Mahajan Uday Dagadu, Gadullah Moheeb, Marsh Alastair, Fenton Paul Andrew
Registrar T&O, University Hospitals Birmingham NHS Foundation Trust, UK.
Department of trauma and Orthopaedics, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2GW, UK.
J Clin Orthop Trauma. 2024 Aug 27;55:102518. doi: 10.1016/j.jcot.2024.102518. eCollection 2024 Aug.
Functional outcome following ankle fracture fixation is linked to the restoration of joint congruity, anatomic alignment and stability. If surgical fixation fails to achieve these goals, revision surgery may be indicated. This retrospective study aims to report a consecutive series of fourteen patients with a minimum of one year follow up after revision ankle fixation and describe CT scan based modified Pettrone score used to assess quality of primary fixation.
Between April 2019 and August 2021, fourteen patients underwent revision ankle fracture fixation. Patients were identified by the multidisciplinary team through a review of intra-operative radiographs. Subsequently, a CT scan-based criteria which is modification of original Pettrone criteria based on plain radiographs was applied to further assess sub-optimal fixation. Demographic, clinical, radiological and patient-reported outcome measures data were collected and examined.
Twelve patients exhibited protonation type injuries according to the Lauge-Hansen classification system. Syndesmotic joint was readdressed in eleven patients. The mean duration between the index surgery and the subsequent revision surgery was 46 days (inter-quartile range - 42 days). The mean Olerud-Molander Ankle Score was calculated as 58, with an IQR of 45. Similarly, the mean EQ-5D-3L VAS score was determined to be 69, with an IQR of 35. In our series, 60 % patients reported good to excellent results using OMAS. The quality-of-life scores of in these patients were also satisfactory.
We recommend early revision fixation should be considered when primary fixation is considered inadequate in early post-operative period. The modified Pettrone criterion can be used to assess sub-optimal fixation.
踝关节骨折固定后的功能结果与关节一致性、解剖对线和稳定性的恢复有关。如果手术固定未能实现这些目标，则可能需要进行翻修手术。本回顾性研究旨在报告连续14例踝关节翻修固定术后至少随访1年的患者，并描述用于评估初次固定质量的基于CT扫描的改良Pettrone评分。
2019年4月至2021年8月期间，14例患者接受了踝关节翻修固定术。多学科团队通过回顾术中X线片确定患者。随后，应用基于CT扫描的标准（该标准是对基于平片的原始Pettrone标准的修改）来进一步评估固定欠佳情况。收集并检查人口统计学、临床、放射学和患者报告的结局指标数据。
根据Lauge-Hansen分类系统，12例患者表现为旋前型损伤。11例患者重新处理了下胫腓联合。初次手术与随后的翻修手术之间的平均间隔时间为46天（四分位间距 - 42天）。Olerud-Molander踝关节平均评分为58分，四分位间距为45分。同样，EQ-5D-3L视觉模拟评分平均确定为69分，四分位间距为35分。在我们的系列中，60%的患者使用OMAS报告了良好至优秀的结果。这些患者的生活质量评分也令人满意。
我们建议，当认为初次固定在术后早期不充分时，应考虑早期翻修固定。改良的Pettrone标准可用于评估固定欠佳情况。
