Surgical treatment of grade III pronation-external rotation fractures of ankle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TANG Yanghua , ZENG Linru , XU Canda , YUE Zhenshuang , XIN Dawei , HU Zhongqing

Department of Foot and Ankle Surgery, Xiaoshan TCM Hospital, Hangzhou Zhejiang, 311201, P.R.China;

Corresponding author：

TANG Yanghua, Email: tangyanghua168@163.com

Keywords：

Pronation-external rotation; ankle fracture; internal fixation; tibiofibular diastasis

DOI：

10.7507/1002-1892.201609025

Video：

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Objective To summarize the short-term effectiveness of the surgical treatment for grade III pronation-external rotation ankle fractures. Methods Between October 2011 and May 2015, 36 patients with pronation-external rotation ankle fractures (grade III) were treated with internal fixation and repair of the anterior lower tibiofibular ligament, including 21 males and 15 females with an average age of 45.2 years (range, 21-72 years). Injury was caused by sprain in 19 cases, by traffic accident in 6 cases, and by falling from height in 11 cases. All patients had closed fractures, with no blood vessel and nerve injury. The locations were the left ankle in 13 cases and the right ankle in 23 cases. The time from injury to operation was 3 to 10 days (mean, 6.5 days). At last follow-up, ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-foot score, and the improvement of pain was evaluated by visual analogue scale (VAS). Results Primary healing of incision was obtained in all patients, no incision infection and skin necrosis occurred. Twenty-eight patients were followed up 12-36 months (mean, 17.5 months). X-ray films showed bone union was achieved within 2.6-5 months (mean, 3.2 months). No fracture of internal fixation and disruption of tibiofibular diastasis occurred. At last follow-up, according to AOFAS score for ankle function evaluation, the pain score was 36.3±2.9, the function score was 44.3±3.2, the ligament condition score was 9.2±0.5, and the total score was 89.8±6.6; the results were excellent in 11 cases, good in 15 cases, and fair in 2 cases. VAS score was 1.6±0.5. The range of motion of the ankle was (13±5)° in dorsiflexion and (38±9)° in planteroflexion. Conclusion Repair of anterior tibial ligament is an effective method to treat tibiofibular diastasis injury in the surgical treatment of grade III pronation-external rotation ankle fractures, with convenient operation, and satisfactory short-term effectiveness.

Citation： TANGYanghua, ZENGLinru, XUCanda, YUEZhenshuang, XINDawei, HUZhongqing. Surgical treatment of grade III pronation-external rotation fractures of ankle. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 31-35. doi: 10.7507/1002-1892.201609025 Copy

1.	Rodriguez EK, Kwon JY, Herder LM, et al. Correlation of AO and Lauge-Hansen classification systems for ankle fractures to the mechanism of injury. Foot Ankle Int, 2013, 34(11): 1516-1520.
2.	Baumhauer JF, Nawoczenski DA, DiGiovanni BF, et al. Reliability and validity of the American Orthopaedic Foot and Ankle Society Clinical Rating Scale: a pilot study for the hallux and lesser toes. Foot Ankle Int, 2006, 27(12): 1014-1019.
3.	DeLoach LJ, Higgins MS, Caplan AB, et al. The visual analog scale in the immediate postoperative period: intrasubjeet variabilityand correlation with a numeric scale. Anesth Analg, 1998, 86(1): 102-106.
4.	Magan A, Golano P, Maffulli N, et al. Evaluation and management of injuries of the tibiofibular syndesmosis. Br Med Bull, 2014, 111(1): 101-115.
5.	董伟强, 余斌, 白波, 等. 下胫腓联合断裂对踝关节生物力学影响的研究. 中华创伤骨科杂志, 2015, 17(6): 532-535.
6.	高化, 赵亮, 李亚东, 等. 踝关节骨折伴下胫腓联合分离的影像学分析. 中华创伤骨科杂志, 2013, 15(12): 1041-1042.
7.	Cherney SM, Spraggs-Hughes AG, McAndrew CM, et al. Incisura Morphology as a Risk Factor for Syndesmotic Malreduction. Foot Ankle Int, 2016, 37(7): 748-754.
8.	Morris MW, Rice P, Schneider TE. Distal tibiofibular syndesmosis reconstruction using a free hamstring autograft. Foot and Ankle International, 2009, 30(6): 506-511.
9.	Bava E, Charlton T, Thordarson D. Ankle fracture syndesmosis fixation and management: the currentm practice of orthopedic surgeons. Am J Onhop, 2010, 39(5): 242-246.
10.	余斌峰, 王伟良, 林锡鹏. 皮质螺钉治疗下胫腓联合分离伴踝关节骨折. 中国骨伤, 2015, 28(7): 663-665.
11.	Fei J, Lai Z, Wei W, et al. Biomechanical study on different internal fixation methods of joint stability reconstruction of distal tibiofibular syndesmosis injury. China J Orthop Trauma, 2015, 28(12): 1147-1152.
12.	Jasqui-Remba S, Torres-Gómez A, Salas-Morales GA, et al. Changes in the radiological measurements of the tibiofibular syndesmal area in patients with Weber C ankle fractures who were treated with open reduction, internal fixation, and transyndesmal screw. Acta Ortop Mex, 2015, 29(6): 303-308.
13.	刘清华, 余斌, 张垄, 等. 下胫腓联合螺钉位置对踝关节活动度影响的有限元研究. 中华创伤骨科杂志, 2014, 16(9): 784-787.
14.	Klitzman R, Zhao H, Zhang LQ, et al. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int, 2010, 31(1): 69-75.
15.	芦浩, 徐海林, 姜保国, 等. 下胫腓钩与 Suture-button 技术治疗下胫腓联合损伤. 中华创伤杂志, 2015, 31(2): 117-120.
16.	Peterson KS, Chapman WD, Hyer CF, et al. Maintenance of reduction with suture button fixation devices for ankle syndesmosis repair. Foot Ankle Int, 2015, 36(6): 679-684.
17.	Zhan Y, Yan X, Xia R, et al. Anterior-inferior tibiofibular ligament anatomical repair and augmentation versus trans-syndesmosis screw fixation for the syndesmotic instability in external-rotation type ankle fracture with posterior malleolus involvement: A prospective and comparative study. Injury, 2016, 47(7): 1574-1580.
18.	Steinmetz S, Puliero B, Brinkert D, et al. Tibiofemoral syndesmosis injury treated by temporary screw fixation and ligament repair. Orthop Traumatol Surg Res, 2016, 102(8): 1069-1073.
19.	汤峰, 王勤业, 徐忠良, 等. 缝合锚弹性固定生理重建修复下胫腓联合损伤. 中国组织工程研究, 2013, 17(30): 5466-5471.

