Abstract：
OBJECTIVE: To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures.
METHODS: A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18-65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American orthopedic foot and ankle society score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or t-test.
RESULTS: During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, preoperative complications with diabetes, smoking history, preoperative waiting time, operation time, and length of hospital stay (all p > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American orthopedic foot and ankle society score revealed no significant difference between dislocation and no-dislocation patients.
CONCLUSIONS: Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.
METHODS: A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18-65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American orthopedic foot and ankle society score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or t-test.
RESULTS: During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, preoperative complications with diabetes, smoking history, preoperative waiting time, operation time, and length of hospital stay (all p > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American orthopedic foot and ankle society score revealed no significant difference between dislocation and no-dislocation patients.
CONCLUSIONS: Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.
摘要：
目的：评估旋后-外旋（SER）踝关节骨折脱位与功能结局之间的关系。
方法：对2015年1月至2021年12月在大型创伤中心手术治疗的踝关节骨折患者进行了回顾性病例系列研究。纳入标准为18-65岁的中青年SER踝关节骨折患者，可通过Lauge-Hansen分类进行分类，并在我们的创伤中心接受手术。排除标准是严重危及生命的疾病，开放性骨折,骨折延迟超过3周，骨折部位≥2等。然后将患者分为脱位组和无脱位组。患者人口统计学，损伤特征,手术相关结果,收集并分析术后功能结局.在术后1年面对面随访时，使用足踝预后评分（FAOS）和美国骨科足踝社会评分以及2名经验丰富的骨科医师对SER踝关节骨折的功能预后进行评估。相关数据采用SPSS22.0版卡方或t检验进行分析。
结果：在研究期间，有371个踝关节骨折.其中,SER模式为190（51.2％），其中69（36.3％）合并位错。与无脱位组相比,脱位组性别差异无统计学意义,年龄构成,骨折类型,糖尿病术前并发症，吸烟史,术前等待时间,操作时间,住院时间（均p>0.05），但Lauge-Hansen损伤等级（p<0.001）和联合椎板螺钉固定率（p=0.033）明显更高。此外，功能恢复较差，在运动/记录量表中显示出明显较低的FAOS(p<0.001)。亚组分析显示,在SERIV型踝关节骨折患者中,对于脱位患者，FAOS在疼痛（p=0.042）和运动/rec量表（p<0.001）方面低得多。美国矫形足和踝关节协会评分显示脱位和无脱位患者之间没有显着差异。
结论：SER踝关节骨折脱位提示损伤更严重，对功能恢复有负面影响，主要表现为疼痛较多,运动功能较差,尤其是在SERIV踝关节病例中。
方法：对2015年1月至2021年12月在大型创伤中心手术治疗的踝关节骨折患者进行了回顾性病例系列研究。纳入标准为18-65岁的中青年SER踝关节骨折患者，可通过Lauge-Hansen分类进行分类，并在我们的创伤中心接受手术。排除标准是严重危及生命的疾病，开放性骨折,骨折延迟超过3周，骨折部位≥2等。然后将患者分为脱位组和无脱位组。患者人口统计学，损伤特征,手术相关结果,收集并分析术后功能结局.在术后1年面对面随访时，使用足踝预后评分（FAOS）和美国骨科足踝社会评分以及2名经验丰富的骨科医师对SER踝关节骨折的功能预后进行评估。相关数据采用SPSS22.0版卡方或t检验进行分析。
结果：在研究期间，有371个踝关节骨折.其中,SER模式为190（51.2％），其中69（36.3％）合并位错。与无脱位组相比,脱位组性别差异无统计学意义,年龄构成,骨折类型,糖尿病术前并发症，吸烟史,术前等待时间,操作时间,住院时间（均p>0.05），但Lauge-Hansen损伤等级（p<0.001）和联合椎板螺钉固定率（p=0.033）明显更高。此外，功能恢复较差，在运动/记录量表中显示出明显较低的FAOS(p<0.001)。亚组分析显示,在SERIV型踝关节骨折患者中,对于脱位患者，FAOS在疼痛（p=0.042）和运动/rec量表（p<0.001）方面低得多。美国矫形足和踝关节协会评分显示脱位和无脱位患者之间没有显着差异。
结论：SER踝关节骨折脱位提示损伤更严重，对功能恢复有负面影响，主要表现为疼痛较多,运动功能较差,尤其是在SERIV踝关节病例中。
