Ankle and Foot Injury
A modified posterolateral approach for lateral and posterior malleolar fractures: a preliminary report
Wenlai Fang, Mochuan Chen, Liaojun Sun, Jianzhong Kong
Published 2020-01-15
Cite as Chin J Orthop Trauma, 2020, 22(1): 45-48. DOI: 10.3760/cma.j.issn.1671-7600.2020.01.008
Abstract
ObjectiveTo observe the clinical efficacy of internal fixation through a modified posterolateral approach in the treatment of lateral and posterior malleolar fractures.
MethodsFrom January 2015 to January 2018, 25 patients with fracture involving the lateral and posterior malleolus were treated at Department of Orthopedics, The Second Affiliated Hospital to Wenzhou Medical University. They were 13 males and 12 females, aged from 18 to 70 years (mean, 43.1 years). By the Lauge-Hansen classification for ankle injury, 9 cases belonged to supination-supination type of degree Ⅲ, 11 to supination-supination type of degree Ⅳ, and 5 to pronation-supination type of degree Ⅳ. By the Haraguchi classification, all the posterior malleolar fractures in this series belonged to type Ⅰ. Internal fixation through a modified posterolateral approach was performed for all the lateral and posterior malleolar fractures. Their operation time, fracture healing time and postoperative complications were observed. At the last follow-up, ankle joint function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.
ResultsIn the 25 patients, the operation time ranged from 50 to 100 min (mean, 70 min). Of this group, 21 patients were followed up for 12 to 18 months (mean, 14 months). Bony union was achieved after 3 to 5 months after operation. Superficial wound infection was observed in 3 cases. No such complications occurred like postoperative adhesion, deep infection, contracture of flexor hallucis longus tendon, or loosening or breakage of implants. By the AOFAS ankle-hindfoot scale at the last follow-up, the ankle function was excellent in 13 cases, good in 6 and fair in 2.
ConclusionThe modified posterolateral approach is worth popularizing in clinic because it provides possibilities of fixating the lateral and posterior malleolar fractures by the same incision, not stripping the muscular origins of the flexor hallucis longus and reducing postoperative adhesion of the flexor hallucis longus.
Key words:
Fractures, bone; Ankle joint; Fracture fixation, internal; Approach
Contributor Information
Wenlai Fang
Department of Orthopedics, The Second Affiliated Hospital to Wenzhou Medical University, Wenzhou 325027, China
Mochuan Chen
Department of Orthopedics, The Second Affiliated Hospital to Wenzhou Medical University, Wenzhou 325027, China
Liaojun Sun
Department of Orthopedics, The Second Affiliated Hospital to Wenzhou Medical University, Wenzhou 325027, China
Jianzhong Kong
Department of Orthopedics, The Second Affiliated Hospital to Wenzhou Medical University, Wenzhou 325027, China
长屈肌腱挛缩畸形、内固定松动、断裂等不良情况发生。末次随访时采用AOFAS的踝-后足评分评定疗效：优13例，良6例，可2例。
长屈肌起点，减少了
长屈肌术后粘连，值得推广。
长屈肌及腓骨长短肌间隙进入的后外侧入路是固定后踝骨块最常用的入路[5,6]。我们在该入路的实践中发现，少数患者出现了
趾的屈曲挛缩[4]。后内侧入路在暴露固定后踝骨折的应用，国内外学者亦有报道。经血管神经束及
长屈肌间隙进入的改良后内侧入路具有后踝暴露良好的优点[6]，但是邻近血管神经束有牵拉损伤的风险。我们自2015年1月至2018年1月结合上述两个入路采用后外侧入路，由
长屈肌内侧暴露后踝治疗了25例踝关节外踝后踝骨折患者，现通过回顾性研究就该入路的临床初步应用疗效报道如下。
