旋后内收2期伴外踝横向骨折及距腓骨前韧带断裂:1例报告及文献复习。

IF 1.6 4区 医学 Q2 SURGERY
Frontiers in Surgery Pub Date : 2025-09-22 eCollection Date: 2025-01-01 DOI:10.3389/fsurg.2025.1658026
Jingxuan Wang, Kangyong Yang, Zhenjiang Liu, Ke Jie, Biqing Huang, Shiheng Wang, Zhihong Mo, Yunxuan Zou
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引用次数: 0

摘要

背景:旋后内收(SAD)型踝关节骨折发生于踝关节处于旋后位时受到内翻力的作用,导致外踝横向骨折或外侧韧带损伤,常伴有内踝垂直骨折。与典型的SAD不同,外踝横向骨折合并距腓骨前韧带(ATFL)断裂的同时发生并不常见,文献中尚未报道;这种损伤在临床实践中经常被忽视,从而影响临床医生的治疗决策和踝关节稳定性和功能的恢复。病例介绍:本报告描述了一例亚洲成年女性患者,因漏步导致左脚踝受伤,导致肿胀和疼痛。最初诊断为左双踝骨折(SAD 2期)。手术中,在稳定内侧和外侧踝后,透视显示距骨无法复位。扩大切口确定ATFL破裂,随后使用Broström-Gould技术修复。修复后的x线检查证实距骨复位满意,踝关节位置正确。固定两周后,患者开始逐渐进行康复训练。在18个月的随访中,患者踝关节功能良好,达到美国骨科足踝协会踝关节-后足量表100分。结论:总结1例SAD 2期踝关节骨折并发ATFL隐匿性损伤的临床诊治经验,提高对同类损伤的认识,防止漏诊。我们强调,对于固定后出现不明原因距骨倾斜的SAD 2期骨折,临床医生应怀疑并评估隐匿性ATFL损伤,以避免漏诊并优化治疗决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Supination adduction stage 2 associated with transverse fracture of the lateral malleolus and rupture of the anterior talofibular ligament: a case report and literature review.

Supination adduction stage 2 associated with transverse fracture of the lateral malleolus and rupture of the anterior talofibular ligament: a case report and literature review.

Supination adduction stage 2 associated with transverse fracture of the lateral malleolus and rupture of the anterior talofibular ligament: a case report and literature review.

Background: Supination-adduction (SAD) type ankle fractures occur when the ankle is subjected to inversion forces while in a supinated position, leading to transverse fractures of the lateral malleolus or lateral ligament injuries, often accompanied by vertical fractures of the medial malleolus. Unlike the typical SAD pattern, the concurrent occurrence of a transverse lateral malleolus fracture combined with rupture of the Anterior Talofibular Ligament (ATFL) is uncommon and has not been reported in the literature; such injuries are frequently missed in clinical practice, which in turn affects clinicians' treatment decisions and the recovery of ankle joint stability and function.

Case presentation: This report describes a case of an adult Asian female patient who sustained a left ankle injury due to a missed step, resulting in swelling and pain. The initial diagnosis was a left double ankle fracture (SAD stage 2). During surgery, after stabilizing the medial and lateral malleoli, fluoroscopy revealed that the talus could not be reduced. An extended incision identified the ATFL rupture, which was subsequently repaired using the Broström-Gould technique. Post-repair fluoroscopy confirmed satisfactory reduction of the talus and proper alignment of the ankle joint. After two weeks of cast immobilization, the patient began gradual rehabilitation exercises. At the 18-month follow-up, the patient exhibited good ankle function, achieving an American Orthopaedic Foot and Ankle Society Ankle - Hindfoot Scale of 100.

Conclusion: This report shares the clinical experience in diagnosing and treating occult injuries of the ATFL in a case of SAD stage 2 ankle fracture to enhance awareness and prevent missed diagnoses in similar injuries. We emphasize that in SAD stage 2 fractures showing unexplained talar tilt after fixation, clinicians should suspect and evaluate for occult ATFL injury to avoid missed diagnoses and optimize treatment decisions.

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来源期刊
Frontiers in Surgery
Frontiers in Surgery Medicine-Surgery
CiteScore
1.90
自引率
11.10%
发文量
1872
审稿时长
12 weeks
期刊介绍: Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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