Department of Orthopedic Surgery, Zhuzhou Central Hospital, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Changsha, China.
Adv Clin Exp Med. 2024 Apr;33(4):343-350. doi: 10.17219/acem/169190.
Malreduction remains a problem in patients with an ankle joint fracture combined with a lower tibiofibular syndesmosis injury. Current methods of malreduction evaluation have many limitations, and novel techniques are required.
The aim of the study was to investigate the association between the distance between the anterior and posterior edges of the fibula at a 15° lateral internal rotation and postoperative malreduction in patients with an ankle joint fracture combined with a lower tibiofibular syndesmosis injury.
This prospective observational cohort study enrolled 187 patients diagnosed with an ankle joint fracture combined with a lower tibiofibular syndesmosis injury between January 2020 and January 2022. The patients were divided into 2 groups according to their postoperative malreduction condition: the malreduction group and the non-malreduction group. After tibiofibular syndesmosis reduction, a computed tomography (CT) scan was used to measure the distance between the anterior and posterior edges of the fibula at a standard lateral position and a position with a lateral internal rotation of 15°. Demographic data and basic clinical characteristics were recorded for all patients.
The mean distance between the anterior and posterior edges of the fibula was longer in malreduction patients than non-malreduction patients at the standard lateral and 15° lateral internal rotation positions. At a lateral internal rotation of 15°, the distance between the anterior and posterior edges correlated negatively with the postoperative Mazur and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and correlated positively with the length of hospitalization and fracture healing time. Receiver operating characteristic (ROC) curves revealed the potential postoperative malreduction diagnostic value of fibular anterior-posterior edge distance using an internal rotation of 15°. Postoperative AOFAS score, length of hospitalization, fracture healing time, and the distance between the anterior and posterior edges of the fibula at a lateral internal rotation of 15° were independent risk factors of malreduction.
The fibular anterior-posterior edge distance at an internal rotation of 15° is associated with postoperative ankle joint function and the occurrence of malreduction.
踝关节骨折合并下胫腓联合损伤患者仍存在复位不良的问题。目前的复位不良评估方法存在许多局限性，需要新的技术。
本研究旨在探讨踝关节骨折合并下胫腓联合损伤患者腓骨前后缘在 15°内旋侧位时的距离与术后复位不良的关系。
本前瞻性观察队列研究纳入 2020 年 1 月至 2022 年 1 月期间诊断为踝关节骨折合并下胫腓联合损伤的 187 例患者。根据术后复位不良情况将患者分为两组：复位不良组和非复位不良组。在完成下胫腓联合复位后，采用 CT 扫描测量标准侧位和 15°内旋侧位时腓骨前后缘的距离。记录所有患者的人口统计学数据和基本临床特征。
在标准侧位和 15°内旋侧位时，复位不良患者的腓骨前后缘距离均大于非复位不良患者。在 15°内旋时，腓骨前后缘距离与术后 Mazur 和美国矫形足踝协会（AOFAS）评分呈负相关，与住院时间和骨折愈合时间呈正相关。ROC 曲线显示 15°内旋时腓骨前后缘距离对术后复位不良有潜在的诊断价值。术后 AOFAS 评分、住院时间、骨折愈合时间和 15°内旋时腓骨前后缘距离是复位不良的独立危险因素。
15°内旋时腓骨前后缘距离与术后踝关节功能和复位不良有关。
