背景:后踝(PM)踝关节骨折的治疗仍存在争议。尽管对小PM碎片固定的建议越来越多,证明与未固定PM相比临床结局改善的高质量证据有限.我们描述了在没有PM碎片固定的情况下治疗的PM踝关节骨折的年轻成年患者的长期临床和影像学结果。
方法:对2009年4月1日至2013年10月31日在我们骨科病房收治的年龄18-55岁的PM踝关节骨折患者进行了回顾性队列研究。纳入标准是ASA1和2,创伤前独立活动,没有预先存在的踝关节病变,具有令人满意的双踝和联合稳定作用。开放性骨折,距骨骨折,跟骨骨折,Pilon骨折,随后的再损伤和主要并发症被排除.所有PM碎片均未固定。使用疼痛视觉模拟评分法(VAS)评估临床结果,足踝能力测量(FAAM)与日常生活活动(ADL)和运动功能分量表,和患者满意度评级。使用改良的Kellgren-Lawrence量表在随访的负重踝关节X线片上评估骨关节炎。
结果:纳入61名参与者。平均随访时间为10.26年。平均PM尺寸为16.2±7.39%。评估所有参与者的临床结果。FAAM-ADL的平均评分为95.5±7.13,FAAM-Sports的平均评分为86.4±15.5,患者满意度为86.2±14.4%,疼痛评分为1.13±1.65。对52名参与者的放射学结果进行了评估,在36/52(69%)中显示无至轻微的骨关节炎,轻度骨关节炎14/52(27%),中度骨关节炎2/52(4%)。疼痛和功能评分与PM碎片大小无关,后还原步骤,位错,踝骨骨折或联合损伤。PM阶跃超过1mm和外伤性脱位/半脱位与影像学上较差的骨关节炎有关。
结论:控制混杂因素后,在10年随访时,未固定的较小的后踝碎片显示出基本令人满意的临床结局,骨关节炎的一些影像学进展.
方法:III级-回顾性队列研究。
BACKGROUND: Treatment of posterior malleolar (PM) ankle fractures remains controversial. Despite increasing recommendation for small PM fragment fixation, high quality evidence demonstrating improved clinical outcomes over the unfixated PM is limited. We describe the long term clinical and radiographical outcomes in younger adult patients with PM ankle fractures managed without PM fragment fixation.
METHODS: A retrospective cohort study was performed on PM ankle fracture patients aged 18-55 years old admitted under our orthopaedic unit between 1st of April 2009 and 31st of October 2013. Inclusion criteria were ASA 1 and 2, independent mobility pre-trauma, no pre-existing ankle pathologies, with satisfactory bimalleolar and syndesmotic stabilisation. Open fractures, talar fractures, calcaneal fractures, pilon fractures, subsequent re-injury and major complications were excluded. All PM fragments were unfixated. Clinical outcomes were evaluated using visual analogue scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sports subscale for function, and patient satisfaction ratings. Osteoarthritis was assessed using modified Kellgren-Lawrence scale on follow-up weightbearing ankle radiographs.
RESULTS: Sixty-one participants were included. Mean follow-up was 10.26 years. Average PM size was 16.2 ± 7.39%. All participants were evaluated for clinical outcomes. Mean score of FAAM-ADL was 95.5 ± 7.13, FAAM-Sports 86.4 ± 15.5, patient satisfaction 86.2 ± 14.4% and pain score 1.13 ± 1.65. Radiographical outcomes were evaluated in 52 participants, showing no-to-minimal osteoarthritis in 36/52 (69%), mild osteoarthritis in 14/52 (27%) and moderate osteoarthritis in 2/52 (4%). Pain and functional scores were independent of PM fragment size, post-reduction step-off, dislocation, malleoli fractured or syndesmotic injury. PM step-off more than 1 mm and traumatic dislocation/subluxation were associated with worse radiographical osteoarthritis.
CONCLUSIONS: After controlling for confounders, the unfixated smaller posterior malleolus fragment at 10-year follow-up demonstrated largely satisfactory clinical outcomes with some radiographical progression of osteoarthritis.
METHODS: Level III - Retrospective cohort study.