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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

대한족부족관절학회지 2014년 18권 1호 p.29 ~ p.35

박세진(Park Se-Jin) - 성균관대학교 의과대학 강북삼성병원 정형외과학교실
정화재(Jeong Hwa-Jae) - 성균관대학교 의과대학 강북삼성병원 정형외과학교실
신헌규(Shin Hun-Kyu) - 성균관대학교 의과대학 강북삼성병원 정형외과학교실
서동석(Seo Dong-Seok) - 성균관대학교 의과대학 강북삼성병원 정형외과학교실
최영민(Choi Young-Min) - 성균관대학교 의과대학 강북삼성병원 정형외과학교실
김유진(Kim Eu-Gene) - 성균관대학교 의과대학 강북삼성병원 정형외과학교실

Abstract

Purpose: The purpose of this study is to compare the radiologic and clinical results of syndesmotic screw fixation and posterior malleolar fixation for syndesmotic injury in Lauge-Hansen classification pronation-external rotation (PER) stage IV ankle fractures with posterior malleolus fracture.

Materials and Methods: We designed a retrospective study that included patients with Lauge-Hansen classification PER stage IV ankle fracture 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 malleolus fixation. There were 15 cases of syndesmotic screw fixation and 14 cases of posterior malleolar fixation. We compared the radiologic and clinical results at one year postoperatively. Posterior malleolus fragment size on a pre-operative computed tomographic image, and tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, and Takakura classification on a postoperative one year followup radiograph were used for comparison of the radiologic results. The clinical results were assessed using the American Orthopaedic
Foot 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 and 27.04%±4.34% in the posterior malleolar fixation group. A statistical difference was observed between the two groups. However, other results, including tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, Takakura classification, and clinical scores showed no statistical difference.

Conclusion: In the Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture, if the posterior malleolus fracture can be reduced anatomically and fixated rigidly, syndesmotic screw fixation, which can cause several complications, is usually not required for achievement of a satisfactory syndesmotic stability; this would be a recommendable option for treatment of syndesmotic injury.

키워드

Ankle, Syndesmotic injury, Syndesmotic screw fixation, Posterior malleolus fixation

KMID : 1130920140180010029

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KCD코드

ICD 03

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