Sarić V, Pećina M, Karadza J
Acta Chir Iugosl. 1983;30(2):187-95.
Authors have analysed some characteristics of the functional anatomy, biomechanics, classification and treatment of fractures of the talocrural joint with special emphasis of sprained fractures. Based on data from different references, as well as on the authors' experience, they came to the conclusion that a great percentage of these fractures heal with shortening of the fibula; the latter causes disorders of the biomechanical mechanism in this joint. The importance of the fibula especially in the statics and the dynamics of the lower limb has been stressed out, as well as the possibility of precise measurement of posttraumatic shortening of the fibula. The treatment of the fractures of talocrural joint should be individual, bearing in mind that in most cases only meticulous surgical reposition of the ligaments does give a correct anatomical relations between the joints bodies and a normal function of the joint itself. By conservative measures and external immobilisation with plaster, it is not possible to avoid dislocation of the fragments when fractures of type C happens, or most of the fractures of Type B, and a few of type A--Weber's classification. The conservative treatment is recommended only with those fractures of the types A and B, where clinically or by x-ray the fragments being impacted, without any dislocation between them, and without lesions of tibio-fibular syndesmosis and collateral ligaments. For all other sprained fractures there is always an indication for surgical correction.
作者分析了踝关节骨折的功能解剖、生物力学、分类及治疗的一些特点，特别强调了扭伤性骨折。基于不同参考文献的数据以及作者的经验，他们得出结论：这些骨折中有很大比例会随着腓骨缩短而愈合；腓骨缩短会导致该关节生物力学机制紊乱。强调了腓骨在下肢静力学和动力学中的重要性，以及精确测量创伤后腓骨缩短的可能性。踝关节骨折的治疗应个体化，要记住在大多数情况下，只有对韧带进行细致的手术复位才能使关节体之间恢复正确的解剖关系并使关节本身具有正常功能。采用保守措施并用石膏进行外部固定时，当发生C型骨折，或大多数B型骨折以及少数A型（韦氏分类法）骨折时，无法避免骨折碎片的移位。仅对于那些临床或X线显示骨折碎片相互嵌插、无移位且胫腓下联合和侧副韧带无损伤的A型和B型骨折，才建议采用保守治疗。对于所有其他扭伤性骨折，总是有手术矫正的指征。
