Ying Li, Yao Can, Wang Bin, Liang Junbo, Chen Guofu
Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai, 317000, Zhejiang Province, China.
J Orthop Traumatol. 2025 May 29;26(1):34. doi: 10.1186/s10195-025-00851-0.
The transfibular fracture region (TFFR) approach can be utilized for managing posterior pilon fractures associated with intercalary fragments. However, its long-term outcomes remain unreported. This study aimed to compare the long-term clinical outcomes of the TFFR approach and the posteromedial approach for posterior pilon fractures (Klammer type 2/3, Danis-Weber type B) associated with displaced intercalary fragments over an average 8 year follow-up.
From 2012 to 2018, a cohort of consecutive patients who underwent open reduction and internal fixation surgery via either the TFFR approach or the posteromedial approach for posterior pilon fracture associated with intercalary fragments were enrolled for this study. Clinical outcomes were evaluated over an average 8 year (range 5-12 years) follow-up. The surgical duration, number of intraoperative fluoroscopies, and postoperative complications were recorded. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), and Short Form-36 (SF-36) score at last follow-up.
Seventy-nine patients were included in the final analysis, including 43 in the TFFR group and 36 in the posteromedial group. No significant differences between the two groups were observed in the FAOS (p = 0.679) or its specific components for symptoms (p = 0.264), pain (p = 0.963), activities of daily living (ADL, p = 0.102), sports (p = 0.156), or quality of life (p = 0.859). There was also no significant difference between the two groups in the FAAM-ADL (p = 0.408), FAAM-Sport (p = 0.617), and SF-36 scores (p = 0.757). Nevertheless, the surgical duration was shorter in the TFFR group (p < 0.001).
The TFFR approach is not inferior to the posteromedial approach. For posterior pilon fractures with lateral malleolar fractures in the same plane, the TFFR approach may be preferred owing to its potential to reduce surgical time and the use of a single incision. Level of Evidence Level III, retrospective cohort study.
经腓骨骨折区域（TFFR）入路可用于治疗伴有间插骨块的后踝骨折。然而，其长期疗效尚未见报道。本研究旨在比较TFFR入路和后内侧入路治疗伴有移位间插骨块的后踝骨折（Klammer 2/3型，Danis-Weber B型）的长期临床疗效，平均随访8年。
2012年至2018年，连续纳入一组通过TFFR入路或后内侧入路行切开复位内固定术治疗伴有间插骨块的后踝骨折患者。平均随访8年（5 - 12年）评估临床疗效。记录手术时间、术中透视次数及术后并发症。末次随访时采用足踝结果评分（FAOS）、足踝能力测量（FAAM）和简明健康状况调查量表（SF - 36）评估功能结局。
最终分析纳入79例患者，其中TFFR组43例，后内侧组36例。两组在FAOS（p = 0.679）及其症状（p = 0.264）、疼痛（p = 0.963）、日常生活活动（ADL，p = 0.102）、运动（p = 0.156）或生活质量（p = 0.859）的特定组成部分方面无显著差异。两组在FAAM - ADL（p = 0.408）、FAAM - 运动（p = 0.617）和SF - 36评分（p = 0.757）方面也无显著差异。然而，TFFR组手术时间更短（p < 0.001）。
TFFR入路不劣于后内侧入路。对于同一平面伴有外踝骨折的后踝骨折，TFFR入路可能更受青睐，因其有可能缩短手术时间并采用单一切口。证据级别：III级，回顾性队列研究。
