Hecht Verena, Mosimann Eléonore Sophie, Krause Fabian, Kurze Christophe, Lustenberger Thomas, Anwander Helen
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Eur J Trauma Emerg Surg. 2025 Apr 3;51(1):161. doi: 10.1007/s00068-025-02803-z.
Ankle fractures represent about 10% of all adult fractures, with increasing incidence. Dislocated ankle fractures often require delayed open reduction and internal fixation due to swelling, necessitating temporary stabilization using a cast or an external fixator. This study aims to assess risk factors for insufficient preliminary reduction immobilized by a cast, focusing on medial clearspace and posterior malleolus fragment size, to identify fractures that would benefit from initial stabilization with an external fixator.
Patients treated for dislocated ankle fractures at our level-1 trauma center from 2011 to 2023 were retrospectively reviewed. The primary outcome was the rate of insufficient reduction during immobilization in a cast. Secondary outcomes included time to definitive surgery, length of surgery and hospital stay.
134 patients met the inclusion criteria. The most common fracture type was AO 44B3, with 71.6%. Sufficient reduction was achieved in 53.7% of patients. Multiple regression analyses revealed the initial medial clearspace at the time of dislocation as an independent risk factor for insufficient reduction after reduction. ROC-analysis revealed that a initial medial clearspace at the time of dislocation of 9 mm is a predictor for insufficient reduction with a sensitivity of 88% and a specificity of 55%.
Initial medial clearspace was an important predictor for insufficient reduction in a cast, with 9 mm being identified as the cutoff for critical initial medial clearspace. Therefore, we recommend primary external fixation or acute internal fixation, if the soft tissue allows it for those patients with initial medial clearspace of > 9 mm. This approach may prevent secondary dislocation, reduce swelling, and expedite definitive surgery.
踝关节骨折约占所有成人骨折的10%，且发病率呈上升趋势。由于肿胀，脱位的踝关节骨折通常需要延迟切开复位内固定，因此需要使用石膏或外固定器进行临时固定。本研究旨在评估石膏固定初步复位不足的危险因素，重点关注内侧间隙和后踝骨折块大小，以确定哪些骨折患者能从外固定器的初始固定中获益。
回顾性分析2011年至2023年在我们一级创伤中心接受治疗的脱位踝关节骨折患者。主要结局是石膏固定期间复位不足的发生率。次要结局包括确定性手术时间、手术时长和住院时间。
134例患者符合纳入标准。最常见的骨折类型是AO 44B3，占71.6%。53.7%的患者实现了充分复位。多元回归分析显示，脱位时的初始内侧间隙是复位后复位不足的独立危险因素。ROC分析显示，脱位时初始内侧间隙为9mm是复位不足的预测指标，灵敏度为88%，特异度为55%。
初始内侧间隙是石膏固定复位不足的重要预测指标，9mm被确定为临界初始内侧间隙的截断值。因此，对于初始内侧间隙>9mm的患者，如果软组织条件允许，我们建议进行一期外固定或急诊内固定。这种方法可能会防止继发性脱位，减轻肿胀，并加快确定性手术。
