Böstman O M
Department of Orthopaedics and Traumatology, University Central Hospital, Helsinki, Finland.
Foot Ankle. 1993 Jan;14(1):38-43. doi: 10.1177/107110079301400108.
Three patients (3.8%) of 80 with displaced malleolar fractures treated by open reduction and internal fixation using absorbable polyglycolide rods were found to have developed distal tibiofibular synostosis. To assess the general incidence of this complication, the serial radiographs of 150 patients with an identical distribution of the initial fracture severity treated with AO-ASIF implants were examined for comparison. Among these, no cases of tibiofibular synostosis were found. The difference (P = .04) in incidence was postulated to be due to an osteogenic potential of the absorbable polymeric material, suggested previously in experimental studies. This study included fractures of the lateral malleolus and bimalleolar fractures, but patients with a disruption of the inferior tibiofibular syndesmosis causing tibiofibular diastasis on admission were excluded. The synostoses occurred in middle-aged, sedentary people, and no active measures were necessary because of the mild subjective symptoms of these patients. Previously, posttraumatic distal tibiofibular synostosis has been recorded as an uncommon late complication of severe ankle fractures with tibiofibular diastasis requiring transsyndesmotic fixation, but it has not been reported to occur after malleolar fractures of the kind surveyed in this study.
在80例采用可吸收聚乙醇酸棒切开复位内固定治疗的移位踝关节骨折患者中，有3例（3.8%）发生了下胫腓关节融合。为评估该并发症的总体发生率，对150例采用AO-ASIF植入物治疗且初始骨折严重程度分布相同的患者的系列X线片进行了检查以作比较。在这些患者中，未发现下胫腓关节融合的病例。发生率的差异（P = 0.04）据推测是由于可吸收聚合材料的成骨潜能，这在先前的实验研究中已有提示。本研究纳入了外踝骨折和双踝骨折患者，但入院时伴有下胫腓联合损伤导致胫腓分离的患者被排除。关节融合发生在中年久坐人群中，由于这些患者主观症状较轻，无需采取积极措施。此前，创伤后下胫腓关节融合被记录为严重踝关节骨折伴胫腓分离需要经下胫腓联合固定的一种罕见晚期并发症，但尚未有报道称在本研究中所调查的那种踝关节骨折后发生。
