Li Yongqi, Luo Rui, Li Bing, Wu Hongzi, Bai Zongbiao, Jin Yong, Yang Yunfeng
Department of Orthopedics, Karamay Hospital of People's Hospital of Xinjiang Uygur Autonomous Region(Central Hospital of Karamay), Karamay, 834000, China.
Department of Neurology, Karamay Hospital of People's Hospital of Xinjiang Uygur Autonomous Region(Central Hospital of Karamay), Karamay, 834000, China.
BMC Musculoskelet Disord. 2025 Aug 16;26(1):795. doi: 10.1186/s12891-025-09050-8.
Ankle fracture involving the posterior malleolus is characterized by poor prognosis, and its risk factors remain controversial. This study aims to evaluate the influence of posterior malleolar fractures with different step-off levels on posttraumatic osteoarthritis and functional prognosis and identify the related risk factors that affect the clinical prognosis of posterior malleolar fractures.
The information of 134 patients with ankle fractures involving the posterior malleolus from January 2016 to December 2021 was retrospectively collected. The patients' posterior malleolar fracture reduction quality, fracture healing status, and severity of ankle posttraumatic osteoarthritis (Kellgren-Lawrence scale) were evaluated by radiology, and the ankle function was assessed using Olerud-Molander score, visual analogue scale (VAS) score, and range of ankle motion.
All 134 patients achieved fracture healing, with an average follow-up period of 42 (13,78) months. Thirty-nine patients (29%) showed positive ankle posttraumatic osteoarthritis. The average Olerud-Molander score was 89.9 (70,100), the average VAS score was 1.0 (0,5), and the ankle dorsiflexion restriction was 4.0° (0°,9°) on the average. Compared with the proportion of patients with postoperative step-off of < 1 mm of posterior malleolar fracture, the proportion of patients with positive posttraumatic osteoarthritis at postoperative step-offs of 1-2 and > 2 mm was higher (P < 0.05), and the functions of the affected limbs were evidently degraded Olerud-Molander score, VAS score, and ankle dorsiflexion restriction; P < 0.05). However, the differences in the proportion of patients with positive posttraumatic osteoarthritis and functional prognosis between postoperative step-offs of 1-2 mm and > 2 mm were not statistically significant (P > 0.05). Posterior malleolar step-off was an independent, statistically significant risk factor for posttraumatic osteoarthritis (Wald = 14.23, P < 0.01), and both posterior malleolar step-off and posttraumatic osteoarthritis were independent risk factors that led to the poor functional prognosis (P < 0.05).
Clinically, importance should be given to the anatomical reduction of posterior malleolar fractures and the incidence of posttraumatic osteoarthritis to improve the long-term functional effects on affected limbs.
Natural Science Foundation of Xinjiang Uygur Autonomous Region（2024D01C11; Xinjiang Tianshan Talent Training Program (2023TSYCJC0053); Shanghai Science and Technology Commission Project (22S31900300, 21ZR1458500).
涉及后踝的踝关节骨折预后较差，其危险因素仍存在争议。本研究旨在评估不同台阶移位程度的后踝骨折对创伤后骨关节炎和功能预后的影响，并确定影响后踝骨折临床预后的相关危险因素。
回顾性收集2016年1月至2021年12月134例涉及后踝的踝关节骨折患者的资料。通过影像学评估患者后踝骨折复位质量、骨折愈合情况及踝关节创伤后骨关节炎严重程度（Kellgren-Lawrence分级），并采用Olerud-Molander评分、视觉模拟量表（VAS）评分及踝关节活动度评估踝关节功能。
134例患者均骨折愈合，平均随访时间为42（13，78）个月。39例（29%）患者出现踝关节创伤后骨关节炎阳性。平均Olerud-Molander评分为89.9（70，100），平均VAS评分为1.0（0，5），踝关节背屈受限平均为4.0°（0°，9°）。与后踝骨折术后台阶移位<1mm的患者相比，术后台阶移位1 - 2mm和>2mm的患者创伤后骨关节炎阳性比例更高（P<0.05），患侧肢体功能明显下降（Olerud-Molander评分、VAS评分及踝关节背屈受限；P<0.05）。然而，术后台阶移位1 - 2mm和>2mm的患者创伤后骨关节炎阳性比例及功能预后差异无统计学意义（P>0.05）。后踝台阶移位是创伤后骨关节炎的独立、有统计学意义的危险因素（Wald = 14.23，P<0.01），后踝台阶移位和创伤后骨关节炎均是导致功能预后不良的独立危险因素（P<0.05）。
临床上，应重视后踝骨折的解剖复位及创伤后骨关节炎的发生率，以改善患侧肢体的长期功能效果。
新疆维吾尔自治区自然科学基金（2024D01C11）；新疆天山英才培养计划（2023TSYCJC0053）；上海市科学技术委员会项目（22S31900300，21ZR1458500）。
