ABSTRACT
Objective To evaluate the clinical significance of anatomic reduction and internal fixation of posterior malleolar fracture in ankle fracture surgical treatment. Methods Fifty-four patients with posterior malleolar fracture were treated with anatomic reduction and internal fixation from March 2005 to June 2010. The patients groups consisted of 36 males and 18 females. According to CT scan classification,the group was made up of 36 type Ⅰ cases, 10 type Ⅱ and 8 type Ⅲ cases. All patients were evaluated with modified Baird-Jackson scoring system. The relationship between final result and fracture pattern , fixation methods, the time of exercise initiation fitted operation were analyzed respectively. Results The followedup period varied from 6 months to 36 months, with an average of 18 months. The number of patients whose result was excellent, good, fair and poor was respective 29,18 ,5 and 2. The total percent age of good to excellent clinical result was 87. 03%. There were 4 patients who had only slight pain after long time walking ,the remainder patients were completed with no pain. Conclusion Operative treatment may provide satisfactory fracture anatomic reduction and internal fixation for posterior malleolar fracture. Correct fracture pattern estimation and proper internal fixation are important to achieve and improve reduction quality, and to ameliorate better long term results.
ABSTRACT
PURPOSE: To review the results and factors affecting the surgical treatment of transverse acetabular fractures. MATERIALS AND METHODS: Among 15 cases of transverse fractures with an average follow-up period of 43 months (mean age, 46.6 years), there were 8 cases with and 7 cases without posterior wall fractures. Seven cases included those with a comminution of the weight-bearing dome. The post-operative radiographic results were evaluated using Matta's criteria. The final clinical results were evaluated using a modified Merle d'Aubigne scoring system. RESULTS: All the fractures united. The average time for fracture healing was 17.5 weeks. The post-operative radiology results revealed 6 cases with an anatomic reduction, 5 cases with an imperfect reduction, and 4 cases with a poor reduction. The clinical results showed nine cases with satisfactory results but 6 cases with unsatisfactory results. Regarding complications, there were 4 cases with traumatic osteoarthritis and 3 cases with heterotropic ossification. The cases of an anatomic reduction showed a higher rate of satisfactory results. The comminution of the transverse fracture appeared to have an adverse influence on the radiological results after surgery, and also appeared to correlate with the development of traumatic arthritis. CONCLUSION: Transverse acetabular fractures, if not reduced anatomically, may have a tendency toward traumatic osteoarthritis and a poor clinical outcome. Comminution of the dome may produce a poor outcome.
Subject(s)
Acetabulum , Arthritis , Follow-Up Studies , Fracture Healing , Osteoarthritis , Weight-BearingABSTRACT
PURPOSE: To analyze the clinical and radiological feature of Os subfibulare and to evaluate the results after anatomical reduction and internal fixation with bone graft for Os subfibulare. MATERIALS AND METHODS: Forty-two cases, which underwent anatomic reduction and bone graft for Os subfibulare from October 1998 to September 2004 were reviewed. We analysed preopertive symptoms and onset of symptoms and radiologically measured the size and amounts of displacement of Os subfibulare under the inversion stress. Postoperatively we evaluated the clinical results measured by Hasegawa method and evidence of union. RESULTS: Preoperatively there were only pain around the lateral malleolus in 16 cases, only instability of ankle joint in 3 cases, and pain and instability in 23 cases. The age of symptom onset averaged 23 years(range, 13-38 years). Radiographically Os sufibulare anteriorly located from lateral malleolus were in 40 cases, posteriorly situated in 2 cases. The size of Os subfibulare ranged from 1 x 4 mm to 8 x 17 mm. In 22 cases of inversion stress view, displacement of the Os sbufibulare averaged 1.5+/-1.1 mm (0 to 5 mm). The postoperative clinical results were excellent in 41 cases, poor in 1 case. There were complications of 1 case of irritation of sural nerve, 1 case of nonunion. CONCLUSION: Anatomic reduction and bone graft is effective treatment method for symptomatic Os subfibulare.
Subject(s)
Ankle Joint , Sural Nerve , TransplantsABSTRACT
PURPOSE: To analyze the clinical and radiological feature of Os subfibulare and to evaluate the results after anatomical reduction and internal fixation with bone graft for Os subfibulare. MATERIALS AND METHODS: Forty-two cases, which underwent anatomic reduction and bone graft for Os subfibulare from October 1998 to September 2004 were reviewed. We analysed preopertive symptoms and onset of symptoms and radiologically measured the size and amounts of displacement of Os subfibulare under the inversion stress. Postoperatively we evaluated the clinical results measured by Hasegawa method and evidence of union. RESULTS: Preoperatively there were only pain around the lateral malleolus in 16 cases, only instability of ankle joint in 3 cases, and pain and instability in 23 cases. The age of symptom onset averaged 23 years(range, 13-38 years). Radiographically Os sufibulare anteriorly located from lateral malleolus were in 40 cases, posteriorly situated in 2 cases. The size of Os subfibulare ranged from 1 x 4 mm to 8 x 17 mm. In 22 cases of inversion stress view, displacement of the Os sbufibulare averaged 1.5+/-1.1 mm (0 to 5 mm). The postoperative clinical results were excellent in 41 cases, poor in 1 case. There were complications of 1 case of irritation of sural nerve, 1 case of nonunion. CONCLUSION: Anatomic reduction and bone graft is effective treatment method for symptomatic Os subfibulare.
Subject(s)
Ankle Joint , Sural Nerve , TransplantsABSTRACT
Acetabular fractures are relatively uncommon, but when they occur they often result in permanent disability due to management difficulties. Undisplaced acetabular fractures have a good prognosis but major displaced acetabular fractures have always given rise to difficulty and concern during treatment and have a variable prognosis in different reports. In order to restore excellant function to a displaced acetabular fracture, anatomic open reduction and secure internal fixation followed by early mobilization are neccessary. And in order to approach fracture of acetabulm safely and with maximum ease, it is neccessary to understand the pathologic anatomy. The authors studied the sex and age distribution, clssification according to roentgenographic findings, associated injuries and methods of treatment of 49 patients who were admitted to the department of orthopedic surgery of our hospital from January, 1976 to June, 1981 under the diagnosis of acetabular fracture. The results of treatment of 31 patients who were followedup over a 6month period were as follows: 1. The mean age was 37 years, the range being from 17 to 71. 2. The most common cause of injury was traffic accidents (38 cases: 77.6%) which was followed by falls from heights (5 cases;10.2%). 3. Thirty cases were treated by conservative mea ures and 19 by surgery. The results were as follows: Excllent-10(32.3%), Good-14 (45.2%), Fair-6(19.3%), Poor-1 (3.2%), 4. The one case that had a poor result was a “T” shaped fracture with a central dislocation, which was impossible to reduce surgically due to severe comminution. 5. If the grossly displaced fragments are present they should be reduced and fixed surgically. But only if anatomical reduction and secure internal fixation is possible, surgery should be done. With a severely comminuted fracture, medial wall fracture, or central fracture-dislocation, surgical treatment is difficult therefore conservative treatment is better. 6. It is of great help to have various methods of roentgenography, conventional tomography, and computed axial tomographic scan in order to understand the pathologic anatomy of complicated acetabular fractures. 7. If surgery is attempted, it is essential to achieve an anatomic reduction and firm fixation by fully understanding the pathologic anatomy and by choosing an appropriate approach and fixative device.