A comparative study on the effects of preoperative calcaneal traction <i>versus</i> plaster splint fixation on the prognosis of unstable ankle fractures_West China Medical Journal

Authors：

TENG Lin ,  GOU Yongsheng , WANG Na , LIU Dahai

Department of Orthopedics, the first People’s Hospital of Shuangliu District / West China (Airport) Hospital Sichuan University, Chengdu, Sichuan 610200, P. R. China;

Corresponding author：

GOU Yongsheng, Email: 15002828117@163.com

Keywords：

Calcaneal traction; plaster splint; unstable fractures; ankle fractures

DOI：

10.7507/1002-0179.202411142

Video：

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Objective To investigate the effects of preoperative calcaneal traction versus plaster splint fixation on the prognosis of unstable ankle fractures. Methods Patients with unstable ankle fractures admitted to the first People’s Hospital of Shuangliu District / West China (Airport) Hospital Sichuan University between April 2021 and March 2023 were selected. The enrolled patients were randomly divided into the experimental group (calcaneal traction fixation) and the control group (plaster splint) by using a random number table method. The preoperative waiting time, surgical duration, intraoperative blood loss, number of complications, fracture healing time, length of hospital stay, total hospitalization costs, and American Orthopaedic Foot and Ankle Society scores for the ankle joint were compared between the two groups. Results A total of 100 patients were included. Among them, there were 48 cases in the experimental group and 52 cases in the control group. There was no statistically significant difference between the two groups in terms of gender, age, and Denis-Weber typing (P>0.05). The patients were followed up for 12-26 months, with an average of (18.6±4.5) months. All ankle fractures clinically healed. The experimental group reported two cases of post-traumatic arthritis; the control group had one case of post-traumatic arthritis, one case of preoperative tension blisters with epidermal necrosis, and one case of superficial infection at the surgical incision postoperatively. The preoperative waiting time in the experimental group was significantly shorter than that of the control group [(7.35±3.23) vs. (10.04±5.34) days; P<0.05]. There was no statistically significant difference in the surgical duration, intraoperative blood loss, clinical fracture healing time, length of hospital stay, and total hospitalization costs between the two groups (P>0.05). Additionally, American Orthopaedic Foot and Ankle Society scores at postoperative months 1, 3, 6, 12, and at the last follow-up showed no significant differences between the two groups (P>0.05). Conclusions In conclusion, for unstable ankle fractures, there is no significant difference in clinical efficacy between preoperative calcaneal traction and plaster splint fixation. Calcaneal traction may reduce preoperative waiting time and lower the risk of soft tissue complications.

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2.	Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg, 2018, 24(1): 34-39.
3.	Monestier L, Riva G, Coda Zabetta L, et al. Outcome after unstable fractures of the ankle: what’s new? A systematic review. Orthop Rew (Pavia), 2022, 14(4): 35688.
4.	Roberts V, Mason LW, Harrison E, et al. Does functional outcome depend on the quality of the fracture fixation? Mid to long term outcomes of ankle fractures at two university teaching hospitals. Foot Ankle Surg, 2019, 25(4): 538-541.
5.	Carter TH, Mackenzie SP, Bell KR, et al. Selective fixation of the medial malleolus in unstable ankle fractures. Injury, 2019, 50(4): 983-989.
6.	Hong CC, Nashi N, Prosad Roy S, et al. Impact of trimalleolar ankle fractures: how do patients fare post-operatively?. Foot Ankle Surg, 2014, 20(1): 48-51.
7.	Tejwani NC, McLaurin TM, Walsh M, et al. Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury?. J Bone Joint Surg Am, 2007, 89(7): 1438-1441.
8.	Tosun B, Selek O, Gok U, et al. Posterior malleolus fractures in trimalleolar ankle fractures: malleolus versus transyndesmal fixation. Indian J Orthop, 2018, 52(3): 309-314.
9.	Hoelsbrekken SE, Kaul-Jensen K, Mørch T, et al. Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial. J Orthop Trauma, 2013, 27(11): 633-637.
10.	Monestier L, Riva G, Coda Zabetta L, et al. Outcomes after unstable fractures of the ankle: what’s new? A systematic review. Orthop Rev (Pavia), 2022, 14(4): 35688.
11.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12.	Thur CK, Edgren G, Jansson KÅ, et al. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91, 410 Swedish inpatients. Acta Orthop, 2012, 83(3): 276-281.
13.	Yablon IG, Heller FG, Slouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg Am, 1977, 59(2): 169-173.
14.	赵太行, 黄玉福, 吕建国, 等. 三踝骨折的手术治疗. 临床骨科杂志, 2006, 9(4): 375.
15.	Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am, 1976, 58(3): 356-357.
16.	Pflüger P, Braun KF, Mair O, et al. Current management of trimalleolar ankle fractures. EFORT Open Rev, 2021, 6(8): 692-703.
17.	Singh RA, Trickett R, Hodgson P. Early versus late surgery for closed ankle fractures. J Orthop Surg (Hong Kong), 2015, 23(3): 341-344.
18.	Schepers T, De Vries MR, Van Lieshout EM, et al. The timing of ankle fracture surgery and the effect on infectious complications: a case series and systematic review of the literature. Int Orthop, 2013, 37(3): 489-494.
19.	Naumann MG, Sigurdsen U, Utvåg SE, et al. Associations of timing of surgery with postoperative length of stay, complications, and functional outcomes 3-6 years after operative fixation of closed ankle fractures. Injury, 2017, 48(7): 1662-1669.
20.	Breederveld RS, van Straaten J, Patka P, et al. Immediate or delayed operative treatment of fractures of the ankle. Injury, 1988, 19(6): 436-438.
21.	Zídek T, Urban J, Holub K, et al. Comparison of plaster fixation and Kirschner wire transfixation as temporary fixation of displaced ankle fracture-randomized prospective study. Acta Chir Orthop Traumatol Cech, 2019, 86(2): 141-146.
22.	Kearney RS, McKeown R, Gallacher D, et al. Ankle injury rehabilitation (AIR): a feasibility randomised controlled trial comparing functional bracing to plaster cast in the treatment of adult ankle fractures. Pilot Feasibility Stud, 2019, 5: 55.
23.	Kearney RS, McKeown R, Stevens S, et al. Cast versus functional brace in the rehabilitation of patients treated for an ankle fracture: protocol for the UK study of ankle injury rehabilitation (AIR) multicentre randomised trial. BMJ Open, 2018, 8(12): e027242.
24.	邵朋, 高亮, 刘娟, 等. 跟骨牵引与石膏外固定在 Denis-Weber C 型踝关节骨折术前治疗中应用的效果比较. 中国骨与关节损伤杂志, 2020, 35(8): 804-807.
25.	邵建萍. 对跟骨牵引的再认识. 中国中医骨伤科杂志, 1991, 7(2): 56.

