[Clinical efficacy of closed reduction and percutaneous pinning in the treatment of Lauge-Hansen typeⅡankle fractures with posterior-external rotation].

Abstract

Objective: To explore clinical efficacy of closed reduction and percutaneous pinning technique in treating Lauge-Hansen typeⅡankle fractures with posterior-external rotation.

Methods: A retrospective analysis was conducted on clinical data of 106 patients with Lauge-Hansen posterior and external rotation typeⅡankle fractures who were admitted from January 2021 to February 2024. The patients were divided into closed reduction and percutaneous pinning internal fixation group (minimally invasive group) and open reduction and internal fixation (ORIF) group based on surgical methods. There were 53 patients in minimally invasive group, included 24 males and 29 females;aged from 32 to 75 years old with an average of (52.40±9.12) years old;27 patients on the left side and 26 patients on the right side. There were 53 patients in ORIF group, included 23 males and 30 females;aged from 30 to 72 years old with average of (51.72±9.65) years old;25 patients on the left side and 28 patients on the right side. Operation time, intraoperative blood loss, hospital stay, and complication rate between two groups were compared. The pain condition was evaluated by visual analogue scale (VAS) at 1, 2, 3, 7 and 30 days after operation;clinical efficacy was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Olerud-Molander ankle score (OMAS) at 3 and 6 months after operation;ankle joint range of motion at 6 months after operation was recorded and compared.

Results: Both groups of patients were successfully completed operation and followed up. The follow-up period ranged from 9 to 15 months with an average of (12.15±2.37) months. Operation time, hospital stay and intraoperative blood loss in minimally invasive group were (19.09±6.87) min, (10.19±2.91) days and (5.94±3.00) mL respectively, while those in ORIF group were (26.57±6.92) min, (12.58±3.49) days and (12.87±4.65) mL respectively;there were statistically significant differences between two groups (P<0.05). The comparison of VAS between two groups at 30 days after operation showed no statistically significant difference (P>0.05). The comparisons of AOFAS ankle-hind foot scores and OMAS scores between two groups at 3 and 6 months after operation also showed no statistically significant differences (P>0.05). There were no statistically significant differences in ankle joint flexion and extension ranges of motion between the healthy and the affected sides at 6 months after operation (P>0.05). The differences of internal and external rotation activities in minimally invasive grou were (2.60±1.52)° and(1.36±0.59)°, which were better than those of ORIF group (5.49±1.72)° and (2.57±1.37)°;the differences were statistically significant (P<0.05). The incidence of complications in minimally invasive group was 5.66%(3/53), which was lower than that in ORIF group 20.75% (11/53), and the difference was statistically significant (P<0.05). No patients of nonunion of fractures or loss of reduction occurred in either group.

Conclusion: Closed reduction and percutaneous pinning for Lauge-Hansen typeⅡankle fractures with posterior-external rotation has shorter operation time and hospital stay, less bleeding, relieve pain, improve the range of motion of ankle internal and external rotation, and reduce the occurrence of complications.