Indications for screw fixation of posterior malleolas fractures / 中国组织工程研究

ABSTRACT

BACKGROUND:Posterior maleolar fractures are often accompanied by ankle joint instability,if the stability of ankle joint is not recovered,it is prone to traumatic arthritis of the ankle.However,the indications of internal fixation of posterior maleolar fractures remain controversial.OBJECTIVE:To explore the indications for internal fixation of posterior maleolar fractures by comparing the clinical effects of posterior maleolar fractures treated with internal fixation or not.METHODS:42 patients with maleolar fractures involving posterior ankle were recruited from the First Affiliated Hospital of Chongqing Medical University from January 2007 to January 2012.According to preoperative CT scans of ankle joint,42 cases were divided into the internal fixation group and the non-fixation group.27 cases in the fixation group had posterior maleolar fractures in more than 10％of the distal tibial articular surface and/or dislocation of the posterior maleolar fractures greater than 2 mm,and were treated with screws.15 cases in the non-fixation group had posterior maleolar fractures in less than 10％of the distal tibial articular surface anddislocation of the posterior maleolar fractures less than 2 mm,and were treated with non-operation.The average healing time of posterior maleolar fractures,postoperative complications,ankle-hindfoot scores of American Orthopedic Foot and Ankle Society were compared during the folow-up postoperatively.RESULTS AND CONCLUSION:Al of 42 patients with ankle fractures achieved bony union within 6 months.In the fixation group,1 case had postoperative superficial infection of the wounds in the medial ankle and lateral ankle,and the wound got healed completely with anti-infection therapy.One case in each group had postoperative superficial necrosis in the incisional edges,and got healed by dress changing.For the other cases,there was no wound infection,internal fixation loosening,breakage or failure and other adverse events during the folow-ups.Ankle functions were evaluated one year after operations according to the ankle-hindfoot score standard of American Orthopedic Foot and Ankle Society.The score of the fixation group was (83.74±10.35) points,with excelent ankle functions in 10 cases,good in 12 cases,fair in 5 cases,and no poor case,and the rate of patients achieving excelent and good ankle functions reached 82％; the score of non-fixation group was (85.60±10.40) points,with excelent ankle functions in 7 cases,good in 5 cases,fair in 3 cases and no poor case.The rate of patients achieving excelent and good ankle functions reached 80％.The ankle function evaluation results of both groups showed no statistical difference (P＞0.05).It is reasonable to consider posterior maleolar fractures is higher than 10％of the distal tibial articular surface and/or dislocation of the posterior maleolar fractures greater than 2 mm as the indications for internal fixation of posterior maleolar fractures.