Ⅱ-Ⅲ级），其中 11 例合并骨间韧带（IOL）Ⅱ级损伤，4 例合并 IOL Ⅲ级损伤。
大多数旋后外旋Ⅳ度踝关节骨折患者经闭合复位、石膏联合夹板固定后预后良好。对于预后较差的 IOL 损伤患者，行切开复位内固定治疗较为合适。
