Clinic of Orthopedics, Hand and Trauma Surgery, City Hospital Zurich, Tièchestrasse 99, 8037, Zurich, Switzerland.
Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
Arch Orthop Trauma Surg. 2023 Oct;143(10):6193-6200. doi: 10.1007/s00402-023-04949-0. Epub 2023 Jun 19.
Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value. Current computed-tomography (CT)-based fracture classifications led to an increase in fixation of the posterior malleolus. The aim of this study was to describe the functional outcome after a two-stage stabilisation with direct fixation of the posterior fragment in trimalleolar dislocation fractures.
In a retrospective study, all patients presenting with a trimalleolar dislocation fracture, an available CT scan, and a two-stage operative stabilisation including the posterior malleolus by a posterior approach were included. All fractures were treated with initial external fixator and delayed definitive stabilisation including fixation of the posterior malleolus. Next to clinical and radiological follow-up, outcome measures (Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS), Activity of Daily Living (ADL), Hulsmans implant removal score) and complications were analysed.
Between 2008 and 2019, of 320 trimalleolar dislocation fractures, 39 patients were included. Mean follow-up was 49 months (standard deviation (SD) 29.7, range 16-148). Mean age was 60 years (SD 15.3, 17-84) with 69% female patients. The mean FAOS was 93/100 (SD 9.7, 57-100), NRS 2 (interquartile range (IQR) 0-3) and ADL 2 (IQR 1-2). Four patients showed a postoperative infection, three re-operations had to be performed and implants were removed in 24 individuals.
A two-stage procedure of trimalleolar dislocation fractures with in-direct reduction and fixation of the posterior tibial fragment through a posterior approach leads to good functional outcome scores with a low rate of complications.
三踝骨折较难治疗，复位不良可导致功能受损。后踝骨受累的预测价值较差。目前基于计算机断层扫描（CT）的骨折分类导致后踝骨固定增加。本研究旨在描述经后外侧入路直接固定后踝骨碎片的两阶段稳定治疗三踝骨折脱位的功能结果。
在回顾性研究中，纳入所有存在三踝骨折脱位、有可用 CT 扫描且行两阶段手术稳定治疗（包括后踝）的患者。所有骨折均采用初始外固定架和延迟确定性固定治疗，包括后踝固定。除临床和影像学随访外，还分析了功能结果（足踝评分（FAOS）、数字评分量表（NRS）、日常生活活动（ADL）、Hulsmans 植入物去除评分）和并发症。
2008 年至 2019 年，320 例三踝骨折脱位患者中，有 39 例患者纳入本研究。平均随访时间为 49 个月（标准差（SD）29.7，范围 16-148）。平均年龄为 60 岁（SD 15.3，17-84），女性占 69%。FAOS 平均为 93/100（SD 9.7，57-100），NRS 为 2（四分位距（IQR）0-3），ADL 为 2（IQR 1-2）。4 例患者术后发生感染，3 例患者需再次手术，24 例患者取出了植入物。
经后外侧入路间接复位和固定后踝骨碎片的三踝骨折脱位两阶段手术可获得良好的功能结果，并发症发生率低。
