Abstract：
OBJECTIVE: Ankle fracture-dislocations (AFD) often necessitate staged management involving temporary external fixation (EF) due to mechanical instability or blistering. However, limited literature exists on the optimal temporary immobilization method for low-energy closed AFD. This study compared baseline patient and fracture characteristics, along with clinical and radiological outcomes between AFD initially immobilized with EF versus splinting.
METHODS: A retrospective cohort study was conducted involving patients with AFD temporarily immobilized using EF or splinting, followed by definitive open reduction and internal fixation. Quality of reduction (QOR) was assessed for each patient post-initial immobilization and after the definitive surgery.
RESULTS: The study encompassed 194 patients: 138 treated with a splint (71.1%) and 56 (28.9%) with EF. Secondary loss of reduction had occurred in three patients who were splinted (2.2%). The mean ages in the EF and splint groups were 63.2 and 56.1 years, respectively (p = 0.01). Posterior malleolus fracture (PMF) and blisters were more prevalent in EF patients (69.6% vs. 43.5% for PMF and 76.8% vs. 20.3% for blisters, respectively; p = 0.05 and p < 0.01). Postoperative complication rates were 8.9% for EF versus 10.9% for splinting (p = 0.69). Satisfactory final QOR was attained in 79.8% of patients treated with a splint versus 64.3% with EF (p = 0.02).
CONCLUSIONS: Patients immobilized by EF presented with poorer baseline characteristics and had more unstable injuries. Nevertheless, postoperative complication rates were comparable. Thus, EF appears to be a valuable tool for standardizing outcomes in AFD patients with a less favorable prognosis.
METHODS: A retrospective cohort study was conducted involving patients with AFD temporarily immobilized using EF or splinting, followed by definitive open reduction and internal fixation. Quality of reduction (QOR) was assessed for each patient post-initial immobilization and after the definitive surgery.
RESULTS: The study encompassed 194 patients: 138 treated with a splint (71.1%) and 56 (28.9%) with EF. Secondary loss of reduction had occurred in three patients who were splinted (2.2%). The mean ages in the EF and splint groups were 63.2 and 56.1 years, respectively (p = 0.01). Posterior malleolus fracture (PMF) and blisters were more prevalent in EF patients (69.6% vs. 43.5% for PMF and 76.8% vs. 20.3% for blisters, respectively; p = 0.05 and p < 0.01). Postoperative complication rates were 8.9% for EF versus 10.9% for splinting (p = 0.69). Satisfactory final QOR was attained in 79.8% of patients treated with a splint versus 64.3% with EF (p = 0.02).
CONCLUSIONS: Patients immobilized by EF presented with poorer baseline characteristics and had more unstable injuries. Nevertheless, postoperative complication rates were comparable. Thus, EF appears to be a valuable tool for standardizing outcomes in AFD patients with a less favorable prognosis.
摘要：
目的：踝关节骨折脱位（AFD）由于机械不稳定或起泡，通常需要进行包括临时外固定（EF）的分期治疗。然而,关于低能封闭式AFD的最佳临时固定方法的文献很少。这项研究比较了基线患者和骨折特征，以及最初固定EF和夹板的AFD之间的临床和放射学结果。
方法：进行了一项回顾性队列研究，涉及使用EF或夹板临时固定的AFD患者，随后是明确的切开复位和内固定。初始固定后和确定性手术后评估每位患者的降低质量（QOR）。
结果：该研究包括194例患者：138例接受夹板治疗（71.1%），56例接受EF治疗（28.9%）。在三名夹板固定的患者中发生了继发性减少（2.2％）。EF和夹板组的平均年龄分别为63.2和56.1岁，分别(p=0.01)。后踝骨折（PMF）和水疱在EF患者中更为普遍（69.6％vs.PMF占43.5%，占76.8%。水泡20.3%，分别为p=0.05和p<0.01)。EF的术后并发症发生率为8.9％，而夹板的术后并发症发生率为10.9％（p=0.69）。使用夹板治疗的患者中，有79.8％的患者获得了满意的最终QOR，而EF为64.3％（p=0.02）。
结论：EF固定的患者基线特征较差，损伤不稳定。然而，术后并发症发生率相当.因此，EF似乎是对预后较差的AFD患者的预后进行标准化的有价值的工具。
方法：进行了一项回顾性队列研究，涉及使用EF或夹板临时固定的AFD患者，随后是明确的切开复位和内固定。初始固定后和确定性手术后评估每位患者的降低质量（QOR）。
结果：该研究包括194例患者：138例接受夹板治疗（71.1%），56例接受EF治疗（28.9%）。在三名夹板固定的患者中发生了继发性减少（2.2％）。EF和夹板组的平均年龄分别为63.2和56.1岁，分别(p=0.01)。后踝骨折（PMF）和水疱在EF患者中更为普遍（69.6％vs.PMF占43.5%，占76.8%。水泡20.3%，分别为p=0.05和p<0.01)。EF的术后并发症发生率为8.9％，而夹板的术后并发症发生率为10.9％（p=0.69）。使用夹板治疗的患者中，有79.8％的患者获得了满意的最终QOR，而EF为64.3％（p=0.02）。
结论：EF固定的患者基线特征较差，损伤不稳定。然而，术后并发症发生率相当.因此，EF似乎是对预后较差的AFD患者的预后进行标准化的有价值的工具。
