与涉及后踝的踝关节骨折较差临床结果相关的危险因素。
Risk Factors Associated With Worse Clinical Outcomes of Ankle Fractures Involving the Posterior Malleolus.
作者信息
Rajan Lavan, Eble Stephanie, Kim Jaeyoung, Kukadia Saanchi, Kumar Prashanth, Day Jonathan, Cho David, Drakos Mark, Ellis Scott
机构信息
Hospital for Special Surgery, New York, NY, USA.
Columbia University, New York, NY, USA.
出版信息
Foot Ankle Orthop. 2023 Feb 23;8(1):24730114231154217. doi: 10.1177/24730114231154217. eCollection 2023 Jan.
BACKGROUND
Ankle fractures involving the posterior malleolus (PM) tend to result in inferior clinical outcomes compared to other ankle fractures. However, it is unclear which specific risk factors and fracture characteristics are associated with negative outcomes in these fractures. The aim of this study was to identify risk factors for poor postoperative patient-reported outcomes in patients with fractures involving the PM.
METHODS
This retrospective cohort study included patients who sustained ankle fractures involving the PM between March 2016 and July 2020 and had preoperative computed tomography (CT) scans. In total, 122 patients were included for analysis. One patient (0.8%) had an isolated PM fracture, 19 (15.6%) had bimalleolar ankle fractures involving the PM, and 102 (83.6%) had trimalleolar fractures. Fracture characteristics including the Lauge-Hansen (LH) and Haraguchi classifications and posterior malleolar fragment size were collected from preoperative CT scans. Patient Reported Outcome Measurement Information System (PROMIS) scores were collected preoperatively and at a minimum of 1 year postoperatively. The association between various demographic and fracture characteristics with postoperative PROMIS scores was assessed.
RESULTS
Involvement of more malleoli was associated with worse PROMIS Physical Function ( = .04), Global Physical Health ( = .04), and Global Mental Health ( < .001), and Depression scores ( = .001). Elevated BMI was also associated with worse PROMIS Physical Function ( = .0025), Pain Interference ( = .0013), and Global Physical Health ( = .012) scores. Time to surgery, fragment size, Haraguchi classification, and LH classification were not associated with PROMIS scores.
CONCLUSION
In this cohort, we found that trimalleolar ankle fractures were associated with inferior PROMIS outcomes compared with bimalleolar ankle fractures involving the PM in multiple domains.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
背景
与其他踝关节骨折相比，涉及后踝（PM）的踝关节骨折往往导致较差的临床结果。然而，目前尚不清楚哪些特定的风险因素和骨折特征与这些骨折的不良预后相关。本研究的目的是确定涉及后踝骨折患者术后患者报告结局不佳的风险因素。
方法
这项回顾性队列研究纳入了2016年3月至2020年7月期间发生涉及后踝的踝关节骨折且术前行计算机断层扫描（CT）的患者。总共纳入122例患者进行分析。1例患者（0.8%）为单纯后踝骨折，19例（15.6%）为涉及后踝的双踝骨折，102例（83.6%）为三踝骨折。从术前行CT扫描中收集骨折特征，包括Lauge-Hansen（LH）和原口分类以及后踝骨折块大小。术前和术后至少1年收集患者报告结局测量信息系统（PROMIS）评分。评估各种人口统计学和骨折特征与术后PROMIS评分之间的关联。
结果
更多踝骨受累与更差的PROMIS身体功能（P = 0.04）、总体身体健康（P = 0.04）、总体心理健康（P < 0.001）和抑郁评分（P = 0.001）相关。BMI升高也与更差的PROMIS身体功能（P = 0.0025）、疼痛干扰（P = 0.0013）和总体身体健康（P = 0.012）评分相关。手术时间、骨折块大小、原口分类和LH分类与PROMIS评分无关。
结论
在本队列中，我们发现与涉及后踝的双踝骨折相比，三踝骨折在多个领域的PROMIS结局较差。
证据水平
III级，回顾性队列研究。
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