- Volume 17 Issue 1
Operative Treatment of the Ankle Fracture with Dislocation: Minimum 2-year Follow Up Results
탈구를 동반한 족관절 골절에서 수술적 치료 후 최소 2년 추시 결과
- Jo, Sueng-Hwan (Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University College of Medicine) ;
- Lee, Jun-Young (Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University College of Medicine) ;
- Cho, Sung-Won (Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University College of Medicine) ;
- Pak, Chi-Hyoung (Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University College of Medicine)
- 조승환 (조선대학교 의과대학 정형외과학교실) ;
- 이준영 (조선대학교 의과대학 정형외과학교실) ;
- 조성원 (조선대학교 의과대학 정형외과학교실) ;
- 박치형 (조선대학교 의과대학 정형외과학교실)
- Received : 2013.01.20
- Accepted : 2013.02.14
- Published : 2013.03.15
Purpose: In previous study, the frequency of osteoarthritis and discomfort were high in ankle fracture-dislocation but detail results about ankle fracture-dislocation has rarely been investigated. In this study, we retrospectively analyze the outcome of the operative treatment of ankle fracture with dislocation for over-2 years follow up. Materials and Methods: There were 47 cases of ankle fracture-dislocation in our hospital from March 2007 to May 2010. We investigated 20 patients who underwent operation and were possible for over-2 years follow up. The result was estimated with the direction of dislocation, fracture type, the time of bone union and post-traumatic osteoarthritis with plain radiologic images. In clinical assessment, we statistically evaluated the function and pain through AOFAS score and Olerud & Molander scoring system. Results: By Lauge-Hansen classification, there were 13 cases(65%) of pronation-external rotation and 6 cases(30%) of supination-external rotation, 1 case(5%) of supination-adduction. AOFAS score was 85.5, and Olerud & Molander score was "excellent" in 8 cases, "good" in 5 cases, "fair" in 3 cases and "poor" in 4 cases. Postoperative complications in 4 cases revealed post-traumatic arthritis. All kinds of lateral dislocation of ankle fracture was 15 cases and the most common. Of these, all 3 cases, anterolateral dislocation showed post-traumatic osteoarthritis. Conclusion: In ankle fracture-dislocation, post-traumatic osteoarthritis occurred in 4 of 20 patient(20%). Especially, the possibility of post-traumatic osteoarthritis was more in cases of anterolateral or lateral dislocation. So, it must be needed that deliberate examination, for example, preoperative MRI and sufficient explanation to patient. Also, we have to follow up the patients carefully.
- Bagger J, Holmer P, Nielsen KF. The prognostic importance of primary dislocated ankle joint in patients with malleolar fractures. Acta Orthop Belg. 1993;59:181-3.
- Lubbeke A, Salvo D, Stern R, Hoffmeyer P, Holzer N, Assal M. Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study. Int Orthop. 2012;36:1403-10. https://doi.org/10.1007/s00264-011-1472-7
- Tanaka Y, Takakura Y, Hayashi K, Taniguchi A, Kumai T, Sugimoto K. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Br. 2006;88: 909-13. https://doi.org/10.2106/JBJS.E.01398
- Lindsjo U. Operative treatment of ankle fracturedislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res. 1985;199:28-38.
- Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950;60:957-85. https://doi.org/10.1001/archsurg.1950.01250010980011
- Brodie IA, Denham RA. The treatment of unstable ankle fractures. J Bone Joint Surg Br. 1974;56:256-62.
- Lee J-Y. Treatment of the trimalleolar fracture using posterolateral approach :minimum 2-year follow up results. J Korean Fracture Soc. 2011;24:
- Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. 2007;15:330-9. https://doi.org/10.5435/00124635-200706000-00002
- Marti RK, Raaymakers EL, Nolte PA. Malunited ankle fractures. The late results of reconstruction. J Bone Joint Surg Br. 1990;72:709-13.
- Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 2004;86:1336. https://doi.org/10.2106/00004623-200406000-00032
- Canale ST, Belding RH. Osteochondral lesions of the talus. J Bone Joint Surg Am. 1980;62:97-102. https://doi.org/10.2106/00004623-198062010-00014
- Hintermann B, Regazzoni P, Lampert C, Stutz G, Gachter A. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br. 2000;82:345-51. https://doi.org/10.1302/0301-620X.82B3.10064
- Boraiah S, Paul O, Parker RJ, Miller AN, Hentel KD, Lorich DG. Osteochondral lesions of talus associated with ankle fractures. Foot Ankle Int. 2009;30:481-5. https://doi.org/10.3113/FAI.2009.0481
- Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B. Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg Am. 2010;92:279-86. https://doi.org/10.2106/JBJS.H.01635
- Chu IT, Kim YS, Yoo SH, Oh IS. The incidences and locations of osteochondral lesions of the talus in ankle fracture. J Korean Orthop Assoc. 2004;39:494-7. https://doi.org/10.4055/jkoa.2004.39.5.494