Shirazi Ahmed, Alaradi Hasan, Alanjawi Hussam A, Almeel Ahmed, Alam Mahmood
Orthopaedics and Trauma, Salmaniya Medical Complex, Manama, BHR.
Cureus. 2024 Jun 17;16(6):e62507. doi: 10.7759/cureus.62507. eCollection 2024 Jun.
Introduction Ankle fractures are commonly encountered fractures in emergency departments worldwide. These fractures often have significant articular involvement that requires anatomic surgical reduction and stabilization. Radiographs can be used in everyday practice to evaluate ankle fractures utilizing various parameters to assess reduction quality intraoperatively and postoperatively. Several factors have been found to influence the reduction quality of fractures across body regions. This retrospective study aimed to evaluate the influence of several factors on the reduction quality of ankle fractures in a tertiary care center in the Kingdom of Bahrain. Materials and methods A total of 462 records were identified during the search, and 68 records were excluded. A total of 394 ankle fractures met the inclusion criteria for the study. Five orthopedic surgeons then evaluated the operative films in accordance with the Delphi consensus parameters for evaluating ankle fractures, and the reductions were graded as good, adequate, or poor. Results The study included 394 ankle fractures that met the inclusion criteria, and four significant associations were noted to affect the quality of reduction. Ankle fractures with posterior malleolus involvement (PMI) were significantly associated (p = 0.001) with fragments smaller than 15% and larger than 20% having decreased outcomes. The number of days from admission to operation was also significant (p = 0.009), with the best reductions observed between zero and one day from admission. Operating surgeon was also a significant factor (p = 0.038), with inferior reductions noted in specialist surgeons compared to trainees. The last significant association was the number of malleoli (p = 0.001), with an inferior reduction with a larger number of malleoli involved. Conclusion Ankle fractures are a common and significant orthopedic injury. Reduction quality is important for optimal outcomes after surgical stabilization. Various factors including the number of malleoli, the grade of the operating surgeon, and the time of surgery were significantly related to the quality reduction in this single-center study. Expedited surgical management of fractures that are amenable to early fixation, careful assessment, and meticulous technique in fixation of fractures with multiple fractured malleoli is indicated to reduce the chance of malreduction particularly in complex injuries. Further assessment of factors related to reduction quality with large-scale prospective studies would provide orthopedic surgeons with insights into the identification and optimal treatment of such fractures.
引言
踝关节骨折是全球急诊室中常见的骨折类型。这些骨折常常伴有明显的关节损伤，需要进行解剖复位和稳定固定。在日常临床实践中，X线片可用于评估踝关节骨折，通过各种参数来评估术中及术后的复位质量。已发现有几个因素会影响身体各部位骨折的复位质量。本回顾性研究旨在评估巴林王国一家三级医疗中心中多个因素对踝关节骨折复位质量的影响。
材料与方法
在检索过程中共识别出462份记录，排除68份记录。共有394例踝关节骨折符合本研究的纳入标准。然后，五位骨科医生根据评估踝关节骨折的德尔菲共识参数对手术影像进行评估，复位情况分为良好、尚可或不佳。
结果
本研究纳入了394例符合纳入标准的踝关节骨折，发现有四个显著关联因素影响复位质量。伴有后踝骨折（PMI）的踝关节骨折与小于15%和大于20%的骨折块预后较差显著相关（p = 0.001）。从入院到手术的天数也具有显著意义（p = 0.009），入院后0至1天内进行手术观察到的复位效果最佳。主刀医生也是一个显著因素（p = 0.038），与实习医生相比，专科医生的复位效果较差。最后一个显著关联因素是骨折的内、外踝数量（p = 0.001），涉及的踝部数量越多，复位效果越差。
结论
踝关节骨折是一种常见且严重的骨科损伤。复位质量对于手术稳定后的最佳预后至关重要。在这项单中心研究中，包括踝部数量、主刀医生级别和手术时间等多种因素与复位质量显著相关。对于适合早期固定的骨折，应加快手术治疗，对多踝骨折进行仔细评估并采用精细的固定技术，以减少复位不良的几率，尤其是在复杂损伤中。通过大规模前瞻性研究进一步评估与复位质量相关的因素，将为骨科医生提供有关此类骨折的识别和最佳治疗的见解。
