Zhao Yun-Qing, Wang Xue-Wen, Li Heng, Gong Xiao-Feng, Wu Yong
Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
Department of Orthopedics, Beijing Puren Hospital, Beijing, 100010, China.
BMC Surg. 2025 Aug 11;25(1):366. doi: 10.1186/s12893-025-03087-1.
This study aimed to investigate the early-to-mid-term efficacy of supramalleolar osteotomy (SMO) for the management of post-traumatic ankle arthritis resulting from previous fractures.
A retrospective analysis was conducted on the clinical data of 19 individuals with post-traumatic ankle arthritis secondary to old fractures treated with SMO between March 2018 and September 2022. The cohort included 6 males and 13 females, aged 15 to 59 years, with an average of 37.1 ± 15.8 years. Among these cases, 12 underwent surgical treatment for their initial fractures, while 7 received conservative management. Clinical efficacy was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Foot Function Index (FFI), and Visual Analog Score (VAS) for pain. Imaging analyses were conducted using the changes of tibial anterior surface angle (TAS), talar tilt (TT) angle, and modified Takakura stage. Evaluation of patient satisfaction after surgery was conducted during the final follow-up.
All patients were followed up for 12 to 47 months (mean follow-up: 21.9 ± 11.1 months). At the final follow-up, the AOFAS ankle-hindfoot score improved to 81.9 ± 9.8, the FFI decreased to 24.2 ± 22.8, and the VAS score decreased to 3.2 ± 3.0, all showing significant improvement compared with preoperative values (p < 0.05). The TAS angle increased significantly to 90.2° ± 5.1° postoperatively (p < 0.05), while the TT angle was 0.3° ± 2.5°, without a statistically significant change (p = 0.314). No significant progression was observed in the modified Takakura stage (p = 0.458). The overall patient satisfaction rate was 89.5% (17/19). Prognostic analysis revealed no correlation between fracture-to-surgery interval (1-27 years) and AOFAS improvement ( r = 0.233, p = 0.337). Excessive preoperative TT (> 7.3°) did not compromise outcomes after correction.
SMO demonstrates favorable early-to-mid-term efficacy in the treatment of traumatic fracture-related ankle arthritis, with significant improvements in pain relief, functional scores, and patient satisfaction. Prognostic factors (time since fracture, severe talar tilt) did not adversely affect results, supporting SMO's utility across diverse presentations.
本研究旨在探讨距下关节上截骨术（SMO）治疗既往骨折所致创伤后踝关节炎的早中期疗效。
对2018年3月至2022年9月期间接受SMO治疗的19例陈旧性骨折继发创伤后踝关节炎患者的临床资料进行回顾性分析。该队列包括6名男性和13名女性，年龄15至59岁，平均年龄为37.1±15.8岁。其中，12例患者因初次骨折接受了手术治疗，7例接受了保守治疗。采用美国矫形足踝协会（AOFAS）踝后足评分、足部功能指数（FFI）和视觉模拟评分（VAS）评估疼痛情况，以评估临床疗效。通过胫骨前表面角（TAS）、距骨倾斜（TT）角的变化及改良高仓分期进行影像学分析。在末次随访时评估患者术后满意度。
所有患者均随访12至47个月（平均随访时间：21.9±11.1个月）。末次随访时，AOFAS踝后足评分提高至81.9±9.8，FFI降至24.2±22.8，VAS评分降至3.2±3.0，与术前相比均有显著改善（p<0.05）。术后TAS角显著增加至90.2°±5.1°（p<0.05），而TT角为0.3°±2.5°，无统计学显著变化（p = 0.314）。改良高仓分期未见显著进展（p = 0.458）。患者总体满意度为89.5%（17/19）。预后分析显示，骨折至手术间隔时间（1 - 27年）与AOFAS改善情况无相关性（r = 0.233，p = 0.337）。术前TT角过大（>7.3°）并不影响矫正后的疗效。
SMO在治疗创伤性骨折相关踝关节炎方面显示出良好的早中期疗效，在缓解疼痛、功能评分和患者满意度方面有显著改善。预后因素（骨折后时间、严重距骨倾斜）并未对结果产生不利影响，支持SMO在各种情况下的应用。
