Wu Wangsheng, Liu Bingsheng, Wang Chengwei
Orthopaedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, CHN.
Orthopaedics, Affiliated Tumor Hospital of Xinjiang Medical University, Ürümqi, CHN.
Cureus. 2024 Jan 31;16(1):e53348. doi: 10.7759/cureus.53348. eCollection 2024 Jan.
Pronation-external rotation IV (PER IV) ankle fractures are relatively uncommon among rotational ankle fractures, but they are the most severe type. Although recent studies have shown satisfactory functional recovery in PER IV after surgical treatment, the different outcomes between fracture patterns and equivalent fracture patterns have not yet been evaluated. This study aims to compare short-term outcomes in PER IV ankle injuries between fracture patterns and equivalent fracture patterns.
This retrospective study was conducted at Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China, from July 2023 to October 2023. A total of 41 PER IV injuries from 2018 to 2022 were included and followed for at least one year. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle‑Hindfoot Scale, Ankle Range of Motions (ROM), and Visual Analogue Scale (VAS) for pain scores were the main outcome measures. The rate of postoperative complications was the secondary outcome measure. Patient demographics were compared in PER IV fractures and PER IV ankle equivalent fractures.
The mean follow-up time was 18.2 ± 4.2 (range, 12-24) months. Postoperative X-ray and CT scans showed a satisfactory reduction of the ankle joint and syndesmosis. No reduction loss of distal tibiofibular syndesmosis or ankle joints was found at the 12-month follow-up. The average AOFAS scores after one year in both groups were satisfactory (fracture group vs. fracture equivalent group, 96.72 ± 4.21 vs. 92.63 ± 5.36; P < 0.05). The average VAS scores after one year in both groups were satisfactory (fracture group vs. fracture equivalent group, 1.45 ± 2.01 vs. 1.38 ± 1.96; P > 0.05). The average ROM scores after one year in both groups were satisfactory (dorsiflexion, fracture group vs. fracture equivalent group, 15.21 ± 5.62 vs. 13.46 ± 4.35; P > 0.05; plantar flexion, fracture group vs. fracture equivalent group, 38.62 ± 9.68 vs. 42.32 ± 5.28; P > 0.05).
For patients with PER-IV ankle injuries, the fracture mode had a better prognosis than the fracture equivalent mode.
旋前外旋IV型（PER IV）踝关节骨折在旋转型踝关节骨折中相对少见，但却是最严重的类型。尽管近期研究表明手术治疗后PER IV型骨折患者功能恢复良好，但骨折类型与等效骨折类型之间的不同预后尚未得到评估。本研究旨在比较PER IV型踝关节损伤中骨折类型与等效骨折类型的短期预后。
本回顾性研究于2023年7月至2023年10月在温州医科大学附属衢州医院进行。纳入2018年至2022年期间共41例PER IV型损伤患者，并进行至少一年的随访。主要观察指标为美国矫形足踝协会（AOFAS）踝-后足评分、踝关节活动度（ROM）及视觉模拟评分（VAS）疼痛评分。次要观察指标为术后并发症发生率。比较PER IV型骨折与PER IV型等效踝关节骨折患者的人口统计学特征。
平均随访时间为18.2±4.2（范围12 - 24）个月。术后X线和CT扫描显示踝关节和下胫腓联合复位满意。在12个月随访时未发现下胫腓联合或踝关节复位丢失。两组患者术后一年的平均AOFAS评分均令人满意（骨折组vs等效骨折组，96.72±4.21 vs 92.63±5.36；P<0.05）。两组患者术后一年的平均VAS评分均令人满意（骨折组vs等效骨折组，1.45±2.01 vs 1.38±1.96；P>0.05）。两组患者术后一年的平均ROM评分均令人满意（背屈，骨折组vs等效骨折组，15.21±5.62 vs 13.46±4.35；P>0.05；跖屈，骨折组vs等效骨折组，38.62±9.68 vs 42.32±5.28；P>0.05）。
对于PER-IV型踝关节损伤患者，骨折模式的预后优于等效骨折模式。
