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  • Title: [Comparison of the effectiveness of the posterior malleolus fixed or not on treatment of different Haraguchi's classification of posterior malleolus fractures].
    Author: Chen F, An Z, Zhou F, Fan J, Gao W, Chen Z.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Jun 15; 35(6):722-728. PubMed ID: 34142499.
    Abstract:
    OBJECTIVE: To investigate the effectiveness of fixation the posterior malleolus or not to treat different Haraguchi's classification of posterior malleolus fractures. METHODS: The clinical data of 86 trimalleolar fracture patients who were admitted between January 2015 and September 2019 and met the selection criteria were retrospectively reviewed. There were 29 males and 57 females; the age ranged from 26 to 82 years with a mean age of 55.2 years. According to Haraguchi's classification, 38 patients were in type Ⅰ group, 30 patients in type Ⅱ group, and 18 patients in type Ⅲ group. There was no significant difference in the general data such as gender, age, and fracture location among the 3 groups ( P>0.05). The fixation of the posterior malleolus was performed in 23, 21, and 5 patients in type Ⅰ, Ⅱ, and Ⅲ groups, respectively. The operation time, fracture healing time, full weight-bearing time, postoperative joint flatness, and joint degeneration degree of the patients in each group were recorded and compared. The American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was used to evaluate ankle function, including pain, quality of daily life, joint range of motion, and joint stability. The AOFAS scores were compared between fixation and non-fixation groups in each group. RESULTS: The procedure was successfully completed by all patients in each group, and there was no significant difference in operation time ( F=3.677, P=0.159). All patients were followed up 12-36 months with a mean time of 16.8 months. At last follow-up, 6 patients were found to have suboptimal ankle planarity, including 2 patients (5.3%) in the type Ⅰ group and 4 patients (13.3%) in the type Ⅱ group, with no significant difference between groups ( χ 2=6.566, P=0.161). The ankle joints of all the patients in each group showed mild degeneration; the fractures all healed well and no delayed union or nonunion occurred. There was no significant difference in the fracture healing time and full weight-bearing time between groups ( P>0.05). No complications such as incision infection, fracture displacement, or plate screw loosening and fracture occurred during follow-up. At last follow-up, the total scores and pain scores of the AOFAS scores in the type Ⅱ group were significantly lower than those in the type Ⅰand Ⅲ groups ( P<0.05), there was no significant difference between groups in the scores for the quality of daily life, joint range of motion, and joint stability between groups ( P>0.05). There was no significant difference in any of the scores between the unfixed and fixed groups, except for the pain and quality of daily life scores, which were significantly lower ( P<0.05) in the unfixed group of type Ⅱ group than the fixed group. CONCLUSION: Haraguchi type Ⅱ posterior malleolus fractures have a worse prognosis than types Ⅰ and Ⅲ fractures, especially in terms of postoperative pain, which can be significantly improved by fixing the posterior malleolus; the presence or absence of posterior malleolus fixation in types Ⅰ and Ⅲ has less influence on prognosis. 目的: 探讨固定后踝与否对不同 Haraguchi 分型后踝骨折临床疗效的影响。. 方法: 回顾分析 2015 年 1 月—2019 年 9 月收治且符合选择标准的 86 例三踝骨折患者临床资料。男 29 例，女 57 例；年龄 26～82 岁，平均 55.2 岁。按照 Haraguchi 分型进行分组，其中Ⅰ型组 38 例、Ⅱ型组 30 例、Ⅲ型组 18 例。3 组患者性别、年龄、骨折侧别等一般资料比较差异无统计学意义（ P>0.05）。术中Ⅰ、Ⅱ、Ⅲ型组分别行后踝固定 23、21、5 例。记录并比较各分型组患者手术时间、骨折愈合时间、完全负重时间、术后关节平整度、关节退变程度。采用美国矫形足踝协会（AOFAS）踝与后足评分评价患者踝关节功能，包括疼痛、日常生活质量、关节活动度和关节稳定性 4 个方面。比较各分型组内后踝固定组与未固定组 AOFAS 踝与后足评分差异。. 结果: 各组患者均顺利完成手术，手术时间比较差异无统计学意义（ F=3.677， P=0.159）。患者均获随访，随访时间 12～36 个月，平均 16.8 个月。末次随访时 6 例患者踝关节平整度欠佳，其中Ⅰ型组 2 例（5.3%）、Ⅱ型组 4 例（13.3%），各组间关节平整度比较差异无统计学意义（ χ 2=6.566， P=0.161）。各组患者踝关节均呈轻度退变；骨折均愈合良好，无骨折延迟愈合或不愈合发生，各组骨折愈合时间及完全负重时间比较差异均无统计学意义（ P>0.05）。随访期间无切口感染、骨折移位及钢板螺钉松动、断裂等并发症发生。末次随访时，Ⅱ型组 AOFAS 踝与后足评分的总分和疼痛评分显著低于Ⅰ型组和Ⅲ型组（ P<0.05），Ⅰ型组和Ⅲ型组间比较差异无统计学意义（ P>0.05）；各组日常生活质量、关节活动度及关节稳定性评分比较差异均无统计学意义（ P>0.05）。除Ⅱ型组内未固定组疼痛和日常生活质量评分显著低于固定组（ P<0.05）外，其余各型未固定组与固定组间比较各评分差异均无统计学意义（ P>0.05）。. 结论: HaraguchiⅡ型后踝骨折较Ⅰ型和Ⅲ型预后更差，尤其在术后疼痛方面，后踝切开复位内固定能显著改善其预后；Ⅰ型和Ⅲ型后踝固定与否对预后影响较小。.
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