踝部特殊类型骨折的治疗

目的：对踝部骨折中特殊类型骨折的治疗方法进行探讨。方法：分析我院1988-2002年治疗的31例特殊类型骨折的治疗特殊性。结果：所有病例平均随访6个月，疗效用Leeds评估，优19例，良10例，差2例，优良率96.7％。结论：重视特殊类型踝关节骨折的I临床诊断，注意手术前后区别处理，强调其特殊性，从而获得良好治疗效果。     

Ankle Fractures: Supination-Eversion Fractures Stage II Primary and Late Results of Operative and Non-Operative Treatment

Sixty-nine patients with stage II supination-eversion fractures of the ankle, 34 treated by operation and 35 treated conservatively, were seen at follow-up after 3–10 years. There was no statistically significant difference between the results of the two methods. However, larger series and perhaps a longer observation time are probably needed to decide whether the displacement of the lateral malleolus as a result of non-operative treatment affords the same possibility of unhindered ankle function as union of the lateral malleolus in the anatomical position obtained by operation.     

Ankle Fractures Treated by Fixation of the Medial Malleolus Alone: Late Results in 29 Patients

A review of 29 patients with unstable ankle fractures treated by fixation of the medial malleolus alone is presented. At follow-up the result in 16 patients was classified as unsatisfactory or a failure and all of these patients showed radiological signs of posttraumatic arthrosis deformans. The importance of the position of the lateral malleolus in order to prevent joint incongruity and subsequent arthrosis is emphasized.     

Classification of Trochanteric Fractures

A comparative analysis of the information contained in five different classification systems was performed.

The system classifying the fractures into five types in relation to the comminution of the calcar femorale or greater trochanter was found to be superior to the others, as it contained the most reliable information about the possibility of obtaining stable fracture reduction and gave the most accurate prediction of the risk of secondary fracture dislocation.     

Ankle and Foot Fractures in Diabetics Provoking Neuropathic Joint Changes

Neuropathic joint changes, Charcot joints, in diabetics developing after ankle or foot fractures have received little attention in the literature. Three cases are presented here, one in a previously undiagnosed diabetic. the pathogenesis and the management are discussed, and the importance of adequate protection of these fractures is emphasized. Even fractures of the metatarsal bones should be immobilized and weight—bearing must be postponed until the bone is firmly united.     

Classification of Medial Fractures of the Femoral Neck

The femoral neck angles were determined in 48 pairs of normal specimens from cadavers of elderly Norwegians, 24 males and 24 females. The anteversion angle was found to average 10.4°±6.7° and the neck-shaft angle 127.7°± 7.6°. There were no significant differences between the sexes.

The bilateral differences were analysed. The 95 per cent confidence limits of the anteversion and head-neck-shaft angles were calculated to be 11.8 and 13.8 degrees, respectively.     

Which Ankle Fractures Require Syndesmotic Stabilization?

Syndesmotic ruptures associated with ankle fractures are most commonly caused by external rotation of the foot, eversion of the talus within the ankle mortise, and excessive dorsiflexion. The distal tibiofibular syndesmosis consists of the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, and interosseous ligament, and it is essential for stability of the ankle mortise. Despite the numerous biomechanical and clinical studies pertaining to ankle fractures, there are no uniform recommendations regarding the use of the syndesmotic screw for specific injury patterns and fracture types. The objective of this review was to formulate recommendations for clinical practice related to the use of syndesmotic screw placement.     

Intra-Articular Fractures of the Distal Tibia

In a study of 23 intra-articular fractures of the distal tibia of which 18 were re-examined after an average follow-up period of 5.4 years, two major fracture patterns were identified: type A, a rotational pattern, caused by low energy trauma and type B, a compressive fracture pattern caused by high energy trauma. Type B fractures could be divided into three subgroups: 1) An isolated fracture of the anterior or posterior margin of the distal tibia, 2) an extra-articular comminuted fracture with extension into the ankle joint and 3) a comminuted intra-articular fracture.

When the initial displacement and comminution were severe or the reduction was not complete, the final results of the comminuted intra-articular fractures were not acceptable. The incidence of osteoarthritis was highest in the group of comminuted intra-articular fractures. The extra-articular comminuted fractures seemed to have a better prognosis as indicated by the final clinical results, including the occurrence of osteoarthritis.

It is clear from this study that comminuted intra-articular fractures should not be treated by primary operation. All fractures treated non-operatively had acceptable final clinical results.     

三踝骨折及其手术治疗

从1986年5月～1996年1月收治三踝骨折24例,手法整复6例,余18例经开放整复内固定术治疗。采用螺丝钉固定内踝13例,外踝6例,后踝8例;外踝经克氏针固定5例,克氏针加钢丝固定1例。作者认为三踝骨折是复合性的踝关节骨折,应尽早手术,解剖复位和坚固内固定,才能保证踝关节功能恢复,防止创伤性关节炎发生。本文提出了先外踝,再后、内踝的整复次序,尽早整复固定下胫腓骨韧带联合分离,重视对外踝的正确处理。     

Hip Fractures in the County of Funen,Denmark: Implications of Demographic Aging and Changes in Incidence Rates

In patients 40 years and above a total of 3096 hip fractures (783 in males and 2313 in females) occurred in the entire county of Funen, Denmark from 1 July 1973 to 30 June 1979. the incidence of hip fractures increased exponentially with age in both sexes. During the survey the number of hip fractures in females showed a marked increase above what could be explained by demographic aging alone, whereas this tendency was not so pronounced in males.

Provided the observed increase in incidence rates prevails, aging of the population in combination with this increase will lead to a threefold increase in the number of hip fractures over a 20-year period. This is substantially more than other Scandinavian authors have reported.     

Hip Fractures in the County of Funen, Denmark: Implications of Demographic Aging and Changes in Incidence Rates

In patients 40 years and above a total of 3096 hip fractures (783 in males and 2313 in females) occurred in the entire county of Funen, Denmark from 1 July 1973 to 30 June 1979. the incidence of hip fractures increased exponentially with age in both sexes. During the survey the number of hip fractures in females showed a marked increase above what could be explained by demographic aging alone, whereas this tendency was not so pronounced in males.

Provided the observed increase in incidence rates prevails, aging of the population in combination with this increase will lead to a threefold increase in the number of hip fractures over a 20-year period. This is substantially more than other Scandinavian authors have reported.     

Arthroscopic Assisted Fixation of Juvenile Intra-articular Epiphyseal Ankle Fractures

The purpose of this study was to present the long-term follow-up of a case series of arthroscopically assisted fixation of juvenile intraarticular epiphyseal ankle fractures. The functional and radiographic outcomes of 6 patients with a range of follow-up of 1 to 5 years were evaluated. Five of the 6 patients had triplane injuries, whereas the remaining patient sustained a juvenile Tillaux fracture. All of the patients returned to full activity within 14 weeks of surgery, and none of the patients had any restriction in the ankle range of motion at the time of last follow-up. The results of this small series of patients suggest that arthroscopic-assisted, percutaneous fixation of intraarticular juvenile epiphyseal ankle fractures is an effective, less invasive surgical technique. Several surgical maneuