족관절 개방성 삼과골절의 즉각적인 수술의 결과
Outcomes of Immediate Operative Treatment of Ankle Trimalleolar Open Fractures
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Generally, the treatment of ankle trimalleolar open fractures is divided into two stages: external fixation and debridement; and secondary internal fixation. On the other hand, this two-stage operation takes considerable treatment time and is challenging in procedures requiring reduction. The purpose of this study was to evaluate the radiologic and clinical results of an immediate one-stage internal fixation operation considering the wound conditions to overcome two stage operation disadvantages. Materials and Methods: From September 2009 to January 2018, 24 cases of ankle trimalleolar open fractures, who underwent immediate internal fixation and were followed up for at least one year, were studied retrospectively. The open wound was divided into the Gustilo-Anderson classification. Open reduction and internal fixation were performed on every medial and lateral malleolar fracture. On the other hand, with posterior malleolar fractures, surgical or conservative treatment was performed depending on the fragment size. The radiologic outcome was evaluated using the Burwell and Charnley criteria and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and complications, such as infection and posttraumatic arthritis, were used for the clinical evaluation. Results: The wound was classified into eight cases (33.3%) of type I, 11 cases (45.8%) of type II, and five cases (20.8%) of type IIIa. The degree of reduction was anatomical, fair, and poor in 16 cases (66.7%), six cases (25.0%), and two cases (8.3%), respectively. The mean AOFAS score was 79 points, and there were complications, such as infection in three cases (12.5%) and post-traumatic arthritis in two cases (8.3%). Conclusion: Satisfactory results were obtained through immediate surgical treatment in ankle trimalleolar open fractures of types I, II, and IIIa.
Abstract
Purpose: Generally, the treatment of ankle trimalleolar open fractures is divided into two stages: external fixation and debridement; and secondary internal fixation. On the other hand, this two-stage operation takes considerable treatment time and is challenging in procedures requiring reduction. The purpose of this study was to evaluate the radiologic and clinical results of an immediate one-stage internal fixation operation considering the wound conditions to overcome two stage operation disadvantages. Materials and Methods: From September 2009 to January 2018, 24 cases of ankle trimalleolar open fractures, who underwent immediate internal fixation and were followed up for at least one year, were studied retrospectively. The open wound was divided into the Gustilo-Anderson classification. Open reduction and internal fixation were performed on every medial and lateral malleolar fracture. On the other hand, with posterior malleolar fractures, surgical or conservative treatment was performed depending on the fragment size. The radiologic outcome was evaluated using the Burwell and Charnley criteria and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and complications, such as infection and posttraumatic arthritis, were used for the clinical evaluation. Results: The wound was classified into eight cases (33.3%) of type I, 11 cases (45.8%) of type II, and five cases (20.8%) of type IIIa. The degree of reduction was anatomical, fair, and poor in 16 cases (66.7%), six cases (25.0%), and two cases (8.3%), respectively. The mean AOFAS score was 79 points, and there were complications, such as infection in three cases (12.5%) and post-traumatic arthritis in two cases (8.3%). Conclusion: Satisfactory results were obtained through immediate surgical treatment in ankle trimalleolar open fractures of types I, II, and IIIa.
참고문헌 (19)
- Hulsker CC, "Evidence-based treatment of open ankle fractures", Arch Orthop Trauma Surg, 131, pp.1545~1553 (2011)[DOI]
- Bray TJ, "Treatment of open ankle fractures. Immediate internal fixation versus closed immobilization and delayed fixation", Clin Orthop Relat Res, (240), pp.52~ (1989)
- Gustilo RB, "Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones : retrospective and prospective analyses", J Bone Joint Surg Am, 58, pp.453~458 (1976)[DOI]
- De Vries JS, "Long-term results of ankle fractures with a posterior malleolar fragment", J Foot Ankle Surg, 44, pp.211~217 (2005)[DOI]
- McDaniel WJ, "Trimalleolar fractures of the ankle. An end result study", Clin Orthop Relat Res, (122), pp.37~45 (1977)
- Sachs W, "A surgical approach to a displaced ankle fracture", J Foot Surg, 23, pp.302~307 (1984)
- Talbot M, "Posterolateral approach for open reduction and internal fixation of trimalleolar ankle fractures", Can J Surg, 48, pp.487~490 (2005)
- 이광철, "후외방 도달법에 의한 족관절 삼과골절의 수술적 치료 후 최소 2년 추시 결과", 대한골절학회지, 24(4), pp.328~334 (2011), 대한골절학회
- Burwell HN, "The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement", J Bone Joint Surg Br, 47, pp.634~660 (1965)
- Toolan BC, "An evaluation of the use of retrospectively acquired preoperative AOFAS clinical rating scores to assess surgical outcome after elective foot and ankle surgery", Foot Ankle Int, 22, pp.775~778 (2001)[DOI]
- Kitaoka HB, "Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes", Foot Ankle Int, 15, pp.349~353 (1994)[DOI]
- Roberts CS, "Damage control orthopaedics : evolving concepts in the treatment of patients who have sustained orthopaedic trauma", Instr Course Lect, 54, pp.447~462 (2005)
- Melvin JS, "Open tibial shaft fractures: I. Evaluation and initial wound management", J Am Acad Orthop Surg, 18, pp.10~19 (2010)[DOI]
- Scharfenberger AV, "Primary wound closure after open fracture : a prospective cohort study examining nonunion and deep infection", J Orthop Trauma, 31, pp.121~126 (2017)[DOI]
- Franklin JL, "Immediate internal fixation of open ankle fractures. Report of thirty-eight cases treated with a standard protocol", J Bone Joint Surg Am, 66, pp.1349~1356 (1984)
- Ovaska MT, "Contemporary demographics and complications of patients treated for open ankle fractures", Injury, 46, pp.1650~1655 (2015)[DOI]
- Tho KS, "Grade III open ankle fractures : a review of the outcome of treatment", Singapore Med J, 35, pp.57~58 (1994)
- Joshi D, "Immediate open reduction and internal fixation in open ankle fractures", J Am Podiatr Med Assoc, 96, pp.120~124 (2006)[DOI]
- Johnson EE, "Open ankle fractures. The indications for immediate open reduction and internal fixation", Clin Orthop Relat Res., (292), pp.118~127 (1993)