Touloupakis G, Messori M, Gilli A, Theodorakis E, Ghirardelli S, Antonini G
Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
Department of Orthopedics and Traumatology, Hospital Brixen Bressanone, Bressanone, Italy.
Malays Orthop J. 2023 Mar;17(1):172-179. doi: 10.5704/MOJ.2303.020.
In this retrospective case-series study we discuss the clinical and radiographic outcomes obtained following the "tibia-first concept" in the treatment of distal tibia fractures, both in patients with fibular comminution and in cases with a simple fibula fracture.
We analysed a consecutive series of 64 patients who presented at our emergency department with a distal articular tibial and fibular fracture from January 2015 to September 2020. A total of 22 patients met the inclusion and exclusion criteria and were included in the study. Clinical and radiographic examination were performed at each follow-up. To quantify pain and functional disability, the Foot and Ankle Outcome Score (FAOS) and the American Orthopaedic Foot and Ankle Society's ankle-hindfoot scale (AOFAS) were applied.
The overall mean age was 52.8 years, and the mean follow-up was 13.18 months. Multiple scales data from the FAOS were as follows: pain score 80.70; symptoms score 81.69; activities of daily living score 87.22; quality of life 76.05. The mean AOFAS ankle-hindfoot score was 74.36.
Even though the principles of Rüedi and Allgöwer are still valid, in specific circumstances, the tibia-first concept could be considered as a valid option for the treatment of these demanding fractures. If a good reduction is obtained intra-operatively by ligamentotaxis, we recommend fixing the tibia first, avoiding surgical stress on tissues derived from a previous fibular fixation.
在这项回顾性病例系列研究中，我们讨论了采用“胫骨优先理念”治疗胫腓骨远端骨折的临床和影像学结果，包括腓骨粉碎性骨折患者和单纯腓骨骨折病例。
我们分析了2015年1月至2020年9月期间在我院急诊科就诊的一系列连续64例胫腓骨远端关节骨折患者。共有22例患者符合纳入和排除标准并被纳入研究。每次随访时均进行临床和影像学检查。为了量化疼痛和功能障碍，应用了足踝结果评分（FAOS）和美国矫形足踝协会的踝后足评分量表（AOFAS）。
总体平均年龄为52.8岁，平均随访时间为13.18个月。FAOS的多个量表数据如下：疼痛评分80.70；症状评分81.69；日常生活活动评分87.22；生活质量76.05。AOFAS踝后足平均评分为74.36。
尽管Rüedi和Allgöwer的原则仍然有效，但在特定情况下，胫骨优先理念可被视为治疗这些复杂骨折的有效选择。如果术中通过韧带牵拉获得良好复位，我们建议先固定胫骨，避免对先前腓骨固定部位的组织造成手术应力。
