후과 골절을 동반한 Lauge-Hansen 회내-외회전형 4단계 족관절 골절에서 원위 경비인대 결합 손상에 대한 원위 경비 나사 고정술과 후과 고정술의 결과 비교: 수술 1년째 추시 결과
Results of Syndesmotic Screw Fixation versus Posterior Malleolus Fixation in Syndesmotic Injury at Pronation External Rotation Stage IV Ankle Fracture with Posterior Malleolus Fracture: Postoperative One Year Follow-up
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Purpose: The purpose of this study is to compare the radiologic and clinical results of syndesmotic screw fixation and posterior malleolarfixation for syndesmotic injury in Lauge-Hansen classification pronation-external rotation (PER) stage IV ankle fractures withposterior malleolus fracture. Materials and Methods: We designed a retrospective study that included patients with Lauge-Hansen classification PER stage IV anklefracture with posterior malleolus fracture. Of 723 patients who underwent ankle fracture surgery from March 2005 to November 2012,29 were included in this study. In this study, syndesmotic injury was treated with syndesmotic screw fixation or posterior malleolusfixation. There were 15 cases of syndesmotic screw fixation and 14 cases of posterior malleolar fixation. We compared the radiologicand clinical results at one year postoperatively. Posterior malleolus fragment size on a pre-operative computed tomographic image, andtibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, and Takakura classification on a postoperative oneyear followup radiograph were used for comparison of the radiologic results. The clinical results were assessed using the American OrthopaedicFoot and Ankle Society score, visual analogue scale score, and patient subjective satisfaction score. Results: Posterior malleolar fragment size was 12.62%±3.01% of the joint space in the syndesmotic screw fixation group and27.04%±4.34% in the posterior malleolar fixation group. A statistical difference was observed between the two groups. However, otherresults, including tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, Takakura classification, and clinicalscores showed no statistical difference. Conclusion: In the Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture, if the posterior malleolusfracture can be reduced anatomically and fixated rigidly, syndesmotic screw fixation, which can cause several complications, is usually notrequired for achievement of a satisfactory syndesmotic stability; this would be a recommendable option for treatment of syndesmotic injury.
Abstract
Purpose: The purpose of this study is to compare the radiologic and clinical results of syndesmotic screw fixation and posterior malleolarfixation for syndesmotic injury in Lauge-Hansen classification pronation-external rotation (PER) stage IV ankle fractures withposterior malleolus fracture. Materials and Methods: We designed a retrospective study that included patients with Lauge-Hansen classification PER stage IV anklefracture with posterior malleolus fracture. Of 723 patients who underwent ankle fracture surgery from March 2005 to November 2012,29 were included in this study. In this study, syndesmotic injury was treated with syndesmotic screw fixation or posterior malleolusfixation. There were 15 cases of syndesmotic screw fixation and 14 cases of posterior malleolar fixation. We compared the radiologicand clinical results at one year postoperatively. Posterior malleolus fragment size on a pre-operative computed tomographic image, andtibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, and Takakura classification on a postoperative oneyear followup radiograph were used for comparison of the radiologic results. The clinical results were assessed using the American OrthopaedicFoot and Ankle Society score, visual analogue scale score, and patient subjective satisfaction score. Results: Posterior malleolar fragment size was 12.62%±3.01% of the joint space in the syndesmotic screw fixation group and27.04%±4.34% in the posterior malleolar fixation group. A statistical difference was observed between the two groups. However, otherresults, including tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, Takakura classification, and clinicalscores showed no statistical difference. Conclusion: In the Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture, if the posterior malleolusfracture can be reduced anatomically and fixated rigidly, syndesmotic screw fixation, which can cause several complications, is usually notrequired for achievement of a satisfactory syndesmotic stability; this would be a recommendable option for treatment of syndesmotic injury.
참고문헌 (22)
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