Imaging anatomy characters and surgery treatment of gradeⅡsupination-adduction ankle joint fractures
Lu Liang1, Liu Bin1, Zhang Yu2, Shang Xifu1, Hong Hao3, Zeng Jianxue1, Dong Kaixuan1, Chen Weijian1, Li Duoyu1, Yu Guangrong3
1Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), Hefei 230000, China; 2Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008,China; 3Department of Foot and Ankle Surgery, Tongji Hospital of Tongji University, Shanghai 200065, China
Abstract：Objective To define the imaging characters and effective surgery treatment of stageⅡsupination-adduction type ankle fractures.Methods From June 2014 to December 2017 in the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), 36 patients (24 males and 12 females) with stageⅡsupination-adduction type ankle fractures (21 left ankles and 15 right ankles) ranged from 19 to 56 years old. All patients accepted the treatment of open reduction and internal fixation with buttres plate, and eight patients who also suffered bone defect were treated with bone transplantation. Before operation, all imaging data, including X-ray and computerized tomography(CT) examination, were analyzed the angle (α) between fracture surface and tibia longitudinal axis, the distance (d) from fracture zone to arched roof of tibia distal end joint surface, and area (S) and volume (V) of collapse joint surface, and the relationship between them with three dimension (3D) visualization operation and simulation software system (V1.0.0). The distance (L) between fracture line of fibula and arched roof of tibia distal end joint surface was also measured. The correlation analysis between d,V and α were performed. And then all data were used to analyzed the imaging characters of stageⅡsupination-adduction type ankle fractures. After operations, the results were evaluated with AOFAS and VAS.Results From the pre-operation results of CT imaging of 36 patients, α angle was 4.5°-15.5°(9.85°±4.05°) . And α angle of 20 other patients with collapse of tibia distal end joint surface was 9.85°±4.05°, which was significant smaller than that of the other 16 patients without collapse (12.83°±2.87°) (t=-9.847, P＜0.05). The d, S and V of 20 patients with collapse of tibia distal end joint surface were (8.86±3.69) mm, (47.69±13.95) mm2, and (680±620) mm3 respectively, and the collapse position concentrated on anteromedial ankle joint.Neither d nor V had significant correction to α(rs=0.309, 0.389, all P valus＞0.05), the fracture line of fibula mainly lied in the top point of tibia dome, and the L was 1.27-12.22(5.50±5.54) mm. All patients achieved anatomic reduction and were followed up 10(6-15) months without infection or bone absorption or transposition. Healing time were 10.5 (9-16) weeks. AOFAS and VAS improved to(85±8)and(2.1±0.9).Conclusions The fracture line of stageⅡsupination-adduction type ankle fractures is close to vertical line. Open reduction and internal fixation with buttress plate for tibia fracture fragment is commendable option because of great shear force, larger defect should restore joint surface height by bone grafting, and plate is a good choice to treat fibular fractures.
鹿亮,刘彬,张雨,尚希福,洪浩,曾建学,董凯旋,陈伟健,李多玉,俞光荣. Lauge-Hansen旋后-内收型Ⅱ度踝关节骨折的CT影像解剖学特点及手术治疗[J]. 中华解剖与临床杂志, 2019, 24(2): 106-111.
Lu Liang, Liu Bin, Zhang Yu, Shang Xifu, Hong Hao, Zeng Jianxue, Dong Kaixuan, Chen Weijian, Li Duoyu, Yu Guangrong. Imaging anatomy characters and surgery treatment of gradeⅡsupination-adduction ankle joint fractures. Chinese Journal of Anatomy and Clinics, 2019, 24(2): 106-111.
Warner SJ, Garner MR, Hinds RM, et al. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures[J]. J Orthop Trauma, 2015, 29(12): 574-578. DOI:10.1097/bot.0000000000000393.
[2]
Ebraheim NA, Ludwig T, Weston JT, et al. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry[J]. Foot Ankle Int, 2014, 35(5): 471-477. DOI:10.1177/1071100714524553.
[3]
Lübbeke A, Salvo D, Stern R, et al. Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study[J]. Int Orthop, 2012, 36(7): 1403-1410. DOI:10.1007/s00264-011-1472-7.
McConnell T, Tornetta P 3rd. Marginal plafond impaction in association with supination-adduction ankle fractures: a report of eight cases[J]. J Orthop Trauma, 2001, 15(6): 447-449. DOI:10.1097/00005131-200108000-00013.
Lundeen RO. Medial impingement lesions of the tibial plafond[J]. J Foot Surg, 1987, 26(1): 37-40.
[8]
Labib S, Hage WD, Sutton KM, et al. The effect of ankle position on the static tension in the achilles tendon before and after operative repair: a biomechanical cadaver study[J]. Foot Ankle Int, 2007, 28(4): 478-481. DOI:10.3113/FAI.2007.0478.
[9]
Lauge-Hansen N. Fractures of the ankle. Ⅱ. Combined experimental-surgical and experimental-roentgenologic investigations[J]. Arch Surg, 1950, 60(5): 957-985.
[10]
An S. AO principles of fracture management[J]. Acta Chir Belg, 2018, 118(4): 269. DOI:10.1080/00015458.2018.1467124.
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