Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center -RWJBarnabas Health Livingston/Jersey City, NJ, United States.
Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center -RWJBarnabas Health Livingston/Jersey City, NJ, United States.
Injury. 2024 Dec;55(12):111973. doi: 10.1016/j.injury.2024.111973. Epub 2024 Oct 18.
The purpose of this study was to compare postoperative complications and outcomes of minimally invasive intramedullary fixation (IMF) versus plate fixation (PF) in the treatment of distal fibular fractures.
A retrospective review was performed from identifying all consecutive ankle fracture patients aged ≥18-years-old surgically managed between August 2017 to September 2022 at a tertiary care center with minimum 6 months clinical follow-up. Patients were grouped into those receiving intramedullary versus extramedullary fibular fixation. The primary outcomes were relevant demographic factors (diabetes, osteoporosis, charlson comorbidity index [CCI]), surgical time, complication rates, reoperation rates. Secondary outcomes included time to definitive fracture fixation, fracture characteristics (AO/OTA and Lauge-Hansen classification), syndesmotic instability requiring fixation and discharge disposition.
Forty-one IMF patients (average age 55.3 ± 18.1yrs) and 162 PF patients (47.7 ± 17.4yrs) were identified and included in this study. Within the IMF group, 25 patients received IM nailing and 16 patients received percutaneous screw fixation. A greater proportion of IMF patients had diabetes (39 % vs 22 %, p < 0.001), osteoporosis (22 % vs 3 %, p < 0.001), and moderate or severe CCI (41 % vs 23 %, p = 0.017). Surgical time was significantly reduced when using IMF technique (80.4 ± 43.1 min vs 99.1 ± 43.1 min, p = 0.012). Overall complication rates or time to complication did not differ significantly between groups (p = 0.578 and p = 0.082, respectively); however, when sub-stratified, IMF patients trended towards experiencing fewer wound related complications versus PF patients (5 % vs 9 %, p = 0.291). No IMF patients experienced deep or superficial infections and only 2 (5 %) patients experienced wound dehiscence. Reoperation rates(15 % vs 10 %, p = 0.267) and time to fracture union (2.7 ± 2.2 mos vs 3.1 ± 2.0 mos, p = 0.301) did not differ significantly. At final follow-up (IMF: 15.0 ± 12.2 mos vs PF: 28.5 ± 19.5 mos), Olerud and Molander ankle score was significantly higher in IMF compared to PF (87.1 ± 14.2 vs 76.2 ± 22.6, p = 0.002).
Patients in the IMF group at baseline had several comorbid medical conditions that put them at high risk for wound related complications, however, postoperatively they demonstrated higher functional scores and similar complication rates compared to the PF group. It is important to note, however, while we expected a higher rate of wound issues with the PF group, there were no significant differences in infection rates. Either IMF and PF is reliable for fixation and outcomes, and thus with proper soft tissue, biologically friendly technique, either IMF or PF is a reliable choice in the fixation of fibula fractures.
III, retrospective cohort comparison study.
本研究旨在比较微创髓内固定（IMF）与钢板固定（PF）治疗腓骨远端骨折的术后并发症和结果。
对 2017 年 8 月至 2022 年 9 月在一家三级医疗中心接受手术治疗的年龄≥18 岁的连续踝关节骨折患者进行回顾性分析，随访时间至少为 6 个月。患者分为接受髓内或髓外腓骨固定的组。主要结局是相关的人口统计学因素（糖尿病、骨质疏松症、Charlson 合并症指数[CCI]）、手术时间、并发症发生率、再次手术率。次要结局包括确定性骨折固定的时间、骨折特征（AO/OTA 和 Lauge-Hansen 分类）、需要固定的下胫腓联合不稳定和出院情况。
确定了 41 例 IMF 患者（平均年龄 55.3±18.1 岁）和 162 例 PF 患者（47.7±17.4 岁）纳入本研究。在 IMF 组中，25 例患者接受了 IM 钉固定，16 例患者接受了经皮螺钉固定。IMF 组中糖尿病（39%比 22%，p<0.001）、骨质疏松（22%比 3%，p<0.001）和中度或重度 CCI（41%比 23%，p=0.017）的比例较高。使用 IMF 技术时，手术时间显著缩短（80.4±43.1 分钟比 99.1±43.1 分钟，p=0.012）。两组的总体并发症发生率或并发症发生时间无显著差异（p=0.578 和 p=0.082）；然而，细分时，IMF 患者与 PF 患者相比，伤口相关并发症的发生率较低（5%比 9%，p=0.291）。没有 IMF 患者发生深部或浅部感染，只有 2（5%）例患者发生伤口裂开。再次手术率（15%比 10%，p=0.267）和骨折愈合时间（2.7±2.2 个月比 3.1±2.0 个月，p=0.301）无显著差异。在最终随访（IMF：15.0±12.2 个月比 PF：28.5±19.5 个月）时，IMF 的 Olerud 和 Molander 踝关节评分明显高于 PF（87.1±14.2 比 76.2±22.6，p=0.002）。
IMF 组患者在基线时有多种合并症，使他们有发生伤口相关并发症的高风险，但术后他们表现出较高的功能评分和与 PF 组相似的并发症发生率。需要注意的是，虽然我们预计 PF 组的伤口问题发生率会更高，但感染率并没有显著差异。IMF 和 PF 均可可靠地固定和获得结果，因此，只要有适当的软组织，采用生物相容性好的技术，IMF 或 PF 都是固定腓骨骨折的可靠选择。
III，回顾性队列比较研究。
