Objectives: 

To present long-term patient-reported outcomes of tibial plafond fractures with and without concomitant ankle syndesmotic injury.

Design: 

Retrospective cohort study.

Setting: 

Academic Level 1 trauma center.

Patients/Participants: 

One hundred ninety-seven patients with tibial plafond fractures (OTA/AO 43-B and 43-C) treated with definitive surgical fixation were contacted by telephone or email to obtain patient-reported outcome scores at a minimum follow-up of 1 year. Of those contacted, 148 (75%) had an intact syndesmosis, whereas 49 (25%) experienced a syndesmotic injury.

Intervention: 

The intervention involved open reduction internal fixation of the tibial plafond with syndesmosis repair when indicated.

Main Outcome Measurement: 

The main outcome measurement included patient-reported ankle pain and function using Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function (PF).

Results: 

The cohort including patients with syndesmotic injury had significantly more open fractures (syndesmotic injury = 39%, no syndesmotic injury = 16%, P = 0.001), higher rates of end-stage reconstruction (syndesmotic injury = 27%, no syndesmotic injury = 10%, P = 0.004), and worse PROMIS PF (syndesmotic injury = 42.5 [SD = 8.0], no syndesmotic injury = 47.1 [SD = 9.6], P = 0.045) scores at final follow-up when compared with the cohort comprising patients with no syndesmotic injury. Patients with syndesmotic injury trended toward higher rates of postoperative infection, but this association was not statistically significant. There was no difference between the groups in nonunion or PROMIS pain interference scores.

Conclusion: 

Patients with a tibial plafond fracture and concomitant syndesmotic injury had significantly worse PROMIS PF scores, more end-stage ankle reconstructions, and more open fractures. Syndesmotic injury in the setting of tibial plafond fractures portends worse patient outcomes.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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胫骨平台骨折的联合损伤与更糟糕的患者预后相关

目标： 

提供长期患者报告的胫骨平台骨折伴有和不伴有踝关节联合损伤的结果。

设计： 

回顾性队列研究。

环境： 

学术一级创伤中心。

患者/参与者： 

通过电话或电子邮件联系了 197 名接受明确手术固定治疗的胫骨平台骨折（OTA/AO 43-B 和 43-C）患者，以在至少 1 年的随访中获得患者报告的结果评分。在接触者中，148 人（75%）有完整的联合，而 49 人（25%）经历了联合损伤。

干涉： 

干预涉及胫骨平台的切开复位内固定，并在需要时进行联合修复。

主要成果测量： 

主要结果测量包括使用患者报告的结果测量信息系统 ( PROMIS ) 疼痛干扰和身体功能 (PF) 报告的患者报告的踝关节疼痛和功能。

结果： 

包括联合损伤患者的队列有明显更多的开放性骨折（联合损伤 = 39%，无联合损伤 = 16%，P = 0.001），更高的终末期重建率（联合损伤 = 27%，无联合损伤 = 10 %，P = 0.004）和更差的 PROMIS PF（联合损伤 = 42.5 [SD = 8.0]，无联合损伤 = 47.1 [SD = 9.6]，P = 0.045）在最终随访时与包含患者的队列相比得分无联合损伤。有联合损伤的患者术后感染率趋于较高，但这种关联没有统计学意义。骨不连或PROMIS组之间没有差异疼痛干扰评分。

结论： 

患有胫骨平台骨折并伴有韧带联合损伤的患者的PROMIS PF 评分明显更差，更多的终末期踝关节重建和更多的开放性骨折。胫骨平台骨折情况下的联合损伤预示着患者预后较差。

证据等级： 

预后等级 III。有关证据级别的完整描述，请参见作者说明。