Ahluwalia R, Lewis T, Marhoon Z, Bano C, Howard T, Greenberg H, Vasireddy A, Din A, O'Connor E Fitzgerald, Rose V, Reichert I
Dept of Orthopaedics, Kings College Hospital MTC, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Dept of Orthopaedics, Kings College Hospital MTC, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Foot Ankle Surg. 2025 Jun;31(4):365-371. doi: 10.1016/j.fas.2024.12.007. Epub 2024 Dec 22.
Contemporary guidelines advocate for initial debridement and single-stage definitive fixation with immediate soft tissue reconstruction for open fractures. This study aims to evaluate the effectiveness of single-stage stabilization and immediate definitive soft tissue coverage in open ankle fractures compared to closed fractures.
We compared all isolated open ankle fractures (OF) treated between January 2017 and June 2019 to a control group of operatively managed closed ankle fractures (CF). The OF group included patients with extensive soft tissue injury loss with periosteal stripping and bone exposure (Gustilo and Anderson IIIB) requiring split skin graft, rotational flap or free flap. Clinical outcomes assessed included infection rates, amputation, revision hardware surgery, surgical reduction, non-union rates, and functional outcomes (assessed using the MOXFQ and EQ-5D-5L questionnaires). Health provider matrices were utilized to evaluate cost-benefit parameters, such as length of stay (LOS). Statistical analysis was performed with a significance level set at P < 0.05.
A total of 27 OF and 35 CF cases with AO classification 44 A-C fractures were analyzed following standard treatment protocols. No amputations were reported, but deep/superficial infections occurred in 3 patients in the OF group compared to 2 in the CF group. There was a three-folds increase in mal-union (P = .11), rates of additional surgeries and discharge times in the OF group. (P < 0.05). However, return to functional weight bearing between OF (mean 10.6 weeks) and CF (mean 7.2 weeks) was similar (P = 0.06), and there were no significant differences in EQ-5D-5L and MOXFQ scores at the end of orthopaedic treatment p = 0.5 and 0.16 respectively. The mean hospital LOS was significantly longer for OF (15.6 days) compared to CF (5.4 days) (P < 0.05).
Definitive stabilization and immediate soft tissue reconstruction in the management of open ankle fractures result in high rates of limb salvage and achieve functional outcomes similar to those seen in matched closed ankle fractures upon completion of orthopedic treatment. Although the patient journey is extended, soft tissue and infective complications do not significantly differ. This calls for further investigation to establish the long-term cost-benefit implications of this approach.
当代指南提倡对开放性骨折进行初期清创和一期确定性固定，并立即进行软组织重建。本研究旨在评估与闭合性骨折相比，一期稳定和立即进行确定性软组织覆盖治疗开放性踝关节骨折的有效性。
我们将2017年1月至2019年6月间治疗的所有孤立性开放性踝关节骨折（OF）与手术治疗的闭合性踝关节骨折（CF）对照组进行比较。OF组包括伴有广泛软组织损伤缺失、骨膜剥离和骨外露（Gustilo和Anderson IIIB型）需要进行植皮、旋转皮瓣或游离皮瓣的患者。评估的临床结果包括感染率、截肢率、内固定物翻修手术、手术复位、骨不连率和功能结果（使用MOXFQ和EQ-5D-5L问卷进行评估）。利用医疗服务提供者矩阵评估成本效益参数，如住院时间（LOS）。进行统计分析时，显著性水平设定为P < 0.05。
按照标准治疗方案，共分析了27例OF和35例CF病例，均为AO分类44 A-C型骨折。未报告截肢病例，但OF组有3例发生深部/浅表感染，而CF组有2例。OF组的畸形愈合（P = 0.11）、再次手术率和出院时间增加了三倍（P < 0.05）。然而，OF组（平均10.6周）和CF组（平均7.2周）恢复功能性负重的情况相似（P = 0.06），在骨科治疗结束时，EQ-5D-5L和MOXFQ评分分别为p = 0.5和0.16，无显著差异。OF组的平均住院时间（15.6天）明显长于CF组（5.4天）（P < 0.05）。
在开放性踝关节骨折的治疗中，进行确定性稳定和立即软组织重建可实现较高的肢体挽救率，并在骨科治疗完成后达到与匹配的闭合性踝关节骨折相似的功能结果。虽然患者的治疗过程延长，但软组织和感染性并发症并无显著差异。这需要进一步研究以确定该方法的长期成本效益影响。
