Purpose:To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures.Methods:A retrospective case series study was performed on patients with ankle fract...Purpose:To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures.Methods:A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18 - 65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥ 2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American Orthopedic Foot and Ankle Society ankle hindfoot score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square ort-test.Results:During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, diabetes, or smoking history, preoperative waiting time, operation time, and length of hospital stay (allp > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American Orthopedic Foot and Ankle Society ankle hindfoot score revealed no significant difference between dislocation and no-dislocation patients.Conclusion:Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.展开更多
Purpose： To investigate the early and mid-term results of open reduction and internal fixation （ORIF） with transarticular external fixation （TEF） but no deltoid ligament repair （DLR） in the treatment of supinat...Purpose： To investigate the early and mid-term results of open reduction and internal fixation （ORIF） with transarticular external fixation （TEF） but no deltoid ligament repair （DLR） in the treatment of supination-external rotation type Ⅳ equivalent （SER Ⅳ E） ankle fractures （AO/OTA classification 44-B 3.1 ） and provide evidence for clinical practice. Methods： This study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014, There were 13 males and 9 females, mean age 38.9 years （range, 17-73 years）. Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents （11 cases）, falling from height （6 cases） and sports injuries （5 cases）. The mean period of hospitalization was 9.8 days （range, 6 14 days）. For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8-10 weeks. The preoperative American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score was 56.86 m 4.400, the Medical Outcomes Short Form 36-item （SF-36） questionnaire score was 57.41 ± 4.102 and the visual analog score （VAS） was 5.50 m 1.058. Patients＇ main complaints about inconvenience of daily life were also recorded. Results： All the 22 patients were followed up for 24 63 months （mean, 33.6 months）. None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 e 5.096, 79.59± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data （t - 26.221, p 〈 0.001; t - 11.910, p 〈 0.001; t - 11.571, p 〈 0.001）. The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients＇ main complaints were inconvenience of clothing （17 cases） and extremity cleaning （5 cases）. Conclusion： In the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satis- factory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.展开更多
文摘Purpose:To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures.Methods:A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18 - 65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥ 2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American Orthopedic Foot and Ankle Society ankle hindfoot score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square ort-test.Results:During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, diabetes, or smoking history, preoperative waiting time, operation time, and length of hospital stay (allp > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American Orthopedic Foot and Ankle Society ankle hindfoot score revealed no significant difference between dislocation and no-dislocation patients.Conclusion:Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.
文摘Purpose： To investigate the early and mid-term results of open reduction and internal fixation （ORIF） with transarticular external fixation （TEF） but no deltoid ligament repair （DLR） in the treatment of supination-external rotation type Ⅳ equivalent （SER Ⅳ E） ankle fractures （AO/OTA classification 44-B 3.1 ） and provide evidence for clinical practice. Methods： This study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014, There were 13 males and 9 females, mean age 38.9 years （range, 17-73 years）. Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents （11 cases）, falling from height （6 cases） and sports injuries （5 cases）. The mean period of hospitalization was 9.8 days （range, 6 14 days）. For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8-10 weeks. The preoperative American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score was 56.86 m 4.400, the Medical Outcomes Short Form 36-item （SF-36） questionnaire score was 57.41 ± 4.102 and the visual analog score （VAS） was 5.50 m 1.058. Patients＇ main complaints about inconvenience of daily life were also recorded. Results： All the 22 patients were followed up for 24 63 months （mean, 33.6 months）. None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 e 5.096, 79.59± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data （t - 26.221, p 〈 0.001; t - 11.910, p 〈 0.001; t - 11.571, p 〈 0.001）. The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients＇ main complaints were inconvenience of clothing （17 cases） and extremity cleaning （5 cases）. Conclusion： In the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satis- factory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.
