Orthopaedic and Traumatology, Peking University People's Hospital, Beijing, 100044, China.
Orthopaedic, Qingdao Women and Children's Hospital, Shandong, China.
J Orthop Surg Res. 2023 Jan 4;18(1):10. doi: 10.1186/s13018-022-03488-5.
The treatment of posterior malleolar fractures is changing rapidly, and the evidence base is still catching up. This study aimed to assess the mid-term prognosis of posterior malleolar fractures based on different morphological types and provides evidence for the treatment of posterior malleolar fractures.
We retrospectively analyzed the data of inpatients with posterior malleolar fractures from 1 January 2012 to 31 December 2019 at one high-volume tertiary trauma center. Fracture morphology was classified into small-shell fragment, single-fragment (small-fragment and large-fragment) and multifragment (double-fragment and compressive-fragment) by computed tomography according to our previous study. All patients were followed up at an average of 5.06 (range, 2.21-8.70) years. The Olerud-Molander Ankle Score (OMAS), EuroQol-5 Dimensions (EQ-5D) and American Orthopedic Foot and Ankle Society (AOFAS) score were recorded.
Seventy-nine patients were included, and 7 patients were classified into the small-shell group, 52 patients into the single-fragment group and 20 patients into the multifragment group. Of all the patients, the average OMAS, EQ-5D and AOFAS scores were 85.9, 82.8 and 92.5, respectively. In the single-fragment group, patients who underwent surgical fixation in the posterior malleolus had significantly better scores (P = 0.037, 0.033 and 0.027). Among the patients with small fragments, the surgical fixation group also had higher OMAS (93.1 ± 7.5 vs. 83.5 ± 19.5, P = 0.042) and AOFAS scores (98.1 ± 3.1 vs. 91.0 ± 14.1, P = 0.028). The mean OMAS, EQ-5D and AOFAS scores were 85.5, 85.7 and 91.7, respectively, in patients with multiple fragments who underwent surgical fixation.
This study shows that in fractures with a single fragment, surgical fixation of the posterior malleolar fragment led to a better prognosis in the midterm. All single fragments should be fixed regardless of size. Fixation of the posterior region in all single- and multi-fragments in posterior malleolar fractures led to satisfactory outcomes.
Level III, follow-up study.
后踝骨折的治疗方法正在迅速变化，而证据基础仍在不断发展。本研究旨在根据不同的形态类型评估后踝骨折的中期预后，并为后踝骨折的治疗提供证据。
我们回顾性分析了 2012 年 1 月 1 日至 2019 年 12 月 31 日在一家高容量三级创伤中心住院的后踝骨折患者的数据。根据我们之前的研究，通过计算机断层扫描将骨折形态分为小壳型、单块型（小骨块和大块）和多块型（双块型和压缩块型）。所有患者的平均随访时间为 5.06 年（范围为 2.21-8.70 年）。记录 Olerud-Molander 踝关节评分（OMAS）、欧洲五维健康量表（EQ-5D）和美国矫形足踝协会（AOFAS）评分。
共纳入 79 例患者，其中 7 例为小壳型，52 例为单块型，20 例为多块型。所有患者的 OMAS、EQ-5D 和 AOFAS 评分平均分别为 85.9、82.8 和 92.5。在单块型中，接受后踝骨折手术固定的患者评分显著更好（P=0.037、0.033 和 0.027）。在小骨块患者中，手术固定组的 OMAS 评分（93.1±7.5 vs. 83.5±19.5，P=0.042）和 AOFAS 评分（98.1±3.1 vs. 91.0±14.1，P=0.028）也更高。手术固定多块型患者的 OMAS、EQ-5D 和 AOFAS 评分平均分别为 85.5、85.7 和 91.7。
本研究表明，在单块骨折中，后踝骨折块的手术固定可在中期获得更好的预后。所有小骨块都应固定，无论大小。所有单块和多块后踝骨折的后区固定均可获得满意的结果。
三级，随访研究。
