Abstract：Objective To investigate the guidance of three-column theory in decision-making of ankle joint fracture combined with syndesmosis injury and its result. Methods Fifty-four patients(43 males and 11 females) of ankle joint fracture combined with inferior tibiofibular syndesmosis injury classified by three-column theory and treated by open reduction internal fixation(ORIF)were reviewed from June 2008 to May 2014. The mean age of the patients was 36.7 years old(ranged from 21 to 58 years old). Among all the ankle joint fracture combined with inferior tibiofibular syndesmosis separation, three columns were involved, the lateral column injury in 54, middle column ligament injury in 26, middle column avulsion fracture in 28, the inner side column ligament injury in 31, medial column fracture in 23. Fifty-four patients were perfamed internal fixation according to different damage columns, including 26 patients with two columns fixation and 28 patients with three columns fixation. Visual analogue scale(VAS) pain scores were recorded at 6 months after surgery. The function of ankle joint was assessed by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score system. Imaging Results were evaluated using modified Baird and Jackson evaluation criteria after fracture reduction and fixation. Results Fifty-four patients had been followed up. The average follow-up time was 21 months ranging from 6.0 to 48.0 months. The average healing time was 13.6 weeks ranging from 11.0 to 15.0 weeks. The pain VAS score ranged from 0 to 6 (mean 1.4). Postoperative follow-up of ankle function, ankle hind foot score from 82 to 100 (mean 96) points according to AOFAS evaluation system, an average of 96 branches. Radiological evaluation of curative effect: excellent in 52 cases, good in 2 cases, the excellent and good rate was 100%(54/54) according to Baird and Jackson′s radiology evaluation system. Conclusions As a simple and comprehensive classification, two columns of three columns fixation can achieve the purpose of stable inferior tibiofibular syndesmosis.
王朝亮,黄素芳,朱涛,孙雪生,康颂科,李新霞,申立林,蔺楚,王英振,周东生. 三柱理论在踝关节骨折合并下胫腓联合损伤治疗中的应用[J]. 中华解剖与临床杂志, 2016, 21(3): 236-241.
Wang Chaoliang, Huang Sufang, Zhu Tao, Sun Xuesheng, Kang Songke, Li Xinxia, Shen Lilin, Lin Chu, Wang Yingzhen, Zhou Dongsheng. New strategy for the treatment of ankle joint fracture combined with ankle syndesmosis injury. Chinese Journal of Anatomy and Clinics, 2016, 21(3): 236-241.
Goost H, Wimmer MD, Barg A, et al. Fractures of the ankle joint investigation and treatment options[J]. Dtsch Arztebl Int, 2014, 111(21): 377-388. DOI:10.3238/arztebl.2014.0377
Mann G, Nyska M, Hetsroni I, et al. Scoring systems for evaluating ankle function[J]. Foot Ankle Clin, 2006, 1l(3): 509-519
[10]
Lee MS, Maker JM. Revision of failed flatfoot surgery[J]. Clin Podiatr Med Surg, 2009, 26(1): 47-58. DOI:10.1016/j.cpm.2008.09.002
[11]
Baird RA, Jackson ST. Fractures of the distal part of the fibula with associated disruption of the deltoid ligament-treatment without repair of the deltoid ligament[J]. J Bone Joint Surg Am, 1987, 69(9): 1346-1352
[12]
Nortunen S, Flinkkila T, Lantto I, et al. Diagnostic accuracy of the gravity stress test and clinical signs in cases of isolated supination-external rotation-type lateral malleolar fractures[J]. Bone Joint J, 2015, 97B(8): 1126-1131. DOI:10.1302/0301-620X.97B8.35062
Court-Brown CM, Mcbirnie J, Wilson G. Adult ankle fractures-an increasing problem?[J]. Acta Orthop Scand, 1998, 69(1): 43-47
[17]
Sakaki MH, Rodrigues Matsumura BA, Guerra Dotta TD, et al. Epidemiologic study of ankle fractures in a tertiary hospital[J]. Acta Ortopedica Brasileira, 2014, 22(2): 90-93. DOI:10.1590/1413-78522014220200874
2016, Vol. 21 
