Management of grade III open dislocated ankle fractures: combined internal fixation with bioabsorbable screws/rods and external fixation.
Management of grade III open dislocated ankle fractures: combined internal fixation with bioabsorbable screws/rods and external fixation.
复制标题
Ⅲ级开放性踝关节脱位骨折的治疗：生物可吸收螺钉/棒内固定和外固定联合治疗。
DOI：
10.7547/1010307
复制
发表时间：
2011
影响因子：
0.7
通讯作者：
San
中科院分区：
文献类型：
--
作者：
T. Ye;Aimin Chen;W. Yuan;San
背景
单纯性踝关节脱位合并III级开放性骨折的报道很少。这些踝关节损伤通常包括插孔骨折、胫骨黄斑关节完全脱位、关节囊膜结构破坏和严重的软组织损伤。目前还没有公认的疗法能够产生令人满意的结果。
方法
2003年1月至2007年6月，16名III级开放性脱位踝关节骨折患者立即接受了生物可吸收植入物和外固定器的治疗。按Gustilo和Anderson分级，IIIA级5例，IIIB级7例，IIIC级4例。手术措施包括生物可吸收螺钉/棒联合内固定和外固定。
结果
术后平均18.1个月接受临床和放射学检查。结果优7例(3例IIIA、3例IIIB和1例IIIC)，4例(1例IIIA、2例IIIB和1例IIIC)，3例(1例IIIA、1例IIIB和1例IIIC)，2例差(1例IIIB和1例IIIC)。在2例预后较差的患者中，术中发现胫骨远端有骨缺损和软骨剥落。术后2年发现踝关节痛性骨关节炎。另1例术后3个月外固定器出现针道感染。无晚期深部感染病例。
结论
生物可吸收植入物结合外固定器治疗严重开放性脱位踝关节骨折可能是一种合理和可取的选择。
BACKGROUND
Isolated dislocation of the ankle with grade III open fracture has been scarcely reported. These ankle injuries usually involved mortise fractures, complete dislocation of the tibial astragaloid joint, capsuloligamentous structure disruption, and severe soft-tissue damage. There is no well-recognized regimen that would result in desirable outcomes.
METHODS
Sixteen patients with grade III open dislocated ankle fractures were treated immediately with bioabsorbable implants and an external fixator between January 2003 and June 2007. According to the classification system of Gustilo and Anderson, five patients were grade IIIA, seven were grade IIIB, and four were grade IIIC. Surgical interventions included combined internal fixation with bioabsorbable screws/rods and external fixation.
RESULTS
Patients underwent clinical and radiologic examination at an average of 18.1 months after surgery. Outcomes were excellent in seven patients (three IIIA, three IIIB, and one IIIC), good in four (one IIIA, two IIIB, and one IIIC), fair in three (one IIIA, one IIIB, and one IIIC), and poor in two (one IIIB, and one IIIC). In the two patients with poor outcomes, bone defect and cartilage exfoliating in the distal tibia were found during surgery. Painful osteoarthritis in the ankle was discovered 2 years after surgery. Another case had pin tract infections in the external fixator 3 months after surgery. There was no case of late deep infection.
CONCLUSIONS
It may be a reasonable and desirable option that bioabsorbable implants combined with an external fixator be applied for treatment of severe open dislocated ankle fractures.