Müller Elena, Terstegen Julia, Kleinertz Holger, Weel Hanneke, Frosch Karl-Heinz, Barg Alexej, Schlickewei Carsten
Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
Orthopedics Center, Sint Maartenskliniek, Nijmegen, The Netherlands.
Unfallchirurgie (Heidelb). 2023 May;126(5):387-398. doi: 10.1007/s00113-022-01162-3. Epub 2022 Apr 8.
Posterior malleolar fractures are found in almost 50% of all ankle fractures. The high clinical relevance of these joint fractures is explained by the significantly worse clinical and functional outcome. There is still a lack of unified opinion regarding the classification and treatment of these fractures.
The aim of this article is to provide a systematic literature review of clinical studies that investigated posterior malleolar fractures and classified them using one of the three established classifications according to Haraguchi, Bartonicek/Rammelt, or Mason.
PubMed was searched without time limits. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The methodological quality of the included studies was quantified using the modified Coleman score.
A total of 27 studies with a total of 2220 patients were included in this systematic literature review. Trimalleolar fractures showed a significantly less favorable prognosis than other ankle fractures. The quality of reduction was the most important prognostic factor for the clinical outcome.
None of the three classifications examined has become established in the literature. Most of the classifications are weak or should not be used with respect to a derivable treatment algorithm or a prognosis with respect to the outcome. Only the classification according to Bartonicek/Rammelt is suitable to become established in the literature and in clinical practice due to its derivable treatment algorithm.
在所有踝关节骨折中，后踝骨折的发生率约为50%。这些关节骨折具有较高的临床相关性，其临床和功能预后明显较差。关于这些骨折的分类和治疗，目前仍缺乏统一的意见。
本文旨在对临床研究进行系统的文献综述，这些研究对后踝骨折进行了调查，并根据原口、巴尔托尼塞克/拉梅尔或梅森三种既定分类法之一对其进行了分类。
对PubMed进行无时间限制的检索。根据系统评价和Meta分析的首选报告项目（PRISMA）的现行标准进行系统的文献检索。使用改良的科尔曼评分对纳入研究的方法学质量进行量化。
本系统文献综述共纳入27项研究，涉及2220例患者。三踝骨折的预后明显比其他踝关节骨折差。复位质量是临床预后最重要的预测因素。
所研究的三种分类法在文献中均未得到确立。大多数分类法存在不足，或者就可推导的治疗算法或预后而言不应该使用。只有根据巴尔托尼塞克/拉梅尔分类法因其可推导的治疗算法而适合在文献和临床实践中得到确立。
