Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):539-548. doi: 10.1007/s00590-023-03702-y. Epub 2023 Aug 29.
This study aims to elucidate the pathology of PMFs in the South African population, establish correlations between fracture patterns and international classification guidelines and evaluate the interobserver reliability of current classifications.
A retrospective review was conducted in a multicentre analysis over a one-year period from January 2019 to December 2019 at our institution. Computer tomography scans for foot and ankle injuries were reviewed, and posterior malleolus fractures were included. Pathoanatomical data was collected and analysed according to known classification systems and subsequent treatment modalities evaluated. A panel of observers individually reviewed radiographic data to determine interobserver reliability.
A total of 71 patients were included with a mean age of 41 ± 13.4 years (range 18-78) and a female predominant population (69%). A greater proportion of injuries were high energy (23.9%), with significant fragment comminution (53.5%), and half (52.1%) of all injuries were subluxated/dislocated at presentation. A total of 93% of injuries were managed operatively, despite theatre access limitations resulting in significant delays to fixation (19.1 days). Despite good pathoanatomical agreement with most international classifications, interobserver reliability was poor (Krippendorff α-coefficient < 0.667). Inconsistent treatment patterns in operative and non-operative strategies are reported.
A unique patient population of younger, female individuals incurred posterior malleolar fractures due to higher energy mechanisms of injury. Whilst injury patterns were mostly comparable, significant interobserver variability was noted. Resource limitations, diagnostic challenges, poorly defined and inconsistent treatment strategies, inevitably impact outcomes within the South African population.
Level III.
本研究旨在阐明南非人群中 PMFs 的病理学，建立骨折模式与国际分类指南之间的相关性，并评估当前分类方法的观察者间可靠性。
在我们机构进行了一项为期一年的回顾性多中心分析，时间为 2019 年 1 月至 2019 年 12 月。回顾了足踝损伤的计算机断层扫描，并纳入了后踝骨折。根据已知的分类系统收集和分析病理解剖数据，并评估随后的治疗方式。一组观察者分别对影像学数据进行评估，以确定观察者间的可靠性。
共纳入 71 例患者，平均年龄为 41±13.4 岁（范围 18-78 岁），女性居多（69%）。更多的损伤为高能量（23.9%），显著的骨折粉碎（53.5%），一半（52.1%）的所有损伤在就诊时均为半脱位/脱位。尽管手术入路受限导致固定时间明显延迟（19.1 天），但仍有 93%的损伤采用手术治疗。尽管与大多数国际分类方法具有良好的病理解剖学一致性，但观察者间的可靠性较差（Krippendorff α系数<0.667）。报告了手术和非手术策略中不一致的治疗模式。
年轻、女性的独特患者人群因高能量损伤机制而发生后踝骨折。尽管损伤模式大多相似，但观察到显著的观察者间变异性。资源限制、诊断挑战、定义不明确和不一致的治疗策略不可避免地影响南非人群的结局。
III 级。
