Faraj Ara, Hammett Felix, Lineham Beth, Barron Elizabeth, Hadland Yvonne, Moulder Elizabeth, Muir Ross, Sharma Hemant
Department of Trauma and Orthopaedics, Hull Royal Infirmary, Hull, East Riding of Yorkshire, England, United Kingdom.
Strategies Trauma Limb Reconstr. 2025 Jan-Apr;20(1):6-10. doi: 10.5005/jp-journals-10080-1636. Epub 2025 Aug 18.
Intra-articular distal tibia fractures can lead to post-traumatic osteoarthritis (PTOA). Joint distraction has shown promise in elective cases of osteoarthritis (OA) by temporarily offloading joint forces and potentially facilitating cartilage regeneration. However, its application in acute fractures remains unexplored. This pilot study aims to investigate the benefits of joint distraction in acute fractures.
A retrospective cohort study comprising consecutive patients with intra-articular distal tibia and pilon fractures, treated with a circular ring fixator (CRF) and ankle distraction as part of their fracture management, was undertaken at a single centre.Prospective data collection included radiological assessments, patient-reported outcome measures (PROM), complications, necessity for additional procedures, and the Kellgren and Lawrence grade (KL) for OA.
There were 137 patients included in the study, among them 30 in the distraction group and 107 in the non-distraction group. There were no significant differences in age, gender, distribution of open or closed fractures, diabetic status, and smoking status between the groups. Mean follow-up was 3.73 years.There was no significant difference between the distraction and non-distraction groups in overall complications or need for further procedures. The mean radiological follow-up was 1.90 years, there was no significant difference in progression of KL between the groups (1.81 vs 2.0, = 0.38). There were 32 patients who had radiological follow-up exceeding 2 years (average 3.52 years); here there was no significant difference between these groups (mean change 2.18 vs 2.4, = 0.87).Patient-reported outcome measures data was available for 44 patients (6 in the distraction group, 38 in the non-distraction group) with a mean follow-up of 1.71 years. There were no significant differences in EQ5D and C Olerud-H Molander scores between the two groups.
Ankle joint distraction in the management of acute ankle fractures did not influence outcomes for patients in short and medium term follow-up. Future work should investigate for long-term effects of this auxiliary technique when using circular external fixators, in particular on the development of PTOA.
Faraj A, Hammett F, Lineham B, . Outcomes of Acute Ankle Distraction for Intra-articular Distal Tibial and Pilon Fractures. Strategies Trauma Limb Reconstr 2025;20(1):6-10.
胫骨远端关节内骨折可导致创伤后骨关节炎（PTOA）。关节牵张术通过暂时减轻关节压力并可能促进软骨再生，在骨关节炎（OA）的择期病例中显示出前景。然而，其在急性骨折中的应用仍未得到探索。这项前瞻性研究旨在探讨关节牵张术在急性骨折中的益处。
在单一中心进行了一项回顾性队列研究，纳入连续的胫骨远端关节内骨折和pilon骨折患者，采用环形外固定器（CRF）和踝关节牵张术作为骨折治疗的一部分。前瞻性数据收集包括影像学评估、患者报告的结局指标（PROM）、并发症、额外手术的必要性以及骨关节炎的Kellgren和Lawrence分级（KL）。
该研究共纳入137例患者，其中牵张组30例，非牵张组107例。两组在年龄、性别、开放性或闭合性骨折分布、糖尿病状态和吸烟状态方面无显著差异。平均随访时间为3.73年。牵张组和非牵张组在总体并发症或进一步手术需求方面无显著差异。平均影像学随访时间为1.90年，两组间KL进展无显著差异（1.81对2.0，P = 0.38）。有32例患者影像学随访超过2年（平均3.52年）；两组间无显著差异（平均变化2.18对2.4，P = 0.87）。44例患者（牵张组6例，非牵张组38例）可获得患者报告的结局指标数据，平均随访时间为1.71年。两组间EQ5D和Olerud-H Molander评分无显著差异。
急性踝关节骨折治疗中踝关节牵张术在短期和中期随访中对患者结局无影响。未来的工作应研究使用环形外固定器时这种辅助技术的长期效果，特别是对创伤后骨关节炎发展的影响。
Faraj A, Hammett F, Lineham B, 等。胫骨远端关节内骨折和pilon骨折急性踝关节牵张的结局。创伤肢体重建策略2025；20(1):6 - 10。
