Clinical And Anatomical Research About Posterior Approach For Ankle Fracture

Objective:1. To study the feasibility and outcome of operations performed with a posterior incision to management lateral malleolus fracture;2. To measure 3 parameters of the distal of the fibula in order to provide reference gist for designing internal fixator in posterior of lateral malleolus.Methods:1. 89 cases of ankle fracture operated were followed up from Jan, 2004 to Jan, 2007. According to Danis-Weber, typeâ… 31 cases, typeâ…¡13 cases, typeâ…¢45 cases. These cases were divided to two groups according to the incision. Group A, 45 cases, a lateral incision were performed, Group B, 44 cases, a posterior incision were performed. Cases of Group A were immobilized with low leg non-weight bearing cast, but cases of group B were not, functional rehabilitation training of ankle were instructed. The time of external fixation, any complain of the incision, AOFAS of the end-point of follow up were recorded.2. The relative data of the distal end of the fibula were measured on 16 cadaver specimens of 5 men and 3 women. All data were calculated by SPSS for Windows 11.5 statistic software. According to the data, the internal fixator were designed by software on computer.Results:1. There is not significant difference of the time of external fixation after sutures out. In group A, the incisions of 4 cases of primary operation and 1 cases of the operation taking out the internal fixation were disrupted. There was not any compliance of the incision in group B. There has no significant statistic difference of the AOFAS hindfoot functional score between group A and B. But AOFAS hindfoot functional score in group B such as pain, function, alignment and total score is significant better than group A.2. The parameters comprising the angle between lateral malleolus and fibula, length of lateral malleolus and length from lateral malleolus to critical point that the posterior face of fibula turn to medial. The measure results prompted the ratio of the two length and the angle is the same in different individual. According to the result, we use computer software to set up the model of internal fixator.Conclusion:1. Posterior incision is a good choice to lateral malleolus involved in ankle fracture. It can allow early functional rehabilitation training, improve wound healing and stability, and the outcome may be better.2. The anatomical parameters of the distal end of the fibula should be considered and according it to set up model of internal fixator with computer software. It provided anatomical and configurational evidence to design a better internal fixator for lateral malleolus.