Bastías Gonzalo F, Bravo Francisco, Astudillo Claudia, Giannini Esteban, Contreras Martin, Melo Rodrigo, Muñoz Gerardo, Pellegrini Manuel J, Cuchacovich Natalio
Department of Orthopedic Surgery, Foot and Ankle Unit, Clínica Las Condes-Hospital del Trabajador, Universidad de Chile, Las Condes, Santiago, Chile.
Department of Orthopedic Surgery, Foot and Ankle Unit, Complejo Hospitalario San José-Mutual de Seguridad, Santiago, Chile.
Foot Ankle Orthop. 2022 Dec 8;7(4):24730114221141388. doi: 10.1177/24730114221141388. eCollection 2022 Oct.
Intramedullary nailing of the fibula (FN) is a method of fixation that has proven to be useful for treating distal fibular fractures (DFs). FN minimizes soft tissue complications and provides similar stability to plating, with fewer hardware-related symptoms. Nevertheless, FN has been associated with syndesmotic malreduction and the incapacity of restoring length and rotation of the fibula. We aimed to evaluate the fibular position and syndesmotic reduction after fixation with FN compared with the uninjured ankle in the immediate postoperative period.
Prospective cohort study. Patients with DF fractures treated with IN between January 2017 and January 2020 were included. Immediate postoperative bilateral ankle CT was obtained in all cases. Fibular rotation, length, and translation as well as syndesmotic diastasis were measured on both ankles and compared by 3 independent observers.
Twenty-eight patients were included (16 women). The mean age was 46 years (range 16-91). Fracture type distribution according to AO/ASIF classification included 19 patients with 44.B (67.9%), 8 patients with 44.C (28.6%), and 1 patient with a 44.A fracture (3.6%). No significant differences were identified considering fibular rotation ( = .661), syndesmotic diastasis ( = .147), and fibular length ( = .115) between the injured and uninjured ankle. Fibular translation had statistical differences ( = .01) compared with the uninjured ankle. The intraclass correlation coefficient showed an excellent concordance between observers except for fibular translation on the injured ankle.
In this cohort, fixation of DF fractures with FN allows restoration of anatomical parameters of the ankle in terms of fibular rotation, length, and syndesmotic diastasis. However, fibular translation had significant differences compared with the uninjured ankle based on bilateral CT scan evaluation.
Level II, prospective cohort study.
腓骨髓内钉固定术（FN）是一种已被证明对治疗腓骨远端骨折（DF）有用的固定方法。FN可将软组织并发症降至最低，并提供与钢板固定相似的稳定性，且与硬件相关的症状较少。然而，FN与下胫腓联合复位不良以及无法恢复腓骨长度和旋转有关。我们旨在评估与未受伤的踝关节相比，FN固定术后即刻腓骨的位置和下胫腓联合的复位情况。
前瞻性队列研究。纳入2017年1月至2020年1月期间接受IN治疗的DF骨折患者。所有病例均在术后即刻获得双侧踝关节CT。测量双侧踝关节的腓骨旋转、长度、平移以及下胫腓联合分离，并由3名独立观察者进行比较。
纳入28例患者（16例女性）。平均年龄为46岁（范围16 - 91岁）。根据AO/ASIF分类，骨折类型分布包括19例44.B型患者（67.9%）、8例44.C型患者（28.6%）和1例44.A型骨折患者（3.6%）。在受伤和未受伤的踝关节之间，腓骨旋转（P = 0.661）、下胫腓联合分离（P = 0.147）和腓骨长度（P = 0.115）未发现显著差异。与未受伤的踝关节相比，腓骨平移有统计学差异（P = 0.01）。组内相关系数显示观察者之间具有良好的一致性，但受伤踝关节的腓骨平移除外。
在该队列中，用FN固定DF骨折可使踝关节在腓骨旋转、长度和下胫腓联合分离方面恢复解剖参数。然而，根据双侧CT扫描评估，与未受伤的踝关节相比，腓骨平移存在显著差异。
二级，前瞻性队列研究。
