Objective To evaluate the effectiveness of posterior malleolus fixation on the function of ankle in patients with ankle fracture. Methods Between June 2007 and June 2009, 110 patients with ankle fracture were treated with posteriormalleolus fixation in 59 patients (fixation group) or without fixation in 51 patients (non-fixation group). In fixation group, there were 31 males and 28 females with an average age of 62.6 years (range, 19-75 years); the causes of injury included traffic accident (20 cases), falling (18 cases), and sprain (21 cases) with a disease duration of 1-3 days (2.2 days on average); and the locations were left ankle in 32 cases and right ankle in 27 cases, including 6 cases of type I, 23 of type II, 19 of type III, and 11 of type IV according to the ankle fracture clssification. In non-fixation group, there were 38 males and 13 females with an average age of 64.5 years (range, 16-70 years); the causes of injury included traffic accident (15 cases), falling (12 cases), and sprain (24 cases) with a disease duration of 1-3 days (2.5 days on average); and the locations were left ankle in 22 cases and right ankle in 29 cases, including 8 cases of type I, 16 of type II, 19 of type III, and 8 of type IV according to the ankle fracture clssification. There was no significant difference in general data between 2 groups (P gt; 0.05). Results All patients of 2 groups achieved wound heal ing by first intention. The patients were followed up 12-18 months (16 months on average). X-ray films showed that fractures healed at 8-12 weeks (10 weeks on average) in fixation group and at 10-14 weeks (12 weeks on average) in non-fixation group. There were significant differences in the cl inical score (89.28 ± 8.62 vs. 86.88 ± 9.47, P lt; 0.05), postoperative reposition score (33.34 ± 2.15 vs. 31.24 ± 2.89, P lt; 0.05), and osteoarthritis score (13.22 ± 1.66 vs. 12.46 ± 2.03, P lt; 0.05) according to Phill i ps ankle scoring system between 2 groups at last follow-up. There was no significant difference in cl inical score of type I and II patients between 2 groups (P gt; 0.05), but significant differences were found in cl inical score and osteoarthritis score of type III and IV patients between 2 groups (P lt; 0.05). There were significant differences in the postoperative reposition score between 2 groups in all types of fractures (P lt; 0.05). Conclusion The posterior malleolus fixation may provide satisfactory cl inical functional outcomes for ankle fracture. Proper fracture classification and correct method of internal fixation are important for achieving good reduction and improving the long-term results.
Objective To evaluate the effectiveness of early internal fixation combined with free anterolateral thigh perforator flap (ALTPF) transplantation in the treatment of open ankle fracture-dislocation. Methods A retrospective analysis was performed on the clinical data of 13 patients with open ankle fracture-dislocation who were admitted and met the inclusion criteria between January 2021 and May 2024. Among them, there were 9 males and 4 females, with the ages ranging from 23 to 61 years (mean, 45.3 years). Fracture types included 5 cases of simple medial or lateral malleolar fracture-dislocation, 7 cases of bimalleolar (medial and lateral) fracture-dislocation, and 1 case of trimalleolar fracture-dislocation. Additionally, 3 cases were complicated with bone defects (1 medial malleolus defect and 2 lateral malleolus defects). All injuries were classified as type ⅢB according to the Gustilo-Anderson classification for open fractures. The size of wound defects ranged from 7 cm×5 cm to 18 cm×12 cm. The time from injury to surgery was 2-20 hours (mean, 4 hours). All patients underwent emergency thorough debridement upon admission. The fracture-dislocation was temporarily stabilized with an external fixator, and the wound was covered with antibiotic-impregnated bone cement sheets or vacuum sealing drainage. Definitive internal fixation of the fracture and free ALTPF transplantation were performed 5-7 days after the initial emergency procedure. Postoperatively, wound healing, flap survival, and fracture union were monitored. At last follow-up, clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results All 13 patients were followed up 6-24 months (mean, 8.2 months). All flaps survived completely, and all fractures achieved union, with an union time of 3-11 months (mean, 5.5 months). One patient developed a superficial infection at the wound margin, which healed after regular dressing changes and drainage. No internal fixation-related complication (e.g., deep infection, implant loosening, or secondary ankle instability) were observed. At last follow-up, the total AOFAS ankle-hindfoot score was 78.6±13.5, with 3 excellent, 7 good, 2 fair, and 1 poor cases, yielding an excellent and good rate of 76.9%. ConclusionEarly internal fixation combined with ALTPF transplantation for open ankle fracture-dislocation can shorten the treatment course and maximize the recovery of ankle joint function.
