| Object By contrast two ways prognostic indicators after treatment of posterior malleolar fractures, Discuss the best treatment for fractures of different sizes of posterior malleolar bone, In order to achieve a satisfactory clinical outcome criteria,Achieve better long-term outcomeMethods A retrospective analysis of the application, Contrast The cases of 2nd Hospital of Dalian Medical University from August 2011 to August 2014. In total of 75 cases suffered from posterior malleolar fractures were recruited. Divided all the cases into two groups according to their treatment strategy: The surgery group, Male:14,Female:22, Left ankle:14, Right ankle:22. Age: 46.50±16.20. According to the ankle after the block size divided(I: posterior malleolar fracture involving the joint surface<25%; Bone displacement <2mm; II: posterior malleolar involving the joint surface >25%/ Bone displacement >2mm). I:10, II:26. Way of injury: 11 cases were hurted by falling forces; 6 cases were hurted in traffic accidents; Sprain 19 cases. The conservative treatment group, Male:19, Female:20, Left ankle:15, Right ankle:24. Age:49.50±15.8. I:25, II:14. Injured way: Way of injury: 10 cases were hurted by fallingforces; 7 cases were hurted in traffic accidents; Sprain 22 cases. B–type: 38, C-type: 37,Two groups were compared for age, gender, mode of injury, fracture type(P>0.05), no significant. Compares the score of ankle and posterior foot(AOFAS)between the two group and the cure rate respectively. Compare the healing time by checking the images.Flatness of the ankle joint X-ray film at last follow-up was recorded.Results Following up all the cases for more than 6 months(ranging from 6-26 months,average time: 16 months), 3 cases was lost during the following up. Skin redness was found in 2 patients around the incision, these two cases were healed by using smear topical antibiotics and regular dressing change. One patient suffered from poor wound healing and cured by healing dressing the gauze covering the incision. The others two groups of patients had no nonunion, delayed union, broken nails, etc, When the rear ankle blocks more than 25% of the articular surface. The Surgical treatment group(10), AOFAS: 92.70±6.88. 6 cases were achieved great. 3 cases were good,general result was found in 1 case, no poor case, sharing the preferable rates of90%, The AOFAS of conservative treatment group(25) was 91.48±7.11, Excellent result was achieved in 15 cases, 7 cases achieved good result, general result was found in 3cases, no poor case, shring the preferable rates of 88%, no significant difference was found after analysis(P>0.05), But when the ankle block>25% of the articular surface,The Surgical treatment group(26),AOFAS: 89.25±7.15, Excellent result was achieved in 14 cases, 8 cases achieved good result, general result was found in 3 case, 1poor cases, shring the preferable rates of 84.6%. The conservative treatment group(14),AOFAS: 76.78±8.29, Excellent result was achieved in 4 cases,6 cases gained good result, general result was found in 2 cases, 2 poor cases, reaching the good rates of71.4%, By comparison, Statistically significant data(P<0.05), The healing time: The Surgical treatment group(11.4±1.2W), The conservative treatment group(12.9±1.6W),Statistically significant data(P<0.05). The total cohort of 75 patients were followed up, 2 people had severe joint degeneration, 7 people with varying degrees of mild to moderate joint degeneration, the last follow-up in patients with ankle X-ray normalflatness.Conclusion In ankle Fractures. Posterior malleolar fracture involving the joint surface>25%;Bone displacement>2mm, Fixation was superior to conservative treatment. When the talus dislocation, significant bone displacement and with inferior tibiofibular joint separation, even though posterior malleolar fracture involving the joint surface<25%,should be fixed. The shift is not obvious(<2mm), After avulsion posterior malleolar fracture or small bone(<25%), can use the strategy of conservative treatment, Tibialis anterior minimally invasive technique hollow screw posterior malleolar fracture can lead to satisfactory clinical results. |
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