背景:Maisonneuve骨折是一种特殊类型的严重踝关节损伤。根据我们目前的知识,一旦诊断出Maisonneuve骨折,总是建议进行手术,以免因关节重建不正确而造成后遗症。然而,在这种情况下,我们用短腿石膏治疗了Maisonneuve骨折,41个月的随访显示出良好的预后,没有创伤后骨关节炎,慢性疼痛,和不稳定性。因此,该病例为保守治疗Maisonneuve骨折的可行性提供了证据。
方法:一名二十出头的女性患者在跑步时扭伤了左脚踝,遭受区域性疼痛,肿胀,和有限的流动性。
方法:我们诊断为Maisonneuve骨折伴腓骨上骨折和Volkmann结节骨折,下胫腓骨联合(ITS)的轻微分离。
方法:患者拒绝我们的手术建议,转而采用非手术治疗,除了拒绝固定膝盖。因此,我们不得不用短腿石膏治疗她8周,并要求她回来定期随访。
结果:在最后的随访中,造影显示腓骨近端骨折完全愈合。患者报告双侧脚踝之间没有明显的主观差异。在背屈22°和足屈40°测量左踝关节的运动范围。使用Olerud-Molander踝关节量表和美国骨科足踝协会踝关节量表进行的功能评估均获得100分。此外,影像学评估根据Morrey-Wiedeman分类将关节炎分类为0期。
结论:为了避免漏诊和误诊,体格检查应始终扩展到2个相邻的关节。其次,如果怀疑Maisonneuve骨折,进一步的计算机断层扫描,射线照相术,磁共振成像可以帮助在做出治疗决定之前确定ITS的稳定性和外侧副韧带的完整性。最后,考虑到侧支韧带可能保持完整,我们建议通过修复内侧韧带来稳定ITS,可以通过关节镜进行,并且更具微创性,提供与ITS的生物力学更好地对齐的弹性固定,其特征在于微移动而不是完全固定的关节。
BACKGROUND: Maisonneuve fracture is a specific type of severe ankle injury. To our current knowledge, once a Maisonneuve fracture is diagnosed, the surgery is always recommended for fear of sequelae from inaccurate joint reconstruction. However, in this
case, we treated a Maisonneuve fracture with a short leg cast, and the 41-month follow-up showed a favorable outcome with no post-traumatic osteoarthritis, chronic pain, and instability. Therefore, this
case provides evidence for the feasibility of conservative treatment of Maisonneuve fracture.
METHODS: A female patient in her early twenties sprained her left ankle while running, suffering regional pain, swelling, and limited mobility.
METHODS: We diagnosed a Maisonneuve fracture with superior fibular fracture and Volkmann tuberosity fracture, a slight separation of inferior tibiofibular syndesmosis (ITS).
METHODS: The patient rejected our surgical recommendations in favor of nonsurgical treatment, in addition to refusing immobilization of the knee. Consequently, we had to treat her with a short leg cast for 8 weeks and asked her to return for regular follow-up visits.
RESULTS: At the final follow-up, the radiography showed complete healing of proximal fibula fracture. The patient reported no discernible subjective differences between her bilateral ankles. The range of motion of the left ankle was measured at 22° of dorsiflexion and 40° of plantarflexion. Functional assessments using Olerud-Molander ankle scale and American Orthopedic Foot and Ankle Society Ankle-Hindfoot scale both scored 100 points. Additionally, the radiographic assessment classified arthritis as stage 0 according to Morrey-Wiedeman classification.
CONCLUSIONS: To avoid missing and misdiagnosing, the physical examination should always extend to 2 neighboring joints. Secondly, if a Maisonneuve fracture is suspected, further computed tomography scans, radiography, and magnetic resonance imaging can help to determine the stability of the ITS and the integrity of the lateral collateral ligaments before making therapeutic decisions. Finally, considering the lateral collateral ligaments may remain intact, we recommend stabilizing ITS by repairing the medial ligaments, which can be conducted arthroscopically and be more minimally invasive, providing an elastic fixation that aligns better with the biomechanics of the ITS which is characterized as a micro-mobile rather than fully fixed joint.