Clinical Observation Of Two Methods To Deal With Posterior Malleolar Fractures Of Trimalleolar Fractures

ObjectiveTo explore the clinical effect for the posterior malleolar fractures of trimalleolar fractures with fragments smaller than 25% of the tibial articular surfase by comparing fixated group to nonfixated group.MethodsFrom August 2010 to December 2014, Data of 81 cases with posterior malleolar fractures of trimalleolar fractures with fragments smaller than 25% of the tibial articular surfase from Guangdong province hospital of TCM were retrospectively analyzed.According to Haraguchi CT classfication, patients were simplified into three groups,typel(posterolateral-oblique)group,typell (media-extension)group, typelll(small-shell) group, each further invided into the fixated group and nonfixated group. Typel group consisted of 32, including 14 males and 18 females;aged 18-68 years, average 41.53±13.09 years; 15 cases of falls,17 cases of sprain; 16 cases of left ankle,16 cases of right ankle;7 cases had dislocation or subluxation of ankle joint after injury;15 cases in fixated group and 17 cases in nonfixated group. Typell group consisted of 23, including 12 males and 11 females;aged 19-66 years, average 42.91±14.26 years;10 cases of falls,13 cases of sprain;10 cases of left ankle,13 cases of right ankle;13 cases had dislocation or subluxation of ankle joint after injury; 12 cases in fixated group and 11 cases in nonfixated group. Typelll group consisted of 26, including 14 males and 12 females;aged 18-65 years, average 42.00±12.87 years,14 cases of falls,12 cases of sprain; 12 cases of left ankle,14 cases of right ankle;5 cases had dislocation or subluxation of ankle joint after injury;11 cases in fixated groupand 15 cases in nonfixated group. The period from injury to surgery was 2-15 days, with an average of 6.6 days. Reccording and comparing of fixated group and nonfixated group in each type of fractrues in the operation time, blood loss, fracture healing time, full weight-bearing time, and Olerud and Molander ankle function score which was according to last follow-up, SPSS 17.0 was used for statistical analysis.ResultsAll cases were followed up, mean follow-up was 22.3 months(range,10-48), all fractures healed,no wounds infected,no fixation loss or disruption, no nerve and vascular injury. The incidence of dislocation or subluxation of ankle joint after injury was significant difference in three groups(P<0.05), it was significantly higher in typeⅡ group than in typeⅠ and typeⅢ group (P<0.017), but no significant difference was found between typeⅠ and typeⅢ group(P>0.017). There was no significant difference in comperision of fixatied group and nonfixated group in the operation time, blood loss, fracture healing time, full weight-bearing time in each type fractrue(P>0.05). The fixated group was significantly better than nonfixated group in the Olerud and Molander ankle function scores which was according to last follow-up in typell group(P<0.05),but as for typyⅠ and typeⅢ group, it was no significant difference in comperision of fixatied group and nonfixated group(P>0.05).ConclusionAs for posterior malleolar fractures of trimalleolar fractures with fragments<25% of the tibial articular surfase.Satisfactory reduction during the procedure, typeⅠ and typeⅢ fractures showed a good result whether it was fixed or not.But for typeⅡ fractures, anatomical reduction and reliable internal fixation should be producted during the procedure to restoration of articular surface and stability of ankle joint, to enhance the functional recovery of the ankle joint early.