| Objective:comparative analysis of the clinical outcomes and the complication rate of the ankle fractures accompanied by the distal tibiofibular syndesmotic disruption treated with the Elastic Hook Plate device and4.0mmAO cortical bone screw, then providing a better surgical method for the treatment of the ankle fractures accompanied by the distal tibiofibular syndesmotic disruption.Methods:This paper is a clinical control study, the patients in accordance with the diagnosis standard.53patients of the ankle fractures accompanied by the distal tibiofibular syndesmotic disruption treated with the Elastic Hook Plate device and4.0mmAO cortical bone screw in orthopaedic department of our hospital from June2012to June2013were followed up. The patients were divided into two groups. The patients in group A were treated with the Elastic Hook Plate device, the patients in group B were treated with4.0mm AO cortical bone screw. The patients in Group A including14men and10women, the number of the left distal tibiofibular syndesmotic disruption was11versus the number of the right was13, the mean age of the patients was (37.70±7.03) years (range,19±65years), the average weight was (66.7±5.47) Kg. The patients in Group B consisted of16men and13women, the number of the left distal tibiofibular syndesmotic disruption was14versus the number of the right was15. The mean age of the patients was (36.90±8.86) years (range,18±68years). The average weight was (67.0±5.88) Kg. The patients in Group B were fixed with three layers of cortical bone. To evaluate the differences of operation time, intraoperative blood loss, hospital stay time between the two groups and observe condition of surgical incision. According to reviewing of X-rays regularly, the data of distal tibiofibular syndesmotic reduction, the status of implant, the healing of fracture and the postoperative complications can be obtained, scoring the functional outcomes of ankle according to the Ankle Hind Foot Scale of American Orthopaedic Foot and Ankle Society. At the last, doing the statistical analysis of the relevant data and evaluating the differences of clinical effects between the two groups.Results:the average follow-up time of53patients was12.4months (range,6-18 months). The average operative time in Group A was (65.96±9.08) minutes, the average operative time in Group B was (60.63±7.51) minutes (P>0.05), no statistical differences of operative time between the two groups. The average hospital stay time in Group A was (13.16±1.27) days, the average hospital stay time in Group B was (12.85±1.12) days (P>0.05), no statistical differences of hospital stay time between the two groups. The average intraoperative blood loss in Group A was (74.78±12.82) ml, the average intraoperative blood loss in Group B was (70.06±8.98) ml (P>0.05), no statistical differences of intraoperative blood loss between the two groups. The postoperative X-ray of53patients showed nice healing of fractures, normal mortise and no distal tibiofibular syndesmotic disruption.24patients in Group A, the surgery incision healing was in stage I, we did not find incision infections and skin fester,24patients began their gradual weight-bearing walking postoperative4w-6w and the implant could be removed postoperative10w-12w, no breakage or loosening of the screw and plate, scoring the functional outcomes of ankle according to Ankle Hind Foot Scale of American Orthopaedic Foot and Ankle Society, the results of the last follow-up time were excellent result in16, good in6and fair in2, the excellent and good rate was91.67%.29patients in Group B, the surgery incision healing was in stage I, we did not find incision infections and skin fester,18patients began their gradual weight-bearing walking when the screw was removed postoperative10w-12w,11patients began their gradual weight-bearing walking postoperative10w-12w but no removal of the screw, breakage of the screw in5of11patients and loosening in6of11, the results of the last follow-up time were excellent result in12, good in8, fair in6and poor in3, the excellent and good rate was68.97%. Be statistical differences of the AOFAS score between the two groups (P<0.05).Conclusion:1. the clinical effects of ankle fractures accompanied by the distal tibiofibular syndesmotic disruption treated with4.0mmAO cortical bone screw were not satisfactory, many issues need to be solved, such as breakage or loosening of the screw, these had bad effects on functional recovery of the ankle joint;2. the Elastic Hook Plate is a new device for the treatment of the distal tibiofibular syndesmotic disruption, it can maintain the distal tibiofibular joint physiologic micro-movable feature and the patients could take the functional exercises and walk weight-bearing earlier. In the end, it can lead to better functional outcomes and lower incidence of complication. It is worthy to expand the use of the new device in clinic.3. No statistical differences of intraoperative blood loss, operative time and hospital stay time between the two groups (P>0.05). |
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