Posterior malleolar fracture morphology determines outcome in rotational type ankle fractures
Posterior malleolar fracture morphology determines outcome in rotational type ankle fractures
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DOI：
10.1016/j.injury.2019.06.003
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发表时间：
2019-07-01
影响因子：
2.5
通讯作者：
Doornberg, J. N.
中科院分区：
文献类型：
--
作者：
Blom, R. P.;Meijer, D. T.;Doornberg, J. N.
导读：旋转型踝关节骨折伴后踝骨折与无踝关节骨折相比，临床预后较差。然而，临床意义的后外踝（PM）骨折形态和模式尚未建立。关于这一主题的许多研究报告了碎片大小，而不是基于计算机断层扫描（CT）的骨折形态。本研究的总体目的是阐明PM骨折形态与功能预后的相关性，通过CT成像评估，而不是不可靠的x线平片。方法：2010年1月至2014年5月，194例经手术（ORIF）治疗的踝关节骨折患者前瞻性纳入我们一级创伤中心的随机临床ef3x试验。本研究回顾性分析了73例踝关节旋转型骨折并伴有后踝骨折的患者。根据基于ct的Haraguchi骨折形态，将所有患者分为三组：20例I型（大后外侧-斜位），21例II型（横向中伸）和32例III型（小壳碎片）。在术后12周、1年和2年获得足踝预后评分（FAOS）和SF-36评分，以术后2年的FAOS域评分作为主要研究结果。统计分析包括多元回归分析和二次混合模型分析。结果：与Haraguchi I型和III型相比，Haraguchi II型PM踝关节骨折在两年的随访中表现出明显较差的结局评分。在两年的随访中，平均FAOS域评分显示，Haraguchi II型患者比III型患者明显更差，分别是：症状48.2比61.7 (p = 0.03)，疼痛58.5比84.4 (p < 0.01)，日常生活活动（ADL） 64.1比90.5 （p < 0.01）。结论：骨折线内侧延伸的后踝踝骨折（即Haraguchi II型）与功能预后明显较差相关。目前固定至少25-33%胫骨平台的PM骨折的教条可能会受到挑战，因为后踝骨折的类型和形态-而不是碎片大小-似乎决定了结果。(C) 2019 Elsevier Ltd.版权所有。
Introduction: Rotational type ankle fractures with a concomitant fracture of the posterior malleolus are associated with a poorer clinical outcome as compared to ankle fractures without. However, clinical implications of posterior malleolar (PM) fracture morphology and pattern have yet to be established. Many studies on this subject report on fragment size, rather than fracture morphology based on computed tomography (CT). The overall purpose of the current study was to elucidate the correlation of PM fracture morphology and functional outcome, assessed with CT imaging and not with -unreliableplain radiographs.Methods: Between January 2010 and May 2014, 194 patients with an operatively (ORIF) treated ankle fracture, were prospectively included in the randomized clinical EF3X-trial at our Level-I trauma center. The current study retrospectively included 73 patients with rotational type ankle fractures and concomitant fractures of the posterior malleolus. According to the CT-based Haraguchi fracture morphology, all patients were divided into three groups: 20 Type I (large posterolateral-oblique), 21 Type II (transverse medial-extension) and 32 Type III (small-shell fragment). At 12 weeks, 1 year and 2 years postoperatively the Foot and Ankle Outcome Scores (FAOS) and SF-36 scores were obtained, with the FAOS domain scores at two years postoperative as primary study outcome. Statistical analysis included a multivariate regression and secondary a mixed model analysis.Results: Haraguchi Type II PM ankle fractures demonstrated significantly poorer outcome scores at two years follow-up compared to Haraguchi Types I and III. Mean FAOS domain scores at two years follow-up showed to be significantly worse in Haraguchi Type II as compared to Type III, respectively: Symptoms 48.2 versus 61.7 (p = 0.03), Pain 58.5 versus 84.4 (p < 0.01), Activities of Daily Living (ADL) 64.1 versus 90.5 (p < 0.01).Conclusion: Posterior malleolar ankle fractures with medial extension of the fracture line (i.e. Haraguchi Type II) are associated with significantly poorer functional outcomes. The current dogma to fix PM fractures that involve at least 25-33% of the tibial plafond may be challenged, as posterior malleolar fracture pattern and morphology - rather than fragment size - seem to determine outcome. (C) 2019 Elsevier Ltd. All rights reserved.