Surgical treatment of the pronation and supination eversion (external rotation) trimalleolar fractures
- VernacularTitle:旋前、后外旋型三踝骨折的手术治疗
- Author:
Qiu ZHAO
;
Pei WANG
;
Xinlong MA
- Publication Type:Journal Article
- Keywords:
Ankle joint;
Fracture fixation, internal;
Fractures
- From:
Chinese Journal of Orthopaedics
2001;0(01):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the surgical techniques of open reduction and internal fixation and its clinical results of trimalleolar fractures retrospectively. Methods Between March 1996 and October 2002, 48 consecutive patients, including 27 males and 21 females with an average age of 42.8 years, were treated for trimalleolar fractures. According to the system of Lauge-Hansen, the fractures were classified as pronation-external rotation(grade Ⅳ) injury in 20 cases, and supination-external rotation(grade Ⅳ) in 28 cases. The time from injury to operation was from 2 hours to 21 days. The operation was delayed due to associated injury, skin conditions and so on, and then the patients were manipulated primarily and immobilized with a posterior plaster splint. The medial, lateral and posterior malleolus were exposed by anteromedial and Gatellier-Chastang approaches. The reduction and internal fixation started with the posterior, then the medial and the lateral malleolus and distal tibiofibular syndesmosis in sequence. The ankles were immobilized with plaster in neutral position and elevated. All patients were assessed with Baird and Jackson ankle scoring system based on pain, instability, walking ability, movement and radiological manifestations. Results The follow-up period varied from 6 to 36 months with an average of 13 months. The rates of clinical result were excellent in 26, good in 15, fair in 5 and poor in 2 respectively. The total rate of good to excellent results was 85.4%. There were no local complication, malunion and nonunion of the fractures and the deformity of the ankle. However, the inserted screw to distal tibiofibular syndesmosis was broken in one case. Conclusion Trimalleolar fractures require open reduction and internal fixation more often, especially while the fragment of posterior malleous is so large that it should be anatomically reduced and immobilized with internal fixation. It can ensure anatomical joint restoration and union for the ankle trimalleolar fractures, only by achieving most satisfied kinematics of the ankle joint.