1. Tornetta Iii P, Court-Brown CM, Heckman JD, et al. Rockwood and Green’s fractures in adults. 8 th. Philadelphia, PA: Lippincott Williams & Wilkins, 2014.
2. Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg, 2018, 24(1): 34-39.
3. Monestier L, Riva G, Coda Zabetta L, et al. Outcome after unstable fractures of the ankle: what’s new? A systematic review. Orthop Rew (Pavia), 2022, 14(4): 35688.
4. Roberts V, Mason LW, Harrison E, et al. Does functional outcome depend on the quality of the fracture fixation? Mid to long term outcomes of ankle fractures at two university teaching hospitals. Foot Ankle Surg, 2019, 25(4): 538-541.
5. Carter TH, Mackenzie SP, Bell KR, et al. Selective fixation of the medial malleolus in unstable ankle fractures. Injury, 2019, 50(4): 983-989.
6. Hong CC, Nashi N, Prosad Roy S, et al. Impact of trimalleolar ankle fractures: how do patients fare post-operatively?. Foot Ankle Surg, 2014, 20(1): 48-51.
7. Tejwani NC, McLaurin TM, Walsh M, et al. Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury?. J Bone Joint Surg Am, 2007, 89(7): 1438-1441.
8. Tosun B, Selek O, Gok U, et al. Posterior malleolus fractures in trimalleolar ankle fractures: malleolus versus transyndesmal fixation. Indian J Orthop, 2018, 52(3): 309-314.
9. Hoelsbrekken SE, Kaul-Jensen K, Mørch T, et al. Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial. J Orthop Trauma, 2013, 27(11): 633-637.
10. Monestier L, Riva G, Coda Zabetta L, et al. Outcomes after unstable fractures of the ankle: what’s new? A systematic review. Orthop Rev (Pavia), 2022, 14(4): 35688.
11. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12. Thur CK, Edgren G, Jansson KÅ, et al. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91, 410 Swedish inpatients. Acta Orthop, 2012, 83(3): 276-281.
13. Yablon IG, Heller FG, Slouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg Am, 1977, 59(2): 169-173.
14. 赵太行, 黄玉福, 吕建国, 等. 三踝骨折的手术治疗. 临床骨科杂志, 2006, 9(4): 375.
15. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am, 1976, 58(3): 356-357.
16. Pflüger P, Braun KF, Mair O, et al. Current management of trimalleolar ankle fractures. EFORT Open Rev, 2021, 6(8): 692-703.
17. Singh RA, Trickett R, Hodgson P. Early versus late surgery for closed ankle fractures. J Orthop Surg (Hong Kong), 2015, 23(3): 341-344.
18. Schepers T, De Vries MR, Van Lieshout EM, et al. The timing of ankle fracture surgery and the effect on infectious complications: a case series and systematic review of the literature. Int Orthop, 2013, 37(3): 489-494.
19. Naumann MG, Sigurdsen U, Utvåg SE, et al. Associations of timing of surgery with postoperative length of stay, complications, and functional outcomes 3-6 years after operative fixation of closed ankle fractures. Injury, 2017, 48(7): 1662-1669.
20. Breederveld RS, van Straaten J, Patka P, et al. Immediate or delayed operative treatment of fractures of the ankle. Injury, 1988, 19(6): 436-438.
21. Zídek T, Urban J, Holub K, et al. Comparison of plaster fixation and Kirschner wire transfixation as temporary fixation of displaced ankle fracture-randomized prospective study. Acta Chir Orthop Traumatol Cech, 2019, 86(2): 141-146.
22. Kearney RS, McKeown R, Gallacher D, et al. Ankle injury rehabilitation (AIR): a feasibility randomised controlled trial comparing functional bracing to plaster cast in the treatment of adult ankle fractures. Pilot Feasibility Stud, 2019, 5: 55.
23. Kearney RS, McKeown R, Stevens S, et al. Cast versus functional brace in the rehabilitation of patients treated for an ankle fracture: protocol for the UK study of ankle injury rehabilitation (AIR) multicentre randomised trial. BMJ Open, 2018, 8(12): e027242.
24. 邵朋, 高亮, 刘娟, 等. 跟骨牵引与石膏外固定在 Denis-Weber C 型踝关节骨折术前治疗中应用的效果比较. 中国骨与关节损伤杂志, 2020, 35(8): 804-807.
25. 邵建萍. 对跟骨牵引的再认识. 中国中医骨伤科杂志, 1991, 7(2): 56.

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