Introduction

Lateral malleolar fractures are present in about 90% of ankle fractures. The standard treatment is plate osteosynthesis. Although the plates are thin, the risk of cicatricial complications is not insignificant and can lead to cutaneous or even infectious complications and the latter can cause functional repercussions. We therefore aimed to evaluate a technique consisting of osteosynthesis of the lateral malleolus using two cerclages and two intramedullary pins.

Hypothesis

Our hypothesis is that the use of osteosynthesis by pin/cerclage of the lateral malleolus makes it possible to have objective reduction criteria, similar to the reference treatment.

Methods

This is a retrospective study of patients who had an interligamentous spiral fracture of the lateral malleolus. One group of patients had internal fixation of the lateral malleolus fracture by pins, and the other by plate. Our primary outcome was to compare the reduction of the fracture of the lateral malleolus between the two techniques using the “Dime sign”, the measurement of the talocrural angle and respect for Shenton's line.

Results

A total of 118 lateral malleolar fractures were included: 56 patients (47.5%) in the “pin” group and 62 patients (52.5%) in the “plate” group. The mean age of the patients was 46.6 years (17.4) with an average body mass index of 25.2 kg/m² (4.8) and 55.1% of the patients were women. We found a difference in the reduction criteria between the two groups by looking at Shenton's line: 73.2% (41/56) of postoperative X-rays in the “pin” group respected Shenton's line, compared to 90.3% (56/62) in the “plate” group (p = 0.02). We did not find any difference regarding the “Dime sign” and the talocrural angle.

Conclusion

Our study shows the superiority of plate osteosynthesis for lateral malleolar fractures compared to pin/cerclage osteosynthesis, regarding one of the three radiological criteria for reduction. No significant difference was found in the one-year rates of complications and of hardware removal, between the two groups.

Level of evidence

IV, retrospective study.

中文翻译：

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针/环扎外踝骨折接骨术有效吗？一项回顾性研究

介绍

大约 90% 的踝关节骨折都存在外踝骨折。标准治疗是钢板接骨术。尽管钢板很薄，但瘢痕并发症的风险并非微不足道，可导致皮肤甚至感染并发症，后者可引起功能性影响。因此，我们旨在评估一种技术，该技术包括使用两个环扎术和两个髓内针的外踝接骨术。

假设

我们的假设是，通过外踝的针/环扎术使用接骨术可以制定​​客观的复位标准，类似于参考治疗。

方法

这是一项针对外踝韧带间螺旋骨折患者的回顾性研究。一组患者采用针内固定外踝骨折，另一组患者采用钢板内固定。我们的主要结果是使用“Dime 标志”、测量距小腿角度和尊重 Shenton 线来比较两种技术在外踝骨折复位方面的效果。

结果

共纳入 118 例外踝骨折：“针”组 56 例（47.5%），“钢板”组 62 例（52.5%）。患者的平均年龄为 46.6 岁 (17.4)，平均体重指数为 25.2  kg/m ² (4.8)，55.1% 的患者为女性。通过观察 Shenton 线，我们发现两组之间的复位标准存在差异：“针”组术后 X 线片中 73.2% (41/56) 符合 Shenton 线，而“针”组为 90.3% (56/62) “盘子”组 ( p  =  0.02)。我们没有发现“Dime 标志”和距小腿角度有任何差异。

结论

我们的研究表明，在三个放射学复位标准之一方面，与针/环扎接骨术相比，钢板接骨术治疗外踝骨折具有优越性。两组之间的一年并发症发生率和硬件移除率没有显着差异。

证据等级

四、回顾性研究。