Transfibular osteotomy with open reduction and fixation for treatment of old ankle fractures involving the posterior malleolus in middleaged and elderly patients
Su Yan, Li Zhendong, Xue Jianfeng, Zou Jian, Mei Guohua, Jiang Jiantao, Gu Wenqi, Chen Cheng, Shi Zhongmin.
Abstract：Objective To evaluate the clinical results of reduction and fixation via fibular osteotomy for treatment of old ankle fractures involving the posterior malleolus in middle-aged and elderly patients. Methods A retrospective case series study was made for 13 middle-aged and elderly patients with old ankle fractures involving the posterior malleolus treated from July 2013 to March 2018 in Sixth Peoples Hospital Affiliated to Shanghai Jiao Tong University. There were 2 males and 11 females, with age of 48-63 years (mean, 54.8 years). The mean surgical period was 8-18 weeks from injury (mean, 9-6 weeks). According to Haraguchi classification, all posterior malleolar fractures were type I. According to Lauge-Hansen classification, there were 2 patients with pronation-external rotation type and 11 with supination-external rotation type. All patients underwent open reduction and fixation via fibular osteotomy. Bone healing time and postoperative complications were recorded. Clinical results were assessed by visual analogue scale (VAS) score and American orthopedic foot and ankle society (AOFAS) ankle-hind score. Results All patients were followed up for average 20.3 months (range, 9-36 months). All patients had bone union, with the mean healing period of 12-15 weeks (average 14.8 weeks). No infection, implant loosening or breakage occurred after operation. X-ray film of one patient suggested mild traumatic arthritis. At the latest follow-up, VAS was improved to (1.0±0.2)points compared to pre-operative (5.3±0.6)points (P<0.05), and the AOFAS ankle-hind score was improved to (85.2±7.4)points compared to pre-operative (42.4±6.7)points (P<0.05). According to the AOFAS ankle-hind score, the results were excellent in 4 patients, good in 8, moderate in 1, with the excellent and good rate of 92%. Conclusion For old ankle fractures involving the posterior malleolus in the middle-aged and elderly patients, reduction and fixation via fibular can reduce postoperative complications, facilitate bone healing, relieve ankle pain and improve function recovery.
苏琰 李振东 薛剑锋 邹剑 梅国华 蒋剑涛 顾文奇 陈城 施忠民. 经腓骨截骨复位内固定治疗中老年累及后踝陈旧性踝关节骨折[J]. 中华创伤杂志, 2020, 36(4): 315-320.
Su Yan, Li Zhendong, Xue Jianfeng, Zou Jian, Mei Guohua, Jiang Jiantao, Gu Wenqi, Chen Cheng, Shi Zhongmin.. Transfibular osteotomy with open reduction and fixation for treatment of old ankle fractures involving the posterior malleolus in middleaged and elderly patients. CHINESE JOURNAL OF TRAUMA, 2020, 36(4): 315-320.
