The Retrospective Analysis Of Treatment Options For Posterior Malleolar Fracture Combined With Tibial And Fibular Spiral Fractures

Purpose:The posterior malleolar fracture combined with tibial and fibular spiral fracture is well known to us,which takes place In Lower Limb Fractures frequently.However,the indication of internal fixation for posterior fractures,and the proportion of fractures in the distal articular surface of the tibiato do fix is still under debate and varies between different surgeons.The purpose of this article is to assess the treatment options of posterior malleolar fracture combined with tibial and fibular spiral fracture and provide better treatment advice for this kind of fraction.Methods:For January 2013-November 2016 First Affiliated Hospital of Dilian Medical University,orthopedic trauma treated a total of 123 cases of tibial and fibularfracture patients(Inclusive criteria:Age ? 18 years old and ? 100 years old needed surgery treatment of adult patients of tibial and fibular fracture with intramedullary nail;exclusive criteria:Age<18 years old got pathologicaland open fracture),which were retrospectively analyzed.We picked out the 29 cases of tibial and fibular spiral fracture(AO types:42-A1?42-B1?42-C1)combined with posterior malleolar fracture.Fixation group has 13 cases carry out internal fixation of posterior malleolus fracture,and 16 cases don't do that but carry out totally plaster external fixation after operation.We conduct a study on the basis of 25%of the proportion of the distal articular surface of the posterior ankle fractures which is always disputed in the literature.We put them into two groups alone,one is that the posterior malleolar fracture distal articular surface is not less than 25%and the other oneis less than 25%,and then according to whether to carry out the fracture of the posterior malleolar fixation,they are divided into fixation group and nonfixation group,through the same operation time,postoperative weight-bearing time,AOFAS ankle and hindfoot score and posttraumatic arthritis to compare and statistically analyze the clinical curative effectbetween the two groups.Results:There were 123 cases of tibial and fibularfracture,of which 29 cases(23.6%)got posterior malleolar fracture combined with tibial and fibular spiral fractures.In the 29 cases,9 cases(31.03%)were that the posterior malleolar fracture distal articular surface is not less than 25%and 20 cases(68.94%)are that the posterior malleolar fracture distal articular surface is less than 25%.In posterior malleolar fracture is not less than 25%of distal tibial articular surface,posterior malleolar fracture fixation group included 4 cases(44.44%),and nonfixation group had 5 cases(55.56%).By comparing the related data of the two groups,there was statistical significance at the time of surgery,posterior malleolar fracture fixation group is more than non fixation group;at postoperative weight-bearing time,the fixation group is earlier than nonfixation group;at the AOFAS score,the fixation group was better than that in the non fixation group,and the two groups had no traumatic osteoarthritis.In the cases whose posterior malleolar fracture is less than 25%of distal tibial articular surface,posterior malleolar fracture fixation group included9 cases(45%),and nonfixation group had 11 cases(55%).By comparing the related data of the two groups,there was statistical significance at the time of surgery,posterior malleolar fracturefixation group is more than non fixation group;at postoperative weight-bearing time,the fixation group is earlier than nonfixation group;at the AOFAS score,the fixation group was more than 90 scores as same as that the non fixation group,which was satisfactory and the two groups had no traumatic osteoarthritis.Conclusion:In the cases whose posterior malleolar fracture is not less than 25%distal articular surface of tibia.Compared with the posterior ankle nonfixation group,the posterior ankle fixation group was earlier on the weight-bearing time,had higher scores at AOFAS,and had better clinical outcome.In the case of posterior malleolar fracture is less than 25%distal tibial articular surface,the posterior malleolus fixation group is earlierthan nonfixation groupon the weight-bearing time,but the surgery time is longer.at the AOFAS score,the fixation group was more than 90 scores as same as that the non fixation group.And the two groups were not different on clinical outcome.At the same time,fixation increased the operationcost of the patient,and brought greater trauma,so we do not need to internal fixation for posterior malleolar fracture,and plaster external fixation will be suitable for such patients.