Møller B N, Krebs B
Acta Orthop Scand. 1982 Dec;53(6):991-6. doi: 10.3109/17453678208992859.
In a study of 23 intra-articular fractures of the distal tibia of which 18 were re-examined after an average follow-up period of 5.4 years, two major fracture patterns were identified: type A, a rotational pattern, caused by low energy trauma and type B, a compressive fracture pattern caused by high energy trauma. Type B fractures could be divided into three subgroups: 1) An isolated fracture of the anterior or posterior margin of the distal tibia, 2) an extra-articular comminuted fracture with extension into the ankle joint and 3) a comminuted intra-articular fracture. When the initial displacement and comminution were severe or the reduction was not complete, the final results of the comminuted intra-articular fractures were not acceptable. The incidence of osteoarthritis was highest in the group of comminuted intra-articular fractures. The extra-articular comminuted fractures seemed to have a better prognosis as indicated by the final clinical results, including the occurrence of osteoarthritis. It is clear from this study that comminuted intra-articular fractures should not be treated by primary operation. All fractures treated non-operatively had acceptable final clinical results.
在一项对23例胫骨干骺端关节内骨折的研究中，其中18例在平均5.4年的随访期后接受了复查，确定了两种主要骨折类型：A型为旋转型骨折，由低能量创伤引起；B型为压缩型骨折，由高能量创伤引起。B型骨折可分为三个亚组：1）胫骨干骺端前缘或后缘孤立骨折；2）延伸至踝关节的关节外粉碎性骨折；3）关节内粉碎性骨折。当初始移位和粉碎严重或复位不完全时，关节内粉碎性骨折的最终结果是不可接受的。骨关节炎的发生率在关节内粉碎性骨折组中最高。从最终临床结果（包括骨关节炎的发生情况）来看，关节外粉碎性骨折似乎预后较好。从这项研究中可以清楚地看出，关节内粉碎性骨折不应进行一期手术治疗。所有接受非手术治疗的骨折最终临床结果均可接受。
