Department of Trauma, University Hospital Zurich, Raemistrasse, Zurich, Switzerland.
Harald Tscherne Laboratory, University of Zurich, Sternwartstrasse, Zurich, Switzerland.
PLoS One. 2022 May 11;17(5):e0268359. doi: 10.1371/journal.pone.0268359. eCollection 2022.
Local soft tissue status (STS) guides the timing for definitive surgical treatment strategies of fracture fixation around the ankle joint. The aim of this study was to assess different types of new technical devices in relation to the surgical treatment in closed ankle and pilon fractures.
This study was designed as a cohort study. Adult patients admitted between February 1, 2019 and December 31, 2020 presenting with closed ankle fracture requiring surgical treatment were eligible. The exclusion criteria were previous injuries to the lower extremity, acute deep venous thrombosis, skin diseases, and delayed presentation (admission >24 hours after injury). Moderate-energy trauma includes injuries sustained during team sports, biking, and running. The primary outcome was the assessment of the degree of soft tissue involvement following closed fractures by comparing different techniques focusing on the ankle region and including ankle and pilon fractures. The variables of interest included the circumference of soft tissue swelling around the ankle, determined within a 5-mm range in the area of the medial and lateral malleolus and the bone-skin distance on a plain radiograph, determined by the largest distance from the malleolus to the border of the soft-tissue shadow. STS assessment included optical measures of local perfusion (O2C, Lea Inc. Germany) and tactile measures of mechanical characteristics (Myoton® tensiometer AS, Estonia). Measurements of Group Temp (temporary stabilization) and Group Def (definitive surgery) were taken on admission and prior to the treatment strategy decision. The contralateral non-injured ankle served as a control. The quality of assessment tools was quantified by calculating the smallest detectable change (SDC).
In total, 38 patients with a mean age of 40.4 (SD 17.8) years were included. The SDC was 3.2% (95%CI 2.5 to 3.8) for local blood flow and 1.1% (95%CI 0.4 to 1.7) for soft tissue stiffness. The circumference of the injured area at admission was significantly higher than that of the healthy site (28.2 [SD 3.4] cm versus 23.9 [SD 2.4] cm, p < 0.001). The local perfusion (blood flow 107.5 (SD 40.79 A.U. vs. 80.1 [SD 13.8] A.U., p = 0.009), and local dynamic stiffness of the skin (668.1 (SD 148.0) N/m vs 449.5 (SD 87.7) N/m, p < 0.001) were significantly higher at the injured site. In Group Temp, the local blood flow was significantly higher when compared with Group Def (109.6 [SD 39.8] vs. 94.5 [SD 13.0], p = 0.023). The dynamic stiffness of the soft tissue was significantly higher in Group Temp (679.4 N/m [SD 147.0] N/m vs. 573.0 N/m (SD 93.8) N/m, p < 0.001). The physical properties of STS were comparable among the fracture types. None of the included patients had local soft tissue complications.
Closed fractures of the ankle and the pilon are associated with an increase in local circulation and local soft tissue stiffness and tension. These changes of the STS following injury can be quantified in a standardized and reproducible manner.
局部软组织状况（STS）指导踝关节周围骨折固定的确定性手术治疗策略的时机。本研究的目的是评估新型技术设备在闭合性踝关节和 pilon 骨折的治疗中的应用。
本研究设计为队列研究。符合以下条件的成年患者纳入研究：2019 年 2 月 1 日至 2020 年 12 月 31 日因闭合性踝关节骨折需手术治疗而入院；排除标准为下肢既往损伤、急性深静脉血栓形成、皮肤病和延迟就诊（入院>24 小时）。中度能量创伤包括在团队运动、骑自行车和跑步中受伤。主要结局是通过比较不同的技术，包括踝关节和 pilon 骨折，评估闭合性骨折后软组织受累程度。感兴趣的变量包括踝关节周围软组织肿胀的周长，在内外踝 5mm 范围内测量；骨皮距在平片上测量，即从踝骨到软组织阴影边界的最大距离。STS 评估包括局部灌注的光学测量（O2C，德国 Lea Inc.）和机械特性的触觉测量（Myoton® tensiometer AS，爱沙尼亚）。在入院时和治疗策略决策前测量 Group Temp（临时稳定）和 Group Def（确定性手术）的测量值。对侧未受伤的踝关节作为对照。通过计算最小可检测变化（SDC）来量化评估工具的质量。
共纳入 38 名平均年龄 40.4（SD 17.8）岁的患者。局部血流的 SDC 为 3.2%（95%CI 2.5 至 3.8），软组织硬度的 SDC 为 1.1%（95%CI 0.4 至 1.7）。入院时受伤区域的周长明显高于健康部位（28.2[SD 3.4]cm 与 23.9[SD 2.4]cm，p<0.001）。局部灌注（血流 107.5[SD 40.79A.U. 与 80.1[SD 13.8]A.U.，p=0.009）和皮肤局部动态硬度（668.1[SD 148.0]N/m 与 449.5[SD 87.7]N/m，p<0.001）在受伤部位明显更高。在 Group Temp 中，与 Group Def 相比，局部血流明显更高（109.6[SD 39.8]与 94.5[SD 13.0]，p=0.023）。软组织动态硬度在 Group Temp 中明显更高（679.4N/m[SD 147.0]N/m 与 573.0N/m（SD 93.8）N/m，p<0.001）。STS 的物理特性在不同骨折类型之间具有可比性。所有纳入的患者均无局部软组织并发症。
踝关节和 pilon 的闭合性骨折与局部循环和局部软组织张力增加有关。这些损伤后 STS 的变化可以以标准化和可重复的方式进行量化。