Objective To summarize the short-term effectiveness of the surgical treatment for grade III pronation-external rotation ankle fractures. Methods Between October 2011 and May 2015, 36 patients with pronation-external rotation ankle fractures (grade III) were treated with internal fixation and repair of the anterior lower tibiofibular ligament, including 21 males and 15 females with an average age of 45.2 years (range, 21-72 years). Injury was caused by sprain in 19 cases, by traffic accident in 6 cases, and by falling from height in 11 cases. All patients had closed fractures, with no blood vessel and nerve injury. The locations were the left ankle in 13 cases and the right ankle in 23 cases. The time from injury to operation was 3 to 10 days (mean, 6.5 days). At last follow-up, ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-foot score, and the improvement of pain was evaluated by visual analogue scale (VAS). Results Primary healing of incision was obtained in all patients, no incision infection and skin necrosis occurred. Twenty-eight patients were followed up 12-36 months (mean, 17.5 months). X-ray films showed bone union was achieved within 2.6-5 months (mean, 3.2 months). No fracture of internal fixation and disruption of tibiofibular diastasis occurred. At last follow-up, according to AOFAS score for ankle function evaluation, the pain score was 36.3±2.9, the function score was 44.3±3.2, the ligament condition score was 9.2±0.5, and the total score was 89.8±6.6; the results were excellent in 11 cases, good in 15 cases, and fair in 2 cases. VAS score was 1.6±0.5. The range of motion of the ankle was (13±5)° in dorsiflexion and (38±9)° in planteroflexion. Conclusion Repair of anterior tibial ligament is an effective method to treat tibiofibular diastasis injury in the surgical treatment of grade III pronation-external rotation ankle fractures, with convenient operation, and satisfactory short-term effectiveness.
ObjectiveTo compare the effectiveness of flexible fixation and rigid fixation in the treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis.MethodsA retrospective analysis was made on the clinical data of 50 patients with ankle pronation-external rotation fractures and distal tibiofibular syndesmosis treated between January 2013 and December 2015. Suture-button fixation was used in 23 patients (flexible fixation group) and cortical screw fixation in 27 patients (rigid fixation group). There was no significant difference in age, gender, weight, side, fracture type, and time from trauma to surgery between 2 groups (P>0.05). The operation time, medial clear space (MCS), tibiofibular clear space (TFCS), tibiofibular overlap (TFO), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Disability Index (FADI) score were compared between 2 groups.ResultsThe operation time was (83.0±9.1) minutes in the flexible fixation group and was (79.6±13.1) minutes in the rigid fixation group, showing no significant difference (t=1.052, P=0.265). All patients achieved healing of incision by first intention. The patients were followed up 12-20 months (mean, 14 months). The X-ray films showed good healing of fracture in 2 groups. There was no screw fracture, delayed union or nounion. The fracture healing time was (12.1±2.5) months in the flexible fixation group and was (11.3±3.2) months in the rigid fixation group, showing no significant difference between 2 groups (t=1.024, P=0.192). Reduction loss occurred after removal of screw in 2 cases of the rigid fixation group. At last follow-up, there was no significant difference in MCS, TFCS, TFO, AOFAS score and FADI score between 2 groups (P>0.05).ConclusionSuture-button fixation has similar effectiveness to screw fixation in ankle function and imaging findings, and flexible fixation has lower risk of reduction loss of distal tibiofibular syndesmosis than rigid fixation.
ObjectiveTo evaluate the difference between using and not using syndesmotic screw to treat pronation external rotation (PER) ankle fracture combined with separation of distal tibiofibular syndesmosis. MethodsBetween April 2011 and October 2014, 46 cases of PER ankle fracture combined with separation of distal tibiofibular syndesmosis were treated, and syndesmotic screw was used in 24 cases (fixation group) and syndesmotic screw was not used in 22 cases (non-fixation group). There was no significant difference in gender, age, weight, cause of injury, side, injury to operation time, and fracture type between 2 groups (P > 0.05). The time for full weight-bearing, fracture healing time, and complications were recorded after operation. Anteroposterior and lateral X-ray films were taken to measure the tibiofibular overlap (TBOL) and tibiofibular clear space (TBCS). Baird-Jackson score was used to evaluate functional recovery of the ankle. ResultsAll incision healed by first intention without complications. The cases were followed up 13-18 months (mean, 15.2 months) in 2 groups. The time for full weight-bearing was 8-12 weeks (median, 11 weeks) in fixation group, which was significantly later than that in non-fixation group (range, 6-10 weeks; median, 8 weeks) (Z=-5.049, P=0.000). X-ray examination showed reduction of separation of distal tibiofibular syndesmosis. All fractures healed. The fracture healing time was (13.83±1.37) weeks in fixation group, and was (13.91±1.31) weeks in non-fixation group, showing no significant difference (t=-0.191, P=0.945). No separation of distal tibiofibular syndesmosis, delayed union, nonunion, loosening, or breakage of fixation devices was observed in 2 groups. There was no significant difference in TBOL, TBCS, Baird-Jackson score and the excellent and good rate between 2 groups (P > 0.05). ConclusionIf the medial, lateral, and posterior structures of the ankle could be repaired according to injury, no significant influence on functional outcome of ankle or radiologic findings could be detected whether syndesmotic fixation is given or not in treating PER ankle fracture (exclude Maisonneuve fracture) combined with separation of distal tibiofibular syndesmosis.
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.
ObjectiveTo evaluate the biomechanical characteristics and effectiveness of repairing anteroinferior tibiofibular ligament and fixing the posterior malleolar fracture in reconstructing syndesmotic stability after ankle fracture of pronation-external rotation type (PER) stage IV. MethodsTwenty-four normal lower extremity cadaver specimens were collected and made into intact ankle specimens. A MTS Bionix 858 test system was used to measure the maximum rotation of the foot under a static axial load of 150 N, internal rotation torque to the tibia at a rate of 1°/second and 4 N·m torque. Then a fracture of PER stage IV model was established in each specimen. Internal fixation of lower tibiofibular ligament union was performed by screws in group A, fixation of posterior malleolar fractures in group B, fixing posterior malleolar fracture combined with repairing anteroinferior tibiofibular ligament in group C (8 specimens each group). Then the maximum rotation of the foot was measured under the same condition, and the syndesmotic stability was calculated. Between July 2009 and September 2012, 32 patients with ankle fracture of PER stage IV were treated. There were 19 males and 13 females with an average age of 35 years (range, 20-63 years). The locations were the left ankle in 14 cases and the right ankle in 18 cases. The time from injury to admission was 3.5 hours on average (range, 1-72 hours). Open reduction and plate compression internal fixation were performed in fibula, and medial malleolus was fixed by conpression screws, then anteroinferior tibiofibular ligament was mended and posterior malleolar fracture was fixed by screws. ResultsThe preservation rates of syndesmotic stability after repair were 46.2%±12.3%, 62.6%±10.7%,and 66.5%±12.6% in groups A, B,and C, respectively; groups B and C were significantly superior to group A (P<0.05),but no significant difference was found between groups B and C (P>0.05). All patients achieved wound healing by first intention, and were followed up 12-24 months (mean,15 months). All fractures healed,with an average healing time of 11.2 weeks (range, 10-14 weeks) on the X-ray films. No seperation of inferior tibiofibular syndesmosis was observed during the follow-up period. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 88.4 on average (range, 61-98) at last follow-up; the results were excellent in 13 cases,good in 15 cases, and fair in 4 cases, with an excellent and good rate of 87.5%. ConclusionIn patients with ankle fracture of PER stage IV, a combination of fixing the posterior malleolar fracture and repairing anteroinferior tibiofibular ligament can reconstruct syndesmotic stability effectively.
ObjectiveTo investigate the safety and effectiveness of anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures.MethodsThe clinical data of 53 patients with pronation ankle fractures between April 2015 and October 2016, who were treated with anatomical approach osteoligaments repair technique applied for fracture reduction and internal fixation, were analysed retrospectively. There were 35 males and 18 females with an average age of 33.1 years (range, 18-60 years). The cause of injury included traffic accidents in 27 cases, tumbling in 5 cases, fall from height in 4 cases, twisted injury in 6 cases, sports injuries in 4 cases, and bruises in 7 cases. According to Lauge-Hansen classification, there were 44 cases of pronation external rotation stage Ⅳ and 9 cases of pronation abduction stage Ⅲ. The interval between injury and operation was 4-10 days (mean, 7 days). Postoperative pain and function of ankles were assessed by American Orthopedic Foot and Ankle Score (AOFAS) and visual analogue pain scale (VAS) score. The medial clear space (MCS), tibiofibular clear space (TFCS), distal fibular tip to lateral process of talus (DFTL), the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle were measured by X-ray films and CT of bilateral ankle joints.ResultsThe tourniquet application time was 55-90 minutes (mean, 72.5 minutes); the frequency of fluoroscopy was 5-13 times (mean, 8.9 times). All incisions healed by first intention and no infection, deep vein thrombosis occurred after operation. All patients were followed up 28-48 months (mean, 36 months). There was no significant difference in postoperative MCS, TFCS, DFTL, the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle between bilateral ankle joints (P>0.05). At last follow-up, no ankle instability occurred and the degenerative changes of ankle joints (Kellgren-Lawrence grading Ⅱ) occurred in 5 cases. The average AOFAS score of the ankle joint was 90.84 (range, 85-95); mean VAS score was 1.23 (range, 0-5). The average dorsiflexion and plantar flexion of ankle joints was 20.24° (range, 15-25°) and 42.56° (range, 30-50°), respectively.ConclusionAnatomical approach osteoligaments repair technique in treatment of pronation ankle fractures can expose the talocrural joint and lower tibiofibular syndesmosis clearly, repair the osteoligaments injury directly, and assist the syndesmosis and talocrural joint reduction, and decline the incidence of ankle degeneration.
