距骨后突内侧结节骨折的治疗

目的探讨距骨后突内侧结节骨折的治疗方法。方法回顾性分析2002年3月～2010年4月收治的11例距骨后突内侧结节骨折,新鲜骨折9例,其中采用切开复位克氏针固定1例,可吸收螺钉固定1例,Herbert螺钉固定3例,石膏外固定4例;陈旧性骨折2例,其中行骨块切除术1例,非手术治疗1例。结果随访6个月~3年,采用美国足踝关节协会后足评分系统评价:优5例,良3例,可1例,差2例。结论距骨后突内侧结节骨折易漏诊,多合并临近部位骨折,应根据受伤时间,是否累及距下关节面,骨折块大小、移位程度及踝管刺激症状等选择治疗方法;一期切开复位坚强内固定预后较佳。

Treatment of medial tubercle fracture of posterior process of talus

Objective To explore the treatment of the medial tubercle fracture of the posterior process of the talus.Methods From Mar.2002 to Apr.2010,data of 11 patients with the medial tubercle fracture of the posterior process of the talus was reviewed retrospectively,which contained 9 cases of fresh fractures and 2 cases of old fracture.In the 9 cases of fresh fractures,5 cases were treated by open reduction and internal fixation(1 case by Kirschner wire,1 case by absorbable screw,3 cases by Herbert screw),and the rest 4 cases were treated by plaster cast.One of the two old fractures underwent excision of fracture fragments,and the other one underwent non-operative treatment.Results Eleven patients were followed up for 6 months to 3 years.The outcome was evaluated according to American Orthopedic Foot&Ankle Society System.Excellent result was achieved in 5 cases,good in 3 cases,fair in 3 cases and poor in 2 cases.Conclusion The medial tubercle fracture of the posterior process of the talus,frequently combined with nearby fractures,were easily ignored.Treatment should be chosen based on the time of injury,involving the subtalar joint surface or not,the fracture fragment size,degree of displacement and the stimulating symptoms of condylar canal.The satisfactory outcome can be achieved by one-stage open reduction and rigid internal fixation.