RESUMEN
Objective To evaluate the effect of double-plate treatment on grade Ⅱsupination adduction ankle frac? tures with impaction of tibial plafond. Methods A total of 17 patients of gradeⅡsupination adduction ankle fractures with impaction of tibial plafond were treated surgically in our hospital. Anteromedial approach to the medial malleolus was taken to expose the tibial plafond and the vertical medial malleolus fractures. One distal radius plate was placed on the anteromei?dal tibial plafond, and another buttress plate was placed on the medial malleolus. Bone grafting was used to restore the height of the collapsed tibia. Lateral malleolus fractures were treated with reconstruction plate. The fracture union after operation was detected by X-ray examination. American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score was used to assess the ankle function. Results Sixteen of 17 patients were followed up postoperatively for a mean period of 2.6 ± 0.9 years. CT cross-sectional study found that the collapsed articular surface of 12 (70.6%) patients was mainly located in the an?teromedial one-fourth area, with the worst at anterior margin. Bony fusion was achieved in all patients after an average peri?od of 2.9±0.5 months. No internal fixation loosening or fracture redisplacement was found by X-ray. The average range of an?kle joint activity was 16.4°±2.8° for dorsiflexion, and was 39.2°±5.3° for plantarflexion. According to AOFAS ankle hindfoot scale, ankle function was excellent in 14 patients and good in 2, with excellence rate of 100%. Conclusion The application of double-plate fixation to treat gradeⅡsupination adduction ankle fractures with impaction of tibial plafond can play a key role in reducing fracture redisplacement and osteoarthritis.
RESUMEN
Objective To explore the treatment strategies for grade Ⅱ supination adduction ankle fracture. Methods From March 2003 to September 2008, 32 patients with grade Ⅱ supination adduction ankle fractures were treated surgically. There were 21 males and 11 females, at a mean age of 44.5 years (range, 21-76 years). Three patients had open ankle fractures. Anteromedial approach to the medial malleolus was taken to expose the vertical medial malleolus fractures and tibial plafond for exploring damage to distal articular surface of the tibia and that to cartilage of the talus. Open reduction and internal fixation with impaction of the articular fragment and possible bone grafting were applied to restore the height of the collapsed tibia. Medial mallcolus fractures were anatomically reduced and the intra-articular cartilage debris removed under direct vision. Repair of the lateral ligament injuries was decided acoording to the stability of the ligament. Different internal fixation was chosen according to fracture displacement of the block size and degree of lateral malleolus fractures. Fracture union, internal fixation and osteoarthritis were detected by X-ray examination. The range of ankle motion was measured. Maryland foot score was taken to assess the ankle function.Results Twenty-three patients were followed up postoperatively for a mean period of 27.9 months ( range, 6-47 months). Two prominent screws were removed from one patient five months after operation because of loosening. Bony fusion was achieved in all patients after an average period of 2.9 months ( range, 2.3-5.1 months). X-ray examination revealed no other internal fixation loosening or osteoarthritis. The average range of motion was 13 degrees of dorsiflexion (range, 6-17 degrees) and 36 degrees of plantarflexion (range, 27-46 degrees). According to Maryland foot score, ankle function was excellent in 19 patients and good in four, with excellence rate of 100%.Conclusions Understanding injury mechanism of supination adduction ankle fracture, strengthening the diagnosis and treatment of damage of tibial plafond articular surface height, cartilage and talar articular surface cartilage can effectively reduce the incidence of complications such as osteoarthritis. Anteromedial incision allows excellent exposure of the medial tibial plafond for clearance of intra-articular cartilage pieces, recovery of distal tibial articular surface height and placement of internal fixation.