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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 21  |  Page : 2551-2557

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws: A Retrospective Comparative Cohort Study


1 Department of Orthopaedics, Chaoyang Hospital, Third Clinical Medical School of Capital Medical University, Bejing 100020; Department of Trauma Orthopaedics, Jishuitan Hospital, Forth Clinical Medical School of Peking University, Beijing 100035, China
2 Department of Trauma Orthopaedics, Jishuitan Hospital, Forth Clinical Medical School of Peking University, Beijing 100035, China
3 Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Bejing 100191, China
4 Department of Orthopaedics, Chaoyang Hospital, Third Clinical Medical School of Capital Medical University, Bejing 100020, China

Correspondence Address:
Dr. Jun-Lin Zhou
Department of Orthopaedics, Chaoyang Hospital, Third Clinical Medical School of Capital Medical University, Bejing 100020
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.244112

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Background: In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type of pronation-external rotation (PER) fractures with supracollicular medial malleolar (SMM) fractures. This study was designed to assess the 3-year functional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies. Methods: This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients (Group 1) were treated without a supplemental syndesmotic screw fixation, according to the negative intraoperative stress test after bony fixation, while 32 patients (Group 2) were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and Visual Analog Scale (VAS) for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and one-way analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models. Results: We observed no difference in the distribution of age, sex, presence of associated posterior malleolus (PM), fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS (Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27) and VAS (Group 1 vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P = 0.12) in association with two strategies. Conclusions: The present study indicates no difference to the use of the syndesmotic screw in terms of the functional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fracture patients with SMM fracture after 3-year follow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.

 

 Abstract in Chinese

对于内踝丘上骨折的PER-Weber C型踝关节骨折是否行下胫腓螺钉固定的预后分析:一个回顾性队列研究

摘要

背景:在踝关节骨折的治疗中,术中应力试验常常被用来检测下胫腓的损伤和不稳定,然而对于是在骨折固定之前还是在骨折固定之后来进行应力试验,很少有相关临床研究的报道。对于合并有内踝丘上骨折(SMM)的旋前外旋型(PER)踝关节骨折,根据骨折固定前或者骨折固定后的应力试验结果可能做出相反的下胫腓螺钉固定的选择。本研究的目的就是筛选在这种特殊类型的PER骨折,回顾性比较这两种不同的应力试验以及相应的下胫腓螺钉固定策略,对于3年预后的影响。

方法:本研究为一个回顾性队列研究,纳入并随访了61例2013/14年于北京积水潭医院手术的合并SMM的PER-Weber C型骨折患者,随访年限为3年。纳入标准包括内踝为丘上骨折,外踝骨折为高于胫骨穹窿上方5cm的斜行或者螺旋形骨折的腓骨骨折。对其术中骨折固定前后两次应力试验结果进行回顾,发现均表现为固定前为阳性,固定后为阴性。其中有29例 (组 1) 按照骨折固定前的阳性结果给予了下胫腓螺钉固定,32例 (组 2) 按照骨折固定后阴性的结果未给予下胫腓螺钉固定。随访按照这两种不同的诊疗策略治疗的61例患者术后3年的AOFAS足踝功能评分和VAS疼痛评分。

结果:这两组病人在年龄、性别、是否合并后踝骨折、合并骨折脱位以及是否对后踝进行固定等方面,分布均没有差异。在本研究的样本量下,也未在AOFAS评分(组 1 vs. 组 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27)和VAS评分( 组 1 vs. 组 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P = 0.12)方面观察到两种诊疗策略的差异。

结论:对于合并有SMM骨折的PER-Weber C型骨折患者,在内外踝坚强固定之后,胫腓螺钉固定并不能给患者带来额外获益,术中依照骨折固定后的阴性结果选择不置入螺钉可能更为合理。对于术中进行应力试验的时机以及踝关节内踝骨折的形态应给与更多的关注。



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