Department of Surgery, Haaglanden Medical Center, Location Westeinde Lijnbaan 32, 2512, The Hague, VA, The Netherlands.
Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):317-326. doi: 10.1007/s00068-022-02066-y. Epub 2022 Aug 26.
The treatment of the posterior fragment in trimalleolar fractures differs from hospital to hospital in the Netherlands. A nationwide survey was performed to evaluate the fixation criteria and practice variation.
An online cross-sectional survey amongst (orthopaedic) trauma surgeons was performed in the Netherlands. It consisted of three sections: a general section, a section showing preoperative images of six cases and a section with postoperative images of nine cases.
A total of 151 surgeons completed the online survey. 45% of the respondents indicated that they fixated the posterior fragment if smaller than 25% of the intra-articular surface. 48% preferred an open posterior approach to fixate the posterior fragment. There was good consensus in treatment for the two cases with Bartonicek type 4 fractures (operative treatment in 73 and 72% respectively). Little consensus was found for Bartonicek type 2 and 3 fractures (88% opted for operative treatment in one case, but 89% for conservative treatment in the second case). Reoperation was mostly considered in cases with a step-off of more than 1 mm (by 33-38% of the respondents). There was great variation in the choice of treatment if only the size of the posterior fragment was considered. Other fixation criteria such as postoperative step-off or instability after fixation of the lateral and medial malleoli are taken into account. In cases where fixation was needed, a percutaneous approach and an open posterolateral approach were equally preferred.
There is much variation in treatment of the posterior malleolar fracture amongst orthopaedic and trauma surgeons in the Netherlands. The percutaneous approach and open posterolateral approach to fixate the posterior malleolar fracture seem to be equally used in the Netherlands. Still, there is no uniformity in treatment of posterior malleolar fracture, especially for Bartonicek 2 and Bartonicek 3 fractures. Reoperation is considered by less than half of the surgeons in case of postoperative persistent step-off of more than 1 mm.
在荷兰，三踝骨折中后踝骨折块的治疗在不同医院之间存在差异。本研究开展了一项全国性调查，旨在评估固定标准和实践差异。
在荷兰，对（骨科）创伤外科医生进行了在线横断面调查。该调查包括三个部分：一般部分、六个病例的术前影像学部分和九个病例的术后影像学部分。
共有 151 名外科医生完成了在线调查。45%的受访者表示，如果关节内表面的后踝骨折块小于 25%，他们会固定后踝骨折块。48%的人更倾向于采用后外侧入路切开复位内固定治疗后踝骨折块。对于 Bartonicek 4 型骨折的两种情况，治疗方法有很好的一致性（分别有 73%和 72%的人选择手术治疗）。对于 Bartonicek 2 型和 3 型骨折，一致性较小（一种情况下 88%的人选择手术治疗，另一种情况下 89%的人选择保守治疗）。如果后踝骨折块有超过 1 毫米的台阶（33%至 38%的受访者），大多数人会考虑再次手术。如果仅考虑后踝骨折块的大小，治疗方法的选择存在很大差异。其他固定标准，如术后台阶或固定内外踝后不稳定，也会被考虑在内。如果需要固定，经皮入路和后外侧入路切开复位内固定同样被推荐。
荷兰骨科和创伤外科医生对后踝骨折的治疗方法存在很大差异。经皮入路和后外侧入路切开复位内固定治疗后踝骨折在荷兰似乎同样被使用。然而，后踝骨折的治疗方法仍不统一，特别是对于 Bartonicek 2 型和 Bartonicek 3 型骨折。如果术后后踝骨折块台阶超过 1 毫米，不到一半的外科医生会考虑再次手术。
