Dislocating The Ankle Joint Treated Dislocated Trimalleolar Fracture Accompanied With The Complicated Hock Fractures And Abruption Of Lower Tibiofibular Ligament Union

Objective: Ankle is body’s load-bearing joints, its stability and flexibility is very important in the body’s standing, walking, squat,etc. Ankle fracture is the common fractures, about 3.9% of the total number of fractures, among the top of the intra-articular fracture with increasing year by year. According to the mechanism of injury and severity,ankle fracture can be divided into single, double ankle fracture, and trimalleolar fracture,severe cases with dislocation and inferior tibiofibular ligament. Trimalleolar fracture, also known as Cotton fracture, is the more seroius type, most of the fracture displacement and ankle hole structure damage, accompanied by the ligament injury of joint and the dislocation of the ankle joint. The ankle stability of bone and ligament have be seriously damaged.The unstable ankle fracture have better choose open reduction and internal fixation, thereby obtaining anatomic reduction and stable fixation. But,the surgery is difficult, especially for a comminuted fracture of the hock, ineffective, the reduction and fixation is still the medical profession’s a major problem, improper treatment leave after a certain degree sequela, ranging from walking instability, while in joint deformities and traumatic arthritis,extremely joint stiffness.Becaues of the superficial anatomical location,it is relatively easy for the reduction and fixation of the internal or external malleolus fractures. But,because its anatomical location is deeper,then dragging and baffling by surrounding ligaments and tendons,it is difficult for the exposure and fixation of posterior malleolar fracture. Therefore, the attention of everyone.In this paper,we discuss the effect of dislocating the ankle joint in treatment of dislocated trimalleolar fracture accompanied with the complicated hock fractures and abruption of lower tibiofibular ligament union,and compromise other related issues to alliance.Methods: From 2012.6 to 2014.6,30 patients were treated by dislocating the ankle joint in our department in which diagnosed as dislocated trimalleolar fracture accompanied with the complicated hock fractures and abruption of lower tibiofibular ligament union according to radiology and checking in the surgery. Guiding the ankle-bone and push the distal ankle joint to the exterior, and spontaneously the ankle joint will be dislocation, exposing the posterior malleolus and the end joint surface of tibia,the posterior malleolus can be anatomic reconstruction by fixing the posterior with absorbable screw at last. Postoperative are fixed with a short plaster slab or brace for 2 to 4 weeks, and take the ankle active function training by the principle of “active,progressive,enhanced”after removing plaster slab.Results: All patients were followed up for 8 to 24 months an average of 13 months. 30 patients were all involved in fracture healing, the shortest healing time 3 months and a maximum of 5 months, an average of 3.5 months.we evaluated the effect according to Baird-Jackson classification system. And we found that 28 cases were excellent and 2 good, giving a good to excellent rate of 93.3%, which were none talar necrosis.Conclusion: The dislocating the ankle joint can achieve the satisfactory results in the treatment of dislocated trimalleolar fracture accompanied with the complicated hock fractures and abruption of lower tibiofibular ligament union by anatomic reconstruction.