Xie Rong-Zhen, Li Xu-Song, Liang Yu-Feng, Huang Jie-Feng
Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, PR China; The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, PR China.
Department of Orthopaedics and Traumatology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528401, Guangdong, PR China.
J Foot Ankle Surg. 2025 Jul-Aug;64(4):329-333. doi: 10.1053/j.jfas.2025.03.002. Epub 2025 Mar 5.
Ankle fractures, particularly those involving the lateral and posterior malleolus, are complex injuries requiring careful surgical management. This study investigates how the sequence of lateral malleolus fixation affects the intraoperative visualization of the posterior malleolus fracture during fluoroscopy. A retrospective and prospective approach was used, comparing outcomes in patients who underwent surgery for combined lateral and posterior malleolar fractures. In the retrospective group, lateral malleolus fixation with a plate often obstructed fluoroscopic visualization of the posterior malleolus, complicating fracture reduction. The prospective group was adjusted to prioritize posterior malleolar fracture visualization before lateral malleolus fixation, using temporary Kirschner wires if necessary. The study aimed to determine if the initial fixation strategy influenced surgical outcomes, including fracture healing and functional recovery. Results showed that for fractures involving the visible posterior malleolar area, no significant differences in outcomes were observed between the two groups. However, for fractures extending into the obstructed region, the prospective approach provided clearer visualization, potentially leading to more accurate reduction and fixation. This study concludes that the appropriate fixation strategy should be based on the extent of the posterior malleolar fracture. For fractures involving the visible area, traditional fixation of the lateral malleolus can be used. For those involving the obstructed area, a more cautious approach with temporary fixation or prior reduction of the posterior malleolus is recommended. This study emphasizes the importance of preoperative assessment to guide surgical planning and optimize patient outcomes.
踝关节骨折，尤其是涉及外踝和后踝的骨折，是复杂的损伤，需要仔细的手术处理。本研究调查了外踝固定顺序如何影响透视下后踝骨折的术中可视化。采用回顾性和前瞻性方法，比较接受外踝和后踝联合骨折手术的患者的结果。在回顾性组中，用钢板固定外踝常常妨碍对后踝的透视可视化，使骨折复位复杂化。前瞻性组进行了调整，以便在外踝固定之前优先考虑后踝骨折的可视化，必要时使用临时克氏针。该研究旨在确定初始固定策略是否影响手术结果，包括骨折愈合和功能恢复。结果表明，对于涉及可见后踝区域的骨折，两组之间在结果上未观察到显著差异。然而，对于延伸至受阻区域的骨折，前瞻性方法提供了更清晰的可视化，可能导致更准确的复位和固定。本研究得出结论，合适的固定策略应基于后踝骨折的范围。对于涉及可见区域的骨折，可采用传统的外踝固定方法。对于涉及受阻区域的骨折，建议采用更谨慎的方法，进行临时固定或先复位后踝。本研究强调术前评估对指导手术规划和优化患者结果的重要性。
