Liu Pengcheng, Xu Chen, Chen Zhaoxun, Xiao Joanna Xi, Zhao Chen, Yang Fei, Li Jiang, Wang Xiaoqing
Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Orthopedics, Changxing People's Hospital of Chongming District, Shanghai, China.
J Foot Ankle Surg. 2022 Nov-Dec;61(6):1287-1292. doi: 10.1053/j.jfas.2022.04.003. Epub 2022 Apr 22.
Excessive lengths of partially threaded cannulated screws in medial malleolus fractures are often related to failure of fixation. This study aimed to analyze the distribution and density of cancellous bone in the medial malleolus among healthy individuals and provide a theoretical basis for determining the lengths of cannulated screws based on preoperative computed tomography (CT) to achieve stable fixation of medial malleolus fractures. Between January 2012 and December 2016, 100 patients (without ankle fractures) who underwent computed tomography of the distal tibia were included. Specific levels on the computed tomography images were selected to assess the density and length of valid cancellous bone in the medial malleolus. Meanwhile, we followed up 44 patients who underwent open reduction and internal fixation of medial malleolus fractures based on preoperative computed tomography-based measurements. The valid lengths of cancellous bone in the medial malleolus were significantly different between men and women (p < .05). In addition, there was a significant difference among different age groups (p < .05). All patients were followed up to union without displacement. Age and gender have a considerable impact on the distribution and density of cancellous bone in the medial malleolus. The density and length of valid cancellous bone decrease with age. The shoulder of the tibial plafond in medial malleolus, which is a weak part of cancellous bone, is a common site of fracture. Short screws are recommended for fixation in elderly patients. In conclusion, preoperative computed tomography can help determine the length and location of cannulated screws.
内踝骨折中部分螺纹空心螺钉过长常与固定失败有关。本研究旨在分析健康个体内踝松质骨的分布和密度，为术前基于计算机断层扫描（CT）确定空心螺钉长度以实现内踝骨折的稳定固定提供理论依据。2012年1月至2016年12月，纳入100例（无踝关节骨折）接受胫骨远端计算机断层扫描的患者。在计算机断层扫描图像上选择特定层面，评估内踝有效松质骨的密度和长度。同时，我们对44例基于术前计算机断层扫描测量结果接受内踝骨折切开复位内固定的患者进行了随访。内踝有效松质骨长度在男性和女性之间存在显著差异（p < 0.05）。此外，不同年龄组之间也存在显著差异（p < 0.05）。所有患者均随访至骨折愈合且无移位。年龄和性别对内踝松质骨的分布和密度有相当大的影响。有效松质骨的密度和长度随年龄增长而降低。内踝处胫骨平台的肩部是松质骨的薄弱部位，是常见的骨折部位。建议老年患者使用短螺钉进行固定。总之，术前计算机断层扫描有助于确定空心螺钉的长度和位置。
