Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University; London Health Sciences Centre, Victoria Hospital, London, ON, Canada.
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada ; and.
J Orthop Trauma. 2024 Nov 1;38(11):615-621. doi: 10.1097/BOT.0000000000002877.
To determine the effect of deltoid ligament repair on the development of posttraumatic arthritis in logsplitter ankle injuries.
Retrospective cohort.
Academic, Level I trauma center.
Patients ≥18 years of age with logsplitter injuries (OTA/AO 44B, 44C) treated with open reduction internal fixation (ORIF) with or without deltoid ligament repair from January 2008 to October 2021.
The rate of posttraumatic arthritis (PTOA) development at the final follow-up (minimum 6 months) after ORIF was evaluated using the Kellgren-Lawrence scale. The achievement of acceptable reduction indicated by articular reduction <2 mm, and a medial clear space ≤4 mm was assessed at 6 weeks postoperatively with weight-bearing radiographs. The effect of deltoid ligament repair on the development of PTOA was investigated.
Fifty-nine patients aged 49.1 ± 17.2 years met inclusion criteria with a mean follow-up of 16.6 months (range = 6 to 96). Twenty-six of 59 patients (44%) had developed PTOA at the final follow-up. Acceptable reduction was achieved in 83.1% (49/59) of fractures. The acceptable reduction rate in fractures undergoing deltoid ligament repair was 100% versus 78% in those without deltoid ligament repair (13/13 vs. 36/46, P = 0.017). The rate of PTOA development was significantly lower in patients who underwent deltoid ligament repair (15%) than those who did not (52%), P = 0.026. Patients who underwent deltoid ligament repair had a significantly reduced rate of PTOA development leading to arthrodesis compared with those who did not (0% vs. 17%, P = 0.013).
Logsplitter injuries resulted in a high rate of development of posttraumatic arthritis. An acceptable reduction is required to minimize the risk of development of PTOA and progression to arthrodesis. Deltoid ligament repair during ORIF may facilitate acceptable reduction and decrease the rate of PTOA and progression to arthrodesis in these injuries.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定修复三角韧带对Logsplitter 踝关节损伤后创伤性关节炎发展的影响。
回顾性队列研究。
学术性一级创伤中心。
2008 年 1 月至 2021 年 10 月，接受切开复位内固定术（ORIF）治疗的Logsplitter 损伤（OTA/AO 44B、44C）患者，年龄≥18 岁，且接受三角韧带修复或未接受三角韧带修复。
采用 Kellgren-Lawrence 分级评估 ORIF 后末次随访（至少 6 个月）时创伤性关节炎（PTOA）的发展率。术后 6 周时，采用负重 X 线片评估关节复位<2mm 和内侧间隙≤4mm 的可接受复位情况。评估三角韧带修复对 PTOA 发展的影响。
59 例年龄 49.1±17.2 岁的患者符合纳入标准，平均随访 16.6 个月（范围=6~96 个月）。59 例患者中有 26 例（44%）在末次随访时发生 PTOA。83.1%（49/59）的骨折达到可接受复位。行三角韧带修复的骨折中可接受复位率为 100%，而未行三角韧带修复的骨折为 78%（13/13 比 36/46，P=0.017）。行三角韧带修复的患者 PTOA 发生率明显低于未行三角韧带修复的患者（15%比 52%，P=0.026）。与未行三角韧带修复的患者相比，行三角韧带修复的患者 PTOA 发展导致融合的发生率显著降低（0%比 17%，P=0.013）。
Logsplitter 损伤导致创伤后关节炎的发生率较高。需要可接受的复位以降低 PTOA 发展和进展为融合的风险。ORIF 中修复三角韧带可能有助于获得可接受的复位，并降低这些损伤中 PTOA 的发生率和进展为融合的风险。
预后 III 级。有关证据水平的完整描述，请参阅作者说明。
