The Radiographic and Functional Outcome of Bimalleolar Fractures Treated by Open Reduction and Internal Fixation with Screws/Tbw and Plates: A Prospective Study

D. Patel
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Abstract

Background: Bimalleolar fractures are one of the most common fractures in orthopedic traumatology. As with all intra articular fracture, malleolar fracture necessitate accurate reduction and stable internal fixation. When malleolar fractures are not reduced accurately they may lead to post traumatic painful restriction of motion or osteoarthritis or both. To study the functional and radiological outcome and result of surgical treatment of bimalleolar fractures and to know the complication of open reduction internal fixation in bimalleolar fractures. Materials A Prospective review was conducted for 60 patients between January 2018 to December 2019 with closed bimalleolar fracture. Open reduction and internal fixation was done with specific modalities. Patients were evaluated with Subjective and objective assessments of the patients’ ankles were done using a modification of the scoring system proposed by Olerud and Molander and radiologically by Kristenson criteria. The functional and radiographic outcome of ORIF and advantages of the procedures were recorded. Functional and radiographic evaluations were performed at immediate post op, 6 weeks, 3 months and 6 months, 1 year after surgery. At each follow up, patients were assessed for syndesmotic reduction, loss of fixation, and implant failure and any arthritis changes. The reduction in quality was evaluated on immediate postoperative radiography. Results: In the present study of 60 patients with bimalleolar fractures treated by open reduction and internal fixation. Excellent results were achieved in 49 (81.7%) patients, good in 9 (15%), and poor in 2 (3.3%) patient. The patient with poor result had mild pain with activities of daily living, diminution in the abilities to run and to do work, reduced motion of ankle and narrowing of joint space. Conclusions: Understanding the mechanism of injury is essential for good reduction and internal fixation. The fibular length has to be maintained for lateral stability of the ankle. Anatomical reduction is essential in all intra articular fractures more so if a weight bearing joint like ankle joint is involved. Our series encourage operative intervention within 48 hours in the management of bimalleolar fractures of the ankle as the key for high percentage of good result.
切开复位内固定螺钉/Tbw和钢板治疗双踝骨折的影像学和功能预后:一项前瞻性研究
背景:双踝骨折是骨科最常见的骨折之一。与所有关节内骨折一样,踝关节骨折需要精确的复位和稳定的内固定。当踝关节骨折没有准确复位时,可能会导致创伤后疼痛的运动受限或骨关节炎,或两者兼而有之。研究双踝骨折手术治疗的功能、放射学结果和结果,了解双踝骨折切开复位内固定术的并发症。材料对2018年1月至2019年12月期间60名闭合性双踝骨折患者进行了前瞻性回顾。采用特定方式进行切开复位和内固定。对患者进行主观和客观评估。使用Olerud和Molander提出的评分系统修改和Kristenson标准进行放射学评估。记录ORIF的功能和放射学结果以及手术的优点。术后即刻、术后6周、3个月和6个月、1年进行功能和放射学评估。在每次随访中,对患者的联合韧带复位、固定损失、植入失败和任何关节炎变化进行评估。术后立即放射线照相术评估质量下降。结果:本研究采用开放复位内固定治疗双踝骨折60例。优良结果49例(81.7%),优良9例(15%),差2例(3.3%)。结果不佳的患者有轻微的疼痛,包括日常生活活动、跑步和工作能力下降、脚踝活动减少和关节间隙变窄。结论:了解损伤机制对于良好的复位和内固定至关重要。为了脚踝的横向稳定性,必须保持腓骨的长度。解剖复位在所有关节内骨折中都是至关重要的,尤其是在涉及踝关节等承重关节的情况下。我们的系列鼓励在48小时内进行手术干预,以治疗踝关节双踝骨折,这是获得高比例良好结果的关键。
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