Pino Felipe, Lagos Leonardo, Urbina Christian, Vargas Fernando, Parra Mauricio, Bravo Francisco, Bastias Christian
Department of Orthopaedic Surgery, Hospital Barros Luco Trudeau, Santiago, Chile.
Clínica Santa María, Santiago de Chile, Chile.
Foot Ankle Orthop. 2024 Oct 30;9(4):24730114241290201. doi: 10.1177/24730114241290201. eCollection 2024 Oct.
Anatomical reduction of posterior malleolar fracture is a key goal in achieving good functional outcomes in patients with ankle fractures. Although there are many approaches for managing this type of fracture, no studies have shown reduction quality of posterior malleolar fracture in postoperative CT scan using the modified posteromedial ankle approach.
A retrospective case series of 66 patients of 2 health centers with type 2, 3, and 4 posterior malleolar fractures according to Bartonicek classification treated using the modified posteromedial ankle approach was performed. The postoperative CT scan was used to assess syndesmotic reduction and articular step-off and residual gap in posterior malleolus reduction.
Reduction of posterior malleolus fracture was determined to be <2 mm in 62 patients and >2 mm in 4 cases. Syndesmotic reduction quality was considered to be anatomical in 61 patients. Four patients showed mild anterior fibular translation in the axial plane and were not reoperated. One syndesmotic malreduction was considered poor.
In this study, we found that 92% (61 of 66) of patients with posterior malleolar fracture were reduced with <2 mm step-off using this modified posteromedial ankle approach and fracture fixation strategy.
Level IV, case series.
后踝骨折的解剖复位是踝关节骨折患者获得良好功能预后的关键目标。尽管有多种方法可用于处理此类骨折，但尚无研究表明采用改良后内侧踝关节入路术后CT扫描时后踝骨折的复位质量情况。
对两个健康中心采用改良后内侧踝关节入路治疗的66例符合Bartonicek分类2型、3型和4型后踝骨折患者进行回顾性病例系列研究。术后CT扫描用于评估下胫腓联合复位情况、关节台阶及后踝复位的残余间隙。
62例患者后踝骨折复位<2mm，4例>2mm。61例患者下胫腓联合复位质量被认为达到解剖复位。4例患者在轴位平面存在轻度腓骨向前移位，未再次手术。1例下胫腓联合复位不良被认为较差。
在本研究中，我们发现采用这种改良后内侧踝关节入路和骨折固定策略，92%（66例中的61例）后踝骨折患者复位台阶<2mm。
四级，病例系列。
