Yun Gao, Yihao Sun, Zhijun Shen, Jinliang Xie, Cheng Chen, Jian Hu, Lei Wang
{"title":"影响皮隆变异性后外踝骨折预后的因素:回顾性研究。","authors":"Yun Gao, Yihao Sun, Zhijun Shen, Jinliang Xie, Cheng Chen, Jian Hu, Lei Wang","doi":"10.1053/j.jfas.2025.05.016","DOIUrl":null,"url":null,"abstract":"<p><p>Poor reduction quality in Pilon variant posterior malleolar (PVPM) fractures may lead to articular incongruity, resulting in functional impairment and eventual post-traumatic arthritis. Although intra-articular impacted fragments (IAIF) are frequently observed in PVPM fractures, the clinical necessity of IAIF reduction remains controversial, and the prognostic significance of IAIF presence or malreduction remains unclear. This retrospective study investigated prognostic factors in 64 surgically treated PVPM fractures with 24-month follow-up. Patients were divided into groups based on their reduction quality. Postoperative articular stepping and/or separation ≥ 2 mm were/was considered \"poor\" reduction, otherwise \"optimal or good\". AOFAS is the primary outcome while the VAS pain score, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) are secondary outcomes. Statistical differences of in AOFAS, SF-36 and VAS were observed between reduction quality groups with the optimal reduction showing significantly better outcomes at postoperative 24 months. Statistical difference of AOFAS, SF-36 and VAS was also found between the sex groups with female cases showing significantly poorer outcomes. Neither IAIF's presence, size, morphological difference or location affected the prognosis. Based on linear regression analysis, \"female\", \"poor reduction\" and \"syndesmotic fixation\" are categorical variables that impair the functional prognosis of PVPM fractures at postoperative 24 months. This study indicates that the reduction quality based on articular stepping and separation was positively associated with clinical outcomes in PVPM fractures at 24 months postoperatively, which is independent of IAIF. Therefore, regardless of the presence of the IAIF, the reduction quality of the articular congruity positively affects the prognosis of PVPM fracture.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors for the prognosis of pilon variant posterior malleolar fracture: A retrospective study.\",\"authors\":\"Yun Gao, Yihao Sun, Zhijun Shen, Jinliang Xie, Cheng Chen, Jian Hu, Lei Wang\",\"doi\":\"10.1053/j.jfas.2025.05.016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Poor reduction quality in Pilon variant posterior malleolar (PVPM) fractures may lead to articular incongruity, resulting in functional impairment and eventual post-traumatic arthritis. Although intra-articular impacted fragments (IAIF) are frequently observed in PVPM fractures, the clinical necessity of IAIF reduction remains controversial, and the prognostic significance of IAIF presence or malreduction remains unclear. This retrospective study investigated prognostic factors in 64 surgically treated PVPM fractures with 24-month follow-up. Patients were divided into groups based on their reduction quality. Postoperative articular stepping and/or separation ≥ 2 mm were/was considered \\\"poor\\\" reduction, otherwise \\\"optimal or good\\\". AOFAS is the primary outcome while the VAS pain score, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) are secondary outcomes. Statistical differences of in AOFAS, SF-36 and VAS were observed between reduction quality groups with the optimal reduction showing significantly better outcomes at postoperative 24 months. Statistical difference of AOFAS, SF-36 and VAS was also found between the sex groups with female cases showing significantly poorer outcomes. Neither IAIF's presence, size, morphological difference or location affected the prognosis. Based on linear regression analysis, \\\"female\\\", \\\"poor reduction\\\" and \\\"syndesmotic fixation\\\" are categorical variables that impair the functional prognosis of PVPM fractures at postoperative 24 months. This study indicates that the reduction quality based on articular stepping and separation was positively associated with clinical outcomes in PVPM fractures at 24 months postoperatively, which is independent of IAIF. Therefore, regardless of the presence of the IAIF, the reduction quality of the articular congruity positively affects the prognosis of PVPM fracture.</p>\",\"PeriodicalId\":50191,\"journal\":{\"name\":\"Journal of Foot & Ankle Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-07-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Foot & Ankle Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1053/j.jfas.2025.05.016\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Foot & Ankle Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1053/j.jfas.2025.05.016","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Factors for the prognosis of pilon variant posterior malleolar fracture: A retrospective study.
Poor reduction quality in Pilon variant posterior malleolar (PVPM) fractures may lead to articular incongruity, resulting in functional impairment and eventual post-traumatic arthritis. Although intra-articular impacted fragments (IAIF) are frequently observed in PVPM fractures, the clinical necessity of IAIF reduction remains controversial, and the prognostic significance of IAIF presence or malreduction remains unclear. This retrospective study investigated prognostic factors in 64 surgically treated PVPM fractures with 24-month follow-up. Patients were divided into groups based on their reduction quality. Postoperative articular stepping and/or separation ≥ 2 mm were/was considered "poor" reduction, otherwise "optimal or good". AOFAS is the primary outcome while the VAS pain score, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) are secondary outcomes. Statistical differences of in AOFAS, SF-36 and VAS were observed between reduction quality groups with the optimal reduction showing significantly better outcomes at postoperative 24 months. Statistical difference of AOFAS, SF-36 and VAS was also found between the sex groups with female cases showing significantly poorer outcomes. Neither IAIF's presence, size, morphological difference or location affected the prognosis. Based on linear regression analysis, "female", "poor reduction" and "syndesmotic fixation" are categorical variables that impair the functional prognosis of PVPM fractures at postoperative 24 months. This study indicates that the reduction quality based on articular stepping and separation was positively associated with clinical outcomes in PVPM fractures at 24 months postoperatively, which is independent of IAIF. Therefore, regardless of the presence of the IAIF, the reduction quality of the articular congruity positively affects the prognosis of PVPM fracture.
期刊介绍:
The Journal of Foot & Ankle Surgery is the leading source for original, clinically-focused articles on the surgical and medical management of the foot and ankle. Each bi-monthly, peer-reviewed issue addresses relevant topics to the profession, such as: adult reconstruction of the forefoot; adult reconstruction of the hindfoot and ankle; diabetes; medicine/rheumatology; pediatrics; research; sports medicine; trauma; and tumors.