Offierski C M, Graham J D, Hall J H, Harris W R, Schatzker J L
Clin Orthop Relat Res. 1982 Nov-Dec(171):145-9.
Eleven patients with fibular malunion after ankle fracture healed with stiff, painful joints and radiographic evidence of fibular malunion, diastasis of the ankle mortice, and talar tilt. Reconstruction was performed by mobilizing the fibula (by osteotomy or through the old fracture site), lengthening the fibula, and restoring the ankle mortice anatomically. The operation was done three months to three years after the initial fracture in patients ranging in age from 26 to 52 years. The average follow-up period was 3.3 years. Radiographically, seven patients had the ankle joint restored anatomically. Four patients had residual talar tilt. On clinical assessment, eight patients were rated as good, two fair and improving, and one poor resulting in fusion. Good functional results were maintained at long-term follow-up examination. The factors that determined the success of the revision were the duration of the malunion, the quality of the reduction achieved, and the condition of the articular cartilage at the time of revision. Late correction of the malunited fibula with diastasis of the ankle mortice is an effective means of salvaging function in a joint otherwise destined to be stiff and painful.
11例踝关节骨折后腓骨畸形愈合的患者，关节僵硬、疼痛，影像学显示存在腓骨畸形愈合、踝关节 mortice 分离及距骨倾斜。通过腓骨松动（截骨或经原骨折部位）、腓骨延长及解剖复位踝关节 mortice 进行重建。手术在初次骨折后3个月至3年进行，患者年龄在26至52岁之间。平均随访期为3.3年。影像学检查显示，7例患者踝关节解剖复位。4例患者残留距骨倾斜。临床评估中，8例患者评定为良好，2例尚可且有改善，1例差，最终关节融合。长期随访检查维持了良好的功能结果。决定翻修成功的因素包括畸形愈合的持续时间、复位的质量以及翻修时关节软骨的状况。晚期矫正伴有踝关节 mortice 分离的畸形愈合腓骨是挽救原本注定僵硬和疼痛关节功能的有效方法。
