Hung Wei-Cheng, Chang Chien-Chun, Kuo Chien-Chung
Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.
Minimally Invasive Spine and Joint Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
Front Surg. 2025 Apr 14;12:1553498. doi: 10.3389/fsurg.2025.1553498. eCollection 2025.
Open fracture-dislocations with significant malleolar bone and soft tissue loss, along with ligament injuries, are complex and often require extensive treatment and staged surgeries. The aim of this report is to highlight treatment strategies and key considerations, including surgical reconstruction with allografts or autografts and various flap techniques as viable options. Additionally, deltoid ligament repair or reconstruction is crucial for surgical success. We report the case of a 29-year-old woman with no significant medical history who sustained an open fracture-dislocation of the left medial malleolus and midfoot due to a lifeboat propeller injury while white water rafting. The injury led to substantial bone and soft tissue loss and deltoid ligament injury. Following multiple wound debridements, the ankle was successfully reconstructed using an AO distal tibia plate, autogenous iliac bone graft, tension band wire, cancellous screw, and free anterolateral thigh flap, with direct deltoid ligament repair. The patient was followed up for 5 years, with favorable outcomes.
伴有明显内踝骨质和软组织缺损以及韧带损伤的开放性骨折脱位较为复杂，通常需要进行广泛治疗和分期手术。本报告旨在强调治疗策略和关键注意事项，包括使用同种异体移植物或自体移植物进行手术重建以及各种皮瓣技术作为可行选择。此外，三角韧带修复或重建对于手术成功至关重要。我们报告了一例29岁女性病例，她既往无重大病史，在白水漂流时因救生艇螺旋桨受伤导致左内踝和中足开放性骨折脱位。该损伤导致大量骨质和软组织缺损以及三角韧带损伤。经过多次伤口清创后，使用AO远端胫骨钢板、自体髂骨移植、张力带钢丝、松质骨螺钉和游离股前外侧皮瓣成功重建了踝关节，并直接修复了三角韧带。对患者进行了5年随访，结果良好。
