Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany.
Eur J Trauma Emerg Surg. 2023 Apr;49(2):851-858. doi: 10.1007/s00068-022-02119-2. Epub 2022 Nov 4.
Complex ankle fractures frequently include the posterior malleolus (PM). Despite advances in diagnostic and treatment strategies, PM fracture involvement still predisposes to worse outcomes. While not incorporated into the most common PM fracture classifications, the presence of an intercalary fragment (ICF) complicates treatment. This study aims to describe the incidence, morphology, and location of ICFs in PM fractures.
A total of 135 patients with a mean age of 54.4 (SD ± 18.9) years and PM fractures were analyzed for the presence of an ICF. Patients with an ICF were compared to those without in terms of age, gender, and treatment received. Characteristics of the ICFs in terms of location and size were assessed. Furthermore, the presence of an ICF in relation to the PM fracture classification according to Haraguchi et al., Bartoníček/Rammelt et al., and Mason et al. was investigated.
ICFs presented in 55 (41%) of the 135 patients. Patients with an ICF were younger, and the PM was more often operatively treated when compared to patients without an ICF. A posterolateral approach was used significantly more often in patients with an ICF. Almost all ICFs were found in the posterolateral (58%) and posterocentral (35%) regions. The majority of fragments were found in Bartoníček/Rammelt type 2 fractures, the most common fracture type. Bartoníček/Rammelt type 3 fractures had the highest relative frequency of ICFs.
ICFs are frequently found in PM fractures; however, they are not incorporated into any of the common classifications. They are generally found in younger patients and associated with more complex PM fractures. As they can complicate reduction of the main fragment and may require direct exposure to restore joint congruency, ICFs should be considered in PM fracture classifications. Due to their location, the majority of ICFs are able to be accessed using a posterolateral approach.
复杂的踝关节骨折常包括后踝（PM）。尽管在诊断和治疗策略方面取得了进展，但 PM 骨折的累及仍然会导致预后更差。尽管在最常见的 PM 骨折分类中没有纳入，但存在间插骨块（ICF）会使治疗变得复杂。本研究旨在描述 PM 骨折中 ICF 的发生率、形态和位置。
共分析了 135 名平均年龄为 54.4（SD±18.9）岁的 PM 骨折患者是否存在 ICF。比较了有 ICF 的患者和无 ICF 的患者在年龄、性别和治疗方面的差异。评估了 ICF 在位置和大小方面的特征。此外，还研究了 ICF 的存在与 Haraguchi 等人、Bartoníček/Rammelt 等人和 Mason 等人的 PM 骨折分类之间的关系。
在 135 名患者中，55 名（41%）存在 ICF。与无 ICF 的患者相比，有 ICF 的患者年龄更小，PM 更常接受手术治疗。当存在 ICF 时，更常采用后外侧入路。几乎所有的 ICF 都位于后外侧（58%）和后中央（35%）区域。大多数骨块位于 Bartoníček/Rammelt 类型 2 骨折中，这是最常见的骨折类型。Bartoníček/Rammelt 类型 3 骨折中 ICF 的相对频率最高。
ICF 常存在于 PM 骨折中，但未纳入任何常见分类。它们通常存在于年轻患者中，并与更复杂的 PM 骨折相关。由于它们可以使主要骨块的复位复杂化，并且可能需要直接暴露来恢复关节的一致性，因此在 PM 骨折分类中应考虑 ICF。由于其位置，大多数 ICF 可以通过后外侧入路进行处理。
