Mandelka Eric, Wikanardi Bernhard A, Beisemann Nils, Gruetzner Paul A, Franke Jochen, Vetter Sven Y, Privalov Maxim
Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany.
Medical Faculty of Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany.
J Clin Med. 2023 Jan 17;12(3):748. doi: 10.3390/jcm12030748.
Studies have reported a high percentage of ankle fracture dislocations with secondary loss of reduction during primary treatment with a splint or cast. This study aimed to assess the rate of secondary loss of reduction in unimalleolar ankle fracture dislocations treated primarily with a cast or external fixator, identify the potential influence of fracture morphology, and investigate the potential implications. Unimalleolar ankle fracture dislocations with and without posterior malleolar fracture between 2011 and 2020 were included. Patients were categorized into two groups, depending on the method of temporary treatment. Fracture morphology, time to definitive surgery, and soft-tissue complications were compared. Of 102 patients, loss of reduction tended to occur more often in the cast group (17.3%) than in the external fixator group (6.0%). The presence of a posterior malleolar fracture did not have a significant influence on loss of reduction in cast immobilization; however, the fragment proved to be significantly bigger in cases with loss of reduction. No statistically significant differences in soft tissue complications or time to definitive surgery were found. Surgeons should consider the application of interval external fixation in the primary treatment of unimalleolar ankle fracture dislocations with additional posterior malleolar fractures.
研究报告称，在使用夹板或石膏进行初次治疗期间，踝关节骨折脱位继发复位丢失的比例很高。本研究旨在评估主要采用石膏或外固定器治疗的单踝踝关节骨折脱位继发复位丢失的发生率，确定骨折形态的潜在影响，并调查其潜在意义。纳入了2011年至2020年间伴有和不伴有后踝骨折的单踝踝关节骨折脱位患者。根据临时治疗方法将患者分为两组。比较了骨折形态、确定性手术时间和软组织并发症。在102例患者中，石膏组继发复位丢失的发生率（17.3%）往往高于外固定器组（6.0%）。后踝骨折的存在对石膏固定继发复位丢失没有显著影响；然而，在继发复位丢失的病例中，骨折块明显更大。在软组织并发症或确定性手术时间方面未发现统计学上的显著差异。外科医生在初次治疗伴有后踝骨折的单踝踝关节骨折脱位时应考虑应用间隔外固定。
