Haaglanden Medical Centre, Lijnbaan 32, The Hague, VA 2512 Netherlands.
Haaglanden Medical Centre, Lijnbaan 32, The Hague, VA 2512 Netherlands.
Injury. 2024 Mar;55(3):111348. doi: 10.1016/j.injury.2024.111348. Epub 2024 Jan 17.
In isolated type B fibular fractures, the decision whether to operate or treat conservatively is principally based on congruency and stability of the ankle joint. The purpose of the current study is to examine the additional diagnostic value of the weight-bearing radiograph (WBR) in assessing stability of potentially unstable type B fibular fractures.
In this retrospective cohort study, patients were selected based on who presented an isolated type B fracture of the fibula. Unstable fractures were directly planned for surgery. Other patients underwent additional weight-bearing imaging 4-7 days after initial trauma, on which definitive treatment was based. The medial clear space (MCS) was compared between the WBR and the conventional radiograph.
A total of 70 patients were included in the period January 2018-December 2021. The average MCS on conventional mortise radiograph was 3.56 mm compared to 3.02 mm on the WBR(p<0.05). The superior clear space (SCS) was equal between both groups (respectively 3.12 mm and 3.08 mm, p = 0.44). All 70 patients were initially treated conservatively with immediate weight-bearing in a brace or soft cast. One patient had the need for open repair and internal fixation due to non-union.
Different techniques for the assessment of deep deltoid ligament integrity exist, such as the MRI, the ultrasonography and different kinds of stress test radiographs. As fractured ankles don't need direct fixation and operative treatment can be postponed, a stepped approach for the assessment of deep deltoid ligament (DDL) integrity can be of assistance in assessing ankle stability. In isolated type B fibular fractures a stepped approach, using the weight-bearing radiograph can be of additional value in assessing the stability. It is a low cost, prevents unnecessary surgery and contributes to a quick weight-bearing non-operative treatment.
在孤立型 B 型腓骨骨折中，是否手术或保守治疗的决策主要基于踝关节的对位和稳定性。本研究的目的是研究负重 X 线片（WBR）在评估潜在不稳定型 B 型腓骨骨折稳定性方面的附加诊断价值。
在这项回顾性队列研究中，根据患者是否存在孤立型 B 型腓骨骨折选择患者。不稳定骨折直接计划手术。其他患者在初次创伤后 4-7 天进行额外的负重影像学检查，在此基础上确定治疗方案。比较 WBR 和常规 X 线片的内侧间隙（MCS）。
2018 年 1 月至 2021 年 12 月期间共纳入 70 例患者。常规踝穴 X 线片上的平均 MCS 为 3.56mm，WBR 上为 3.02mm（p<0.05）。两组的上侧间隙（SCS）相等（分别为 3.12mm 和 3.08mm，p=0.44）。所有 70 例患者最初均采用保守治疗，即用支具或软石膏立即负重。1 例因骨折不愈合需要切开复位内固定。
评估深三角韧带完整性的技术有很多，如 MRI、超声检查和不同类型的应力位 X 线片。由于踝关节骨折不需要直接固定，手术治疗可以推迟，因此评估深三角韧带（DDL）完整性的分阶段方法可以帮助评估踝关节的稳定性。在孤立型 B 型腓骨骨折中，分阶段方法，使用负重 X 线片在评估稳定性方面可能具有附加价值。它是一种低成本、可避免不必要的手术，并有助于快速负重非手术治疗。