1. Rodriguez EK, Kwon JY, Herder LM, et al. Correlation of AO and Lauge-Hansen classification systems for ankle fractures to the mechanism of injury. Foot Ankle Int, 2013, 34(11): 1516-1520.
2. Baumhauer JF, Nawoczenski DA, DiGiovanni BF, et al. Reliability and validity of the American Orthopaedic Foot and Ankle Society Clinical Rating Scale: a pilot study for the hallux and lesser toes. Foot Ankle Int, 2006, 27(12): 1014-1019.
3. DeLoach LJ, Higgins MS, Caplan AB, et al. The visual analog scale in the immediate postoperative period: intrasubjeet variabilityand correlation with a numeric scale. Anesth Analg, 1998, 86(1): 102-106.
4. Magan A, Golano P, Maffulli N, et al. Evaluation and management of injuries of the tibiofibular syndesmosis. Br Med Bull, 2014, 111(1): 101-115.
5. 董伟强, 余斌, 白波, 等. 下胫腓联合断裂对踝关节生物力学影响的研究. 中华创伤骨科杂志, 2015, 17(6): 532-535.
6. 高化, 赵亮, 李亚东, 等. 踝关节骨折伴下胫腓联合分离的影像学分析. 中华创伤骨科杂志, 2013, 15(12): 1041-1042.
7. Cherney SM, Spraggs-Hughes AG, McAndrew CM, et al. Incisura Morphology as a Risk Factor for Syndesmotic Malreduction. Foot Ankle Int, 2016, 37(7): 748-754.
8. Morris MW, Rice P, Schneider TE. Distal tibiofibular syndesmosis reconstruction using a free hamstring autograft. Foot and Ankle International, 2009, 30(6): 506-511.
9. Bava E, Charlton T, Thordarson D. Ankle fracture syndesmosis fixation and management: the currentm practice of orthopedic surgeons. Am J Onhop, 2010, 39(5): 242-246.
10. 余斌峰, 王伟良, 林锡鹏. 皮质螺钉治疗下胫腓联合分离伴踝关节骨折. 中国骨伤, 2015, 28(7): 663-665.
11. Fei J, Lai Z, Wei W, et al. Biomechanical study on different internal fixation methods of joint stability reconstruction of distal tibiofibular syndesmosis injury. China J Orthop Trauma, 2015, 28(12): 1147-1152.
12. Jasqui-Remba S, Torres-Gómez A, Salas-Morales GA, et al. Changes in the radiological measurements of the tibiofibular syndesmal area in patients with Weber C ankle fractures who were treated with open reduction, internal fixation, and transyndesmal screw. Acta Ortop Mex, 2015, 29(6): 303-308.
13. 刘清华, 余斌, 张垄, 等. 下胫腓联合螺钉位置对踝关节活动度影响的有限元研究. 中华创伤骨科杂志, 2014, 16(9): 784-787.
14. Klitzman R, Zhao H, Zhang LQ, et al. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int, 2010, 31(1): 69-75.
15. 芦浩, 徐海林, 姜保国, 等. 下胫腓钩与 Suture-button 技术治疗下胫腓联合损伤. 中华创伤杂志, 2015, 31(2): 117-120.
16. Peterson KS, Chapman WD, Hyer CF, et al. Maintenance of reduction with suture button fixation devices for ankle syndesmosis repair. Foot Ankle Int, 2015, 36(6): 679-684.
17. Zhan Y, Yan X, Xia R, et al. Anterior-inferior tibiofibular ligament anatomical repair and augmentation versus trans-syndesmosis screw fixation for the syndesmotic instability in external-rotation type ankle fracture with posterior malleolus involvement: A prospective and comparative study. Injury, 2016, 47(7): 1574-1580.
18. Steinmetz S, Puliero B, Brinkert D, et al. Tibiofemoral syndesmosis injury treated by temporary screw fixation and ligament repair. Orthop Traumatol Surg Res, 2016, 102(8): 1069-1073.
19. 汤峰, 王勤业, 徐忠良, 等. 缝合锚弹性固定生理重建修复下胫腓联合损伤. 中国组织工程研究, 2013, 17(30): 5466-5471.

Chinese Journal of Reparative and Reconstructive Surgery

Surgical treatment of grade III pronation-external rotation fractures of ankle

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