Clinical Analysis of Trimalleolar Ankle Fracture of 128 Cases
|School||Dalian Medical University|
|Keywords||trimalleolar ankle fractures type treanttme|
Objective: To explore the types, timing of surgery, choice of internal fixation, surgical treatment of trimalleolar ankle fractures.Methods: A retrospectively analysis was conducted in 128 patients with trimalleolar ankle fractures of the second affiliated hospital of Dalian Medical University, from January 2004 to March 2011. 46 male and 82 female, aged from 12 to 76, 43 on average. Traffic accident in 61 cases, 44 cases of falls, sprains in 23 cases. Classified by Lauge-Hansen. 8 cases was without operations. 71 cases of Emergency surgery and 49 cases of elective surgery. In cases of outside malleolar fracture, fixation with Kirschner wire 34, fixation with plates and screw 67, fixation with screw 19; In cases of medial malleolus fracture, fixation with Kirschner wire 26, fixation with bioabsorbable interference screw 14, fixation with hollow tension screw 32, fixation with cancellous screw 18, fixation with headless compression screw 11. In cases of posterior malleolus fracture, there were 19 cases without operations, the others are fixed with bioabsorbable interference screw, cancellous screw or hollow tension screw. Fixation order of trimalleolar ankle fractures: outside malleolar-medial malleolus- posterior malleolus 39, posterior malleolus-outside malleolar-medial malleolus 17, medial malleolus-outside malleolar-posterior malleolus 28. Inferior tibiofibular syndesmosis of 4 cases were fixed. Patients were followed up 6 months to 6 years. AOFAS was used to determine the recovery.Results: 6 cases of 8 cases without operations were open reduction and fixation again because of fracture replacement. There are no wound infections, nonunion and all reach clinical healing. Of 79 cases of emergency operation, the average duration of operations is 1h45m, and the length of stay is 7.5d on average. Of 49 cases of elective surgery, the average duration of operations is 2h02m, and the length of stay is 13.4d on average. The effect of medial malleolus fracture fixation with Kirschner wire, bioabsorbable interference screw, hollow tension screw , cancellous screw or headless compression screw is all satisfaction. There is no difference among fixation order of trimalleolar ankle fractures.Conclusions:1. Trimalleolar ankle fractures happens in ankle fracture of great violence and serious injury, and middle-aged women.2. Opening reduction and fixation should be used in trimalleolar ankle fractures, meanwhile accurate reset and firm internal fixation are requied, which prevent traumatic osteoarthritis.3. Emergency operation can shorten the length of stay, reduce the economic burden; selective operation is good for departure of tissue and operative procedure.4. When treat trimalleolar ankle fractures,the reset of outside malleolar is the most important which should be done first.5 .When accurate reset and firm internal fixation have been done in outside malleolar and medial malleolus,there is no need of fixation of inferior tibiofibular syndesmosis.