Baig Mirza Shahid, Mehta Samir, Morales Daniela S, Maniar Hemil H, Dahodwala Taikhoom, Horwitz Daniel Scott
Geisinger Medical Center, Musculoskeletal Institute, 100N. Academy Avenue, Danville, PA 17822-2130 USA.
Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA USA.
Indian J Orthop. 2023 May 5;57(7):1068-1075. doi: 10.1007/s43465-023-00882-x. eCollection 2023 Jul.
Among diabetics, patients with peripheral neuropathy are at increased risk of developing complications following an ankle fracture. While the outcomes in these patients treated nonoperatively have been poor, the outcomes in those undergoing open reduction and internal fixation are at the best modest. We hypothesize that closed reduction and internal fixation with tibiotalocalcaneal nail is an effective primary procedure in this complication prone patient group.
A retrospective review of diabetic patients with peripheral neuropathy who underwent acute treatment of an ankle fracture with closed reduction and internal fixation with a tibiotalocalcaneal nail at two Level 1 trauma centers was performed. 30 patients were identified and divided into 2 groups with respect to their postoperative weight bearing protocol: 20 patients in the early weight bearing (EWB) group and 10 patients in the touch-down weight bearing (TDWB). The primary outcome was the rate of return to baseline function and the secondary outcomes included the incidence of wound dehiscence, wound infection, implant failure, loss of fixation, loss of reduction and amputation.
In the EWB group, 15/20 patients returned to their baseline function, 5/20 had wound dehiscence and infection, 2/20 had implant failure, 5/20 had loss of fixation, 4/20 had loss of reduction, and 4/20 underwent amputation. In the TDWB group, 9/10 patients returned to their baseline function, 1/10 had implant failure, 1/10 had loss of fixation. No patients from this group had loss of reduction or underwent amputation.
Treatment with tibiotalocalcaneal nail is an effective primary procedure in this complication prone group of patients, assuming that weight bearing is delayed for six weeks to protect soft tissues and surgical incisions.
Level IV, retrospective case series.
在糖尿病患者中，外周神经病变患者踝关节骨折后发生并发症的风险增加。虽然这些非手术治疗患者的预后较差，但接受切开复位内固定治疗的患者预后充其量也只是一般。我们假设，使用胫距跟骨钉进行闭合复位内固定是这类易于发生并发症的患者群体的一种有效初始治疗方法。
对两家一级创伤中心采用胫距跟骨钉闭合复位内固定对踝关节骨折进行急性治疗的外周神经病变糖尿病患者进行回顾性研究。确定了30例患者，并根据术后负重方案将其分为两组：早期负重（EWB）组20例患者和触地负重（TDWB）组10例患者。主要结局是恢复至基线功能的比率，次要结局包括伤口裂开、伤口感染、植入物失败、固定丢失、复位丢失和截肢的发生率。
在EWB组中，20例患者中有15例恢复至基线功能，20例中有5例发生伤口裂开和感染，20例中有2例植入物失败，20例中有5例固定丢失，20例中有4例复位丢失，20例中有4例接受了截肢。在TDWB组中，10例患者中有9例恢复至基线功能，10例中有1例植入物失败，10例中有1例固定丢失。该组无患者发生复位丢失或接受截肢。
对于这类易于发生并发症的患者群体，使用胫距跟骨钉治疗是一种有效的初始治疗方法，前提是推迟六周负重以保护软组织和手术切口。
四级，回顾性病例系列。
