The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures
The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures
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DOI：
10.1007/s00264-013-2224-7
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发表时间：
2014-05-01
影响因子：
2.7
通讯作者：
Hetsroni, Iftach
中科院分区：
文献类型：
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作者：
Palmanovich, Ezequiel;Brin, Yaron S.;Hetsroni, Iftach
目的尽管轻度移位的外踝或后踝骨折的发生率很高，但治疗指南仍然存在争议。这项研究的目的是描述骨科医生对合并和不合并后踝骨折的这些骨折的治疗偏好。我们假设伴随的微小移位的后踝骨折可以将治疗偏好转向手术干预。方法对参加2012年在德国柏林举行的欧洲国家矫形外科协会联合会会议(Efort)的骨科医生进行了一项基于问卷的研究。报告了X线片上显示的轻微移位的外踝骨折的治疗偏好，然后将其与当添加计算机断层扫描(CT)发现伴随的后踝后外侧骨折时的治疗偏好进行比较。结果队列包括来自所有六大洲的177名外科医生。当X线片显示最小移位的外踝骨折时，35%(62)的参与者选择非手术治疗，而65%(115)的参与者倾向于手术干预。在添加CT图像显示伴有微小移位的后外侧踝骨折后，79%(140)的人建议手术干预，只有21%(37)的人主张非手术治疗(p=0.03)。结论大多数外科医生倾向于切开复位内固定治疗微小移位的外踝骨折。在这些病例中，伴发的后踝骨折使治疗偏好进一步转向切开复位内固定。因为在标准的踝关节X线片上后踝骨折可能不能很好地显示，所以高度怀疑是有必要的，在这些病例中应该考虑使用CT。
Purpose Despite the high incidence of cases of minimally displaced lateral or posterior malleolus ankle fractures, treatment guidelines are still an issue of controversy. The purpose of this study was to delineate treatment preferences among orthopaedic surgeons in these fractures with and without concomitant posterior malleolus fractures. We hypothesized that concomitant minimally displaced fractures of the posterior malleolus can shift treatment preference towards operative intervention.Methods A questionnaire-based study was conducted among orthopaedic surgeons attending the 2012 European Federation of National Associations of Orthopaedics and Traumatology Conference (EFORT) in Berlin, Germany. Treatment preferences were reported for minimally displaced lateral malleolus fractures seen on radiographs and were then compared with treatment preferences when computed tomography (CT) was added revealing a concomitant minimally displaced posterolateral fracture of the posterior malleolus.Results The cohort comprised 177 surgeons from all six continents. When radiographs showing a minimally displaced lateral malleolus fracture were presented, nonoperative management was indicated by 35 % (62) of participants, whereas 65 % (115) preferred operative intervention. After CT views were added showing an accompanying minimally displaced posterolateral posterior malleolus fracture, 79 % (140) suggested operative intervention and only 21 % (37) advocated nonoperative management (p = 0.03).ConclusionsMost surgeons prefer open reduction with internal fixation for minimally displaced lateral malleolar fractures. The presence of concomitant posterior malleolus fractures in these cases shifts treatment preference further towards open reduction with internal fixation. Because the posterior malleolus fragment might not be well delineated on standard ankle radiographs, a high index of suspicion is warranted, and the use of CT should be considered in these cases.