Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan; Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan.
Department of Emergency Medical Center, Kagawa Prefectural Central Hospital, Kagawa, Japan.
Injury. 2022 Jun;53(6):2297-2303. doi: 10.1016/j.injury.2022.02.046. Epub 2022 Mar 2.
Recent studies on posterior malleolar fractures mainly focus on the reduction quality and fixation of the posterior fragment since it contributes to ankle stability and articular congruency. However, the association of pre-and postoperative factors considering the whole ankle joint in postoperative functional outcomes remains unclear. Therefore, this study aimed to examine the association between pre-and postoperative variables for postoperative functional outcomes in patients with posterior malleolar fragments (classified as Haraguchi type I or II) and considered the association between reduction and fixation for small posterior malleolar fragments of less than 25% of the intra-articular surface.
This multicenter retrospective cohort study included 110 adult patients who underwent internal fixation for ankle fractures with posterior malleolar fragments. The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) score 12-months postoperatively. As pre-and postoperative variables, the preoperative demographic data, radiographic findings, operative method, postoperative radiographic findings, and complications were evaluated. In addition, univariable and multivariable logistic regression analyses were conducted to examine the association between pre-and postoperative variables and AOFAS scores.
Twenty-four (21.8%) cases had postoperative complications. Univariate analysis showed that age was significantly according to AOFAS score-stratified groups in patients with Haraguchi type II fractures. Multivariable logistic regression analysis using bootstrapping in the Haraguchi type II group showed that postoperative complications were significantly associated with low AOFAS scores, indicating poor functionality. In both fracture types, postoperative complications had the highest odds ratio among the explanatory variables. In patients with small posterior malleolar fragments, fragment reduction, fixation, and ankle stability were not associated with AOFAS scores.
Our results suggest that postoperative complications were associated with AOFAS scores at postoperative 12 months in patients with ankle fractures with posterior malleolar fragments. In patients with small posterior malleolar fragments, reduction and fixation were not associated with AOFAS scores. Therefore, clinical decisions for posterior fragment fixation should be made based on the possible risk of complications related to the surgical procedures in addition to the posterior malleolar fragment size.
最近的后踝骨折研究主要集中在骨折块的复位质量和固定上，因为它有助于踝关节的稳定性和关节面的吻合度。然而，对于整个踝关节，考虑到术后功能结果的术前和术后因素之间的关联仍不清楚。因此，本研究旨在探讨后踝骨折患者（分为 Haraguchi Ⅰ型或Ⅱ型）的术前和术后变量与术后功能结果之间的关系，并考虑了对于关节面内小于 25%的小后踝骨折块的复位和固定之间的关系。
这是一项多中心回顾性队列研究，纳入了 110 例接受后踝骨折内固定的成年患者。主要结局是术后 12 个月的美国矫形足踝协会（AOFAS）评分。作为术前和术后变量，评估了术前的人口统计学数据、影像学发现、手术方法、术后影像学发现和并发症。此外，还进行了单变量和多变量逻辑回归分析，以探讨术前和术后变量与 AOFAS 评分之间的关系。
24 例（21.8%）患者术后发生并发症。单因素分析显示，在 Haraguchi Ⅱ型骨折患者中，年龄与 AOFAS 评分分层组显著相关。Haraguchi Ⅱ型组的多变量逻辑回归分析使用bootstrap 显示，术后并发症与 AOFAS 评分较低显著相关，表明功能较差。在两种骨折类型中，术后并发症是解释变量中出现最高比值比的因素。在小后踝骨折块患者中，骨折块的复位、固定和踝关节稳定性与 AOFAS 评分无关。
我们的结果表明，在后踝骨折患者中，术后并发症与术后 12 个月的 AOFAS 评分相关。在小后踝骨折块患者中，复位和固定与 AOFAS 评分无关。因此，除了后踝骨折块大小之外，还应根据与手术相关的并发症的可能风险来决定是否进行后踝骨折块的固定。
