Background

Trimalleolar fractures are generally considered to have inferior outcomes among ankle injuries. Historically, emphasis was placed on the size of the posterior malleolar fracture (PMF) to guide surgical decision-making and predict outcomes. Recent studies have suggested that the morphology of the PMF fragment is more important than its size. The aim of this systematic review was to determine if the outcomes of trimalleolar fractures depend on the morphology of the PMF as per the Haraguchi classification system after surgical fixation.

Methods

A systematic literature search was conducted in the electronic databases of PubMed, Embase, Scopus, and Ovid. Title and abstracts were screened, and data from eligible studies were extracted. Meta-regression and pooled analysis was performed using appropriate computer software.

Results

11 studies with 597 patients were included in the final analysis. Pooled mean AOFAS score was 87.43 (95% CI 84.24–90.62) after a mean follow-up of 31.6 months. Univariate and multivariate meta-regression analysis demonstrated that as the percentage of Haraguchi type 1 patients increased, there was a statistically significant improvement in outcome scores. A similar trend was noted for Haraguchi type 3 fractures, and a reverse trend was observed for Haraguchi type 2 injuries, although neither were statistically significant.

Conclusion

Our review suggests that the outcomes of trimalleolar fractures after surgical fixation may depend on the morphology of the PMF, with Haraguchi type 1 fractures having overall superior functional outcomes than Haraguchi type 2 and 3 injuries. Future studies need to done to conclusively prove or refute these findings.

中文翻译：

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后踝骨折块形态对三踝骨折预后的影响：系统评价和荟萃分析

背景

三踝骨折通常被认为在踝关节损伤中预后较差。从历史上看，重点放在后踝骨折 (PMF) 的大小上，以指导手术决策和预测结果。最近的研究表明，PMF 片段的形态比其大小更重要。本系统评价的目的是确定三踝骨折的结果是否取决于手术固定后按照 Haraguchi 分类系统的 PMF 的形态。

方法

在 PubMed、Embase、Scopus 和 Ovid 的电子数据库中进行了系统的文献检索。筛选了标题和摘要，并提取了符合条件的研究的数据。使用适当的计算机软件进行元回归和合并分析。

结果

597 名患者的 11 项研究被纳入最终分析。平均随访 31.6 个月后，汇总平均 AOFAS 评分为 87.43（95% CI 84.24–90.62）。单变量和多变量元回归分析表明，随着 Haraguchi 1 型患者比例的增加，结果评分在统计学上有显着改善。Haraguchi 3 型骨折也有类似的趋势，而 Haraguchi 2 型骨折则观察到相反的趋势，尽管两者均无统计学意义。

结论

我们的综述表明，手术固定后三踝骨折的结果可能取决于 PMF 的形态，原口 1 型骨折的总体功能结果优于原口 2 型和 3 型损伤。需要进行未来的研究以最终证明或反驳这些发现。