Comminuted Suprasyndesmotic Ankle Fractures Are Associated With a High Rate of Anterolateral Plafond Involvement.

IF 1.6 3区 医学 Q3 ORTHOPEDICS
Brian D Wahlig, Ankur Khanna, Bailey R MacInnis, Jonathan Copp, William W Cross, Stephen A Sems, Brandon J Yuan, Krystin A Hidden
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引用次数: 0

Abstract

Objectives: The aim of this study was to identify the rate at which the anterolateral (AL) tibial plafond is affected in comminuted suprasyndesmotic ankle fractures (OTA/AO 44C2) and to assess how its involvement affects clinical outcomes.

Methods:

Design: Retrospective review.

Setting: Level 1 Trauma Center.

Patient selection criteria: Patients with a preoperative computed tomography treated surgically for OTA/AO 44C2 fractures from January 2005 to December 2021.

Outcome measures and comparisons: The primary outcome measure was the prevalence of AL plafond impaction or a displaced Tillaux-Chaput fracture. Secondary outcome measures included reoperation rate (excluding hardware removal), rate of new-onset ankle osteoarthritis, rate of ankle osteoarthritis progression, Single Assessment Numeric Evaluation score, and the Olerud Molander Ankle Score.

Results: Fifty-three patients met inclusion criteria. The average age was 50 years (range 18-100), and 53% were female. The AL plafond was involved in 26 patients (49%), with AL plafond impaction in 11 patients (21%) and a displaced Tillaux-Chaput fragment in 15 patients (28%). Five patients (19%) received independent fixation of the AL plafond, and 3 of these patients had AL plafond impaction addressed. Thirty-eight patients (72%) had clinical follow-up of at least 6 months. Patients with AL plafond impaction had a higher rate of reoperation (excluding hardware removal) compared with those without any AL plafond involvement (hazard of reoperation = 8.3, 95% confidence interval, 1.4-15.3, P = 0.022) and a higher rate of new-onset ankle osteoarthritis (83% vs. 23%, P = 0.013). There was no difference in the rate of reoperation (11% vs. 9%, P = 0.748) or new-onset osteoarthritis (63% vs. 23%, P = 0.078) when comparing those with a displaced Tillaux-Chaput fracture to those without AL plafond involvement. There were no differences in Single Assessment Numeric Evaluation (75% vs. 78% vs. 85%, P = 0.661) or Olerud Molander Ankle Score (70 points vs. 69 points vs. 81 points, P = 0.517) scores when comparing those with AL plafond impaction, those with Tillaux-Chaput fragments, and those with no AL plafond involvement.

Conclusions: Computed tomography evaluation is recommended in patients with comminuted suprasyndesmotic fibula fractures (OTA/AO 44C2) given their high association with AL plafond impaction and Tillaux-Chaput fracture. Patients with AL plafond impaction have a higher reoperation rate and new-onset ankle osteoarthritis compared with those without AL plafond involvement.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

粉碎性无韧带上踝关节骨折与高比例的前外侧平台受累有关。
目的:本研究旨在确定粉碎性踝关节无韧带上骨折(AO/OTA 44C2)中胫骨前外侧平台的受累率,并评估其受累如何影响临床结果。方法:设计:回顾性分析。地点:一级创伤中心。患者选择标准:2005年1月至2021年12月接受AO/OTA 44C2骨折手术治疗的术前CT患者。结果测量和比较:主要结果测量是前外侧平台嵌塞或移位的Tillaux-Chaput骨折的发生率。次要结局指标包括再手术率(不包括硬体移除)、新发踝关节骨关节炎率、踝关节骨关节炎进展率、单一评估数值评估(SANE)评分和Olerud Molander踝关节评分(OMAS)。结果:53例患者符合纳入标准。平均年龄50岁(18-100岁),53%为女性。26例(49%)患者涉及前外侧平台,11例(21%)患者有前外侧平台嵌塞,15例(28%)患者有移位的Tillaux-Chaput碎片。5名患者(19%)接受了前外侧平台的独立固定,其中3名患者接受了前外侧平台嵌塞治疗。38例(72%)患者至少有6个月的临床随访。前外侧平台嵌塞患者的再手术率(不包括硬体取出)高于无前外侧平台受累者(HR = 8.3, 95% CI: 1.4-15.3, p=0.022),新发踝关节骨关节炎的发生率更高(83% vs 23%, p=0.013)。移位的Tillaux-Chaput骨折与未累及前外侧平台的患者相比,再手术率(11%对9%,p=0.748)或新发骨关节炎(63%对23%,p=0.078)无差异。与前外侧平台嵌塞、Tillaux-Chaput碎片和无前外侧平台受累的患者相比,SANE (75% vs. 78% vs. 85%, p= 0.661)或OMAS(70分vs. 69分vs. 81分,p=0.517)评分无差异。结论:考虑到粉碎性腓骨无韧带上骨折(AO/OTA 44C2)与前外侧平台嵌塞和Tillaux-Chaput骨折高度相关,建议对其进行CT评估。前外侧平台嵌塞患者的再手术率和新发踝关节骨性关节炎的发生率高于无前外侧平台受累的患者。证据等级:四级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Orthopaedic Trauma
Journal of Orthopaedic Trauma 医学-运动科学
CiteScore
3.90
自引率
8.70%
发文量
396
审稿时长
3-8 weeks
期刊介绍: Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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