Pehlivanoglu Tuna, Demirel Mehmet, Koyuncu Daghan, Valiyev Natiq, Akgül Turgut, Kilicoglu Onder Ismet
*Medicana Bahçelievler Hospital, Istanbul, Turkey.
†Department of Orthopedics and Traumatology, Istanbul Medical School, Istanbul University, Istanbul, Turkey.
J Am Podiatr Med Assoc. 2025 May-Jun;115(3). doi: 10.7547/22-225.
Ankle fractures constitute 10% of all traumatic fractures in clinical practice. Concurrent tibiotalar dislocations form 21% to 36% of all ankle fractures. Although mechanism of injury is similar to nondislocated ankle fractures, fracture-dislocations cause more extensive bone and soft-tissue damage. Treatment is a challenge for orthopedic surgeons due to concomitant pathologies. It is associated with malreduction, chronic pain, and post-traumatic osteoarthritis. We aimed to investigate the relationship between ankle osteoarthritis radiographic stage and clinical outcomes.
Records and data of 27 patients were retrospectively analyzed. Clinical status at final follow-up was evaluated by a single orthopedic surgeon. Range of motion, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score, and visual analog scale score were the clinical parameters that were assessed. Radiologic assessment was made by standard anteroposterior, lateral, and mortise views. Preoperative osseoligamentous injury pattern, presence of posterior malleolar fracture, syndesmosis injury, and postoperative ankle osteoarthritis were investigated.
At final follow-up, mean ± SD Ankle-Hindfoot Score was 98.25 ± 1.06 and visual analog scale score during daily activities was 1.52 ± 0.70. Mean ± SD ankle dorsiflexion and plantarflexion were significantly lower on the affected sides (14.07° ± 7.97° and 36.30° ± 6.59°) than on the unaffected sides (28.15° ± 2.82° and 46.30° ± 2.97°), respectively (P < .001). No significant difference for inversion and eversion was observed. Twenty-four patients demonstrated radiographic signs of ankle osteoarthritis and three did not. No significant difference was found among Takakura stages in any of the variables.
Although the post-traumatic osteoarthritis rate was high for ankle fracture-dislocation, surgical treatment achieved excellent functional results. Even if advanced stages of ankle arthritis according to Takakura classification developed, patients had satisfactory clinical and functional results.
在临床实践中，踝关节骨折占所有创伤性骨折的10%。同时存在的胫距关节脱位占所有踝关节骨折的21%至36%。尽管损伤机制与无脱位的踝关节骨折相似，但骨折脱位会导致更广泛的骨骼和软组织损伤。由于合并多种病变，治疗对骨科医生来说是一项挑战。它与复位不良、慢性疼痛和创伤后骨关节炎有关。我们旨在研究踝关节骨关节炎的放射学分期与临床结果之间的关系。
对27例患者的记录和数据进行回顾性分析。由一名骨科医生评估最终随访时的临床状况。评估的临床参数包括活动范围、美国矫形足踝协会踝-后足评分和视觉模拟量表评分。通过标准的前后位、侧位和斜位X线片进行放射学评估。研究术前骨韧带损伤模式、后踝骨折的存在、下胫腓联合损伤以及术后踝关节骨关节炎情况。
在最终随访时，踝-后足评分的平均值±标准差为98.25±1.06，日常活动中的视觉模拟量表评分为1.52±0.70。患侧踝关节背屈和跖屈的平均值±标准差（分别为14.07°±7.97°和36.30°±6.59°）显著低于未患侧（分别为28.15°±2.82°和46.30°±2.97°）（P<.001）。内翻和外翻未观察到显著差异。24例患者显示出踝关节骨关节炎的放射学征象，3例未显示。在任何变量中，高木分期之间均未发现显著差异。
尽管踝关节骨折脱位的创伤后骨关节炎发生率较高，但手术治疗取得了优异的功能结果。即使根据高木分类法发展为晚期踝关节关节炎，患者的临床和功能结果也令人满意。
