Thomas Sean, Berger Garrett, O'Leary Brendan, Brumm Zachary, Schwartz Alexandra K, Kent William T
School of Medicine, University of California San Diego, La Jolla, CA, USA.
Department of Orthopaedic Surgery, University of California San Diego, 200 West Arbor Drive MC 8894, San Diego, CA, 92103, USA.
Eur J Orthop Surg Traumatol. 2025 Jan 11;35(1):53. doi: 10.1007/s00590-024-04148-6.
While treatment modalities for Maisonneuve fractures involving the proximal third of the fibula are established, no studies to date have reported outcomes associated with syndesmotic-only fixation of middle third fibular shaft fractures. The purpose of this study was to evaluate outcomes associated with syndesmotic-only fixation in the treatment of Maisonneuve fractures involving the middle third of the fibula.
A retrospective review was conducted on 257 cases of syndesmotic ankle instability with associated fibular fractures at a level 1 trauma center between 2013 and 2023. Patients were divided into cohorts based on fibular fracture location in the proximal, middle, or distal third of the fibula. The Chi-square test of independence, two-sample t-test, and analysis of variance were used to compare outcome measures between cohorts.
Sixty-six patients were identified including 48% (n = 32) with proximal third fibular fractures, 20% (n = 13) with middle third fibular fractures, and 32% (n = 21) with distal third fibular fractures. Rates of infection, loss of reduction, wound healing complications, and reoperation did not vary significantly between cohorts. Functional outcome measures including range of motion, time to weight-bearing, and tibiofibular/medial clear space measurements at final follow-up were similar across cohorts.
Patients with Maisonneuve fractures involving the middle third of the fibula demonstrated positive outcomes with syndesmotic fixation alone, with no documented cases of infection, loss of reduction, or wound healing issues. By demonstrating maintenance of anatomic reduction and low rates of complications, our results support the use of syndesmotic-only fixation in the treatment of middle third Maisonneuve fractures.
虽然涉及腓骨近端三分之一的 Maisonneuve 骨折的治疗方式已确立，但迄今为止尚无研究报道仅行下胫腓联合固定治疗腓骨中三分之一骨折的相关结果。本研究的目的是评估仅行下胫腓联合固定治疗涉及腓骨中三分之一的 Maisonneuve 骨折的结果。
对 2013 年至 2023 年期间在一级创伤中心收治的 257 例伴有腓骨骨折的下胫腓联合踝关节不稳病例进行回顾性研究。根据腓骨骨折位于腓骨近端、中部或远端三分之一将患者分为不同队列。采用独立样本卡方检验、两样本 t 检验和方差分析比较各队列之间的结果指标。
共纳入 66 例患者，其中 48%（n = 32）为腓骨近端三分之一骨折，20%（n = 13）为腓骨中三分之一骨折, 32%（n = 21）为腓骨远端三分之一骨折。各队列之间的感染率、复位丢失率、伤口愈合并发症及再次手术率无显著差异。各队列的功能结果指标，包括末次随访时的活动范围、负重时间及胫腓/内侧间隙测量结果相似。
仅行下胫腓联合固定治疗涉及腓骨中三分之一的 Maisonneuve 骨折的患者取得了良好的结果，且无感染、复位丢失或伤口愈合问题的记录病例。通过证明维持解剖复位及低并发症发生率，我们的结果支持仅行下胫腓联合固定治疗中三分之一的 Maisonneuve 骨折。