ObjectiveTo systematically review the efficacy of percutaneous cannulated screw (PCS) versus plate fixation (PF) in the treatment of ankle fractures. MethodsThe Cochrane Library (Issue 5, 2014), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched up to May 28th 2014, for studies concerning the efficacy of percutaneous cannulated screw versus plate fixation for ankle fractures. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. Result A total of 10 studies (3 RCTs and 7 CCTs) involving 627 patients were included. The results of meta-analysis showed that:compared with the PF group, the PCS group was superior in time of the operation (RCT:MD=-6.78, 95%CI -11.95 to -1.60, P=0.01; CCT:MD=-9.76, 95%CI -13.68 to -5.84, P<0.000 01), blood loss during the operation (RCT:MD=-36.14, 95%CI -40.02 to -32.17, P<0.000 01; CCT:MD=-34.80, 95%CI -37.78 to -31.81, P<0.000 01) and the time of the fracture healing (RCT:MD=-1.16, 95%CI -1.51 to -0.81, P<0.000 01; CCT:MD=-1.55, 95%CI -2.97 to -0.13, P=0.03); However, there were no statistical differences between the two groups in complication rate (CCT:OR=0.48, 95%CI 0.08 to 2.81, P=0.41), AOFAS score excellent rate (RCT:OR=2.11, 95%CI 0.81 to 5.49, P=0.12; CCT:OR=1.58, 95%CI 0.75 to 3.30, P=0.23), and postoperative malleolus pain rate (CCT:OR=0.68, 95%CI 0.00 to 148.82, P=0.89). ConclusionCurrent evidence shows that PCS is superior to PF in shorting time of the operation, reducing blood loss during the operation, and shorting time of the fracture healing. However, the complication rate, AOFAS score excellent rate, and postoperative malleolus pain rate are similar for each operation. Due to the quality limitation of the CCTs, the conclusion are needed to be verified by more high quality RCTs in future.
Objective To explore the choice of weight-bearing time and the clinical effect of different starting time of weight bearing after internal fixation of ankle fracture. Methods A total of 48 patients undergoing routine internal fixation for closed ankle fractures were selected. They were randomly divided into a tiral group and a control group, with 24 patients in each group. The patients in the tiral group started weight bearing one week after operation, while the ones in the control group did that four weeks after operation. The two groups were followed up for evaluation according to the modified Weber scale 2, 4, 8, and 12 weeks after operation, and the scale scores were presented as median (lower quartile, upper quartile). Results The fractures recovered well and no complications occurred. Two weeks after operation, the pain score [3.00 (2.00, 3.00) vs. 2.00 (1.00, 2.00)] and swelling score [3.00 (3.00, 4.00) vs. 2.00 (1.00, 2.00)] were significantly different between the trial group and the control group (P<0.05), but there was no significant difference in other indexes of the modified Weber scale between the two groups (P>0.05). Four weeks after operation, the swelling score was significantly different between the two groups [2.00 (2.00, 3.00) vs. 1.00 (0.00, 1.00), P<0.05], but there was no significant difference in other indexes of the modified Weber scale between the two groups (P>0.05). Eight and twelve weeks after operation, there was no significant difference in any of the modified Weber scale scores between the two groups (P>0.05). Conclusions It is feasible to start weight bearing one week after internal fixation of ankle fracture. Although swelling and pain will occur, it does not affect fracture healing or functional recovery.