Epidemiological And Clinical Prognosis Study Of Posterior Malleolar Fractures

Part 1 Epidemiological study of adult posterior malleolar fractures in Peking University Shenzhen Hospital from 2013 through 2017Objective: To investigate the epidemiological characteristics and trends of adult posterior malleolar fractures in Peking University Shenzhen Hospital in 5 years.Methods: We retrospectively analyzed the clinical data of adult posterior malleolar fractures which had been treated in Peking University Shenzhen Hospital from 2013 through 2017.The patients from January 2013 to June 2015 were assigned into group A,while those from July 2015 to December 2017 were assigned into group B.The patients,age,gender,admission period and fracture Weber type were recorded.The general epidemiological characteristics and trends of adult posterior malleolar fractures were summarized.Results: 124 cases of adult posterior malleolar fractures were collected.There were 49 cases in group A,75 in group B.There were 54 males and 70 females.There were 16 cases in the age group of 15 to 29 years,53 in the age group of 30 to 44 years,42 in the age group of 45 to 59 years,and 13 in the age group of ?60 years.There were no Weber A fractures,75 type Weber B ones,43 type Weber C ones and 6 ones without involvement of fibular fractures,with a ratio of Weber B to Weber C of 1.74:1.The ratio of Weber B to Weber C had not statistical significance between admission periods,age groups or genders(P>0.05).There was no significant difference either in constituent ratios of age groups or constituent ratios of genders between different admission periods(P>0.05).However,the difference in constituent ratios of genders was significant between different age group(P<0.05).Conclusion: The incidence of adult posterior malleolar fractures increased from 2013 to 2017 in Peking University Shenzhen Hospital.Most of the fractures were type Weber B.There were more female patients than male ones.The fractures peaked in an age range of 30 to 59 years.The male to female ratio in the age group of ?60 years was lower than that in the age groups of 15 to 29 years.Part 2 Influence of fragment size and operative choice on outcome of posterior malleolar fracturesObjective: To investigate the surgical indications of posterior malleolar fractures by comparing the effect of fragment size and internal fixation of posterior malleolar fractures on the prognosis of trimalleolar fractures.Methods: The clinical data of 81 patients with trimalleolar fractures who underwent surgical treatment in Peking University Shenzhen Hospital from 2013 to 2017 were retrospectively analyzed.According to the fragment size of posterior malleolar fractures in distal tibial articular surface,they were divided into three groups: A(<10%),B(10%-25%),C(>25%).AOFAS and VAS scores were used as functional evaluation indexes.Articular smoothness and degeneration in the X-ray films were considered as image evaluation criteria.The prognosis of patients with fixation of posterior malleolar fractures among the three groups and the prognosis between patients with fixation and non-fixation of posterior malleolar fractures in group A and group B were compared.Results: 63 patients completed the follow-ups which ranged from 9 to 27 months with an average follow-up period of(16.9±5.2)months.There were 31 cases in group A,24 in group B,8 in group C.There were no nonunions.Irregular articular surface was observed in 3 cases and mild degeneration in 2 cases during follow-up.There was no significant difference in VAS score among all groups(P>0.05).AOFAS score of patients with fixation of posterior malleolar fractures in group C was lower than that of group A and group B(P<0.05).AOFAS score had not significant difference between patients with fixation and non-fixation of posterior malleolar fractures in group A(P>0.05),but,there was significant difference in group B(P<0.05).Conclusion: The fragment size of posterior malleolar fractures has a part on the prognosis of trimalleolar fractures.When the fragment is more than 25%,the prognosis is relatively poorer.When the fragment is more than 10%,internal fixation should be considered.When the fragment is less than 10%,conservative treatment may be a better choice.