The hyperplantarflexion ankle fracture variant / 中华创伤骨科杂志

ABSTRACT

Objective To investigate the characteristics,trauma mechanism and treatment of the hyperplantarflexion ankle fracture variant.Methods Between January 2013 and June 2015,125 consecutive patients with ankle fracture received operative treatment.In 18 of them,the ankle joint had been subjected to excessive violence of plantarflexion.They were 6 males and 12 females,aged from 15 to 67 years (average,47.6 years).Their pre-operative ankle radiographs showed sagittal ankle instability and posterior ankle dislocation or subluxation.The injury was complicated with medial malleolus fracture and fibular fracture.Posterolateral approach or posterolateral and posteromedial approach was adopted to treat the patients.Lag screws and anti-glide plates were applied.Results All the 18 patients were followed up for 10 to 25 months (average,16.8 months).All their fractures healed after 11 to 16 weeks (average,13 weeks).Superficial skin necrosis occurred in one patient undergoing dual-plate fixation of the dual malleoli but responded to change of dressing 3 weeks later.No screw loosening,fixation breakage or failure,nonunion or malunion happened.Their final follow-ups showed an average American Orthopedic Foot Ankle Society score of 94.8 ponits (from 76 to 100 points),yielding 13 excellent and 5 good cases (an excellent to good rate of 100％).Conclusions The hyperplantarflextion ankle fracture variant is caused by excessive violence of planter flexion to the ankle joint,with the force on the sagittal plane going from anteriorly to posteriorly,resulting in posterior talar displacement.Its treatment should vary from that for other ankle fractures because it has its own characteristics.Appropriate treatment may lead to satisfactory outcomes.