Analysis Of Clinical Efficacy Of Closed Reduction And Internal Fixation In The Treatment Of Haraguchi Ⅰ Posterior Malleolus Fracture

ObjectiveTo investigate the clinical efficacy and safety of closed reduction percutaneous internal fixation by posterior and anterior cannulated screw in the treatment of middle and posterior malleolus fractures.MethodsA retrospective analysis was performed on 156 patients with Haraguchi I posterior malleolus fracture treated by surgery from January 1,2015 to June 1,2020 in the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University.According to the different surgical fixation methods of posterior malleolus fracture,the patients were divided into open reduction screw internal fixation group(Open group,85 cases)and closed reduction percutaneous hollow screw internal fixation group(Closed group,71 cases).Through the comparative analysis of two groups of patients with preoperative general situation,operation time,intraoperative fluoroscopy times,intraoperative blood loss,postoperative complications,after ankle fracture healing time,postoperative one week and twelve months after operation,the preoperative pain with visual analogue scale(VAS)score,preoperative and postoperative twelve months the American Foot and Ankle Association(AOFAS)function score,ankle BurwelL-Charnley radiographic score and other indicators were used to evaluate the clinical efficacy of the two surgical methods for posterior malleolus fracture.ResultsPatients in both groups successfully completed surgery and were followed up for 12-17 months(average 13.7 months).There was no statistically significant difference in general data between the two groups.The mean operation time,the mean intraoperative blood loss,and the mean one week postoperative VAS score in the closed reduction group were lower than those in the open reduction group.The differences were statistically significant(P<0.05).The number of intraoperative fluoroscopy in closed reduction group was higher than that in open reduction group,and the difference was statistically significant(P<0.05).According to burwell-Charnley radiographic score of ankle joint,the excellent reduction rate of fracture in the closed group was 93.0%,and the good reduction rate of fracture in the open group was 95.3%,there was no significant difference between the two groups(χ2=1.418,P=0.492).There was no significant difference in the average healing time of posterior ankle fracture between the two groups(P>0.05).There were no significant differences in VAS score and AOFAS score between groups at twelve months after surgery(P>0.05).Postoperative complications in the two groups were mainly superficial infection,deep infection,nerve tendon injury,lower limb venous thrombosis,and traumatic arthritis of ankle joint.The incidence of postoperative complications in the closure group was 5.6%,and that in the open group was 16.5%,the difference between the two groups was statistically significant(χ2=4.451,P=0.035).Conclusion1.Both open reduction screw internal fixation and closed reduction screw internal fixation can safely and effectively fix Haraguchi I posterior malleolus fracture.2.Closed reduction and percutaneous internal fixation by posterior and forward cannulated screw for the treatment of posterior ankle fracture has the advantages of short operation time,less trauma and fewer postoperative complications.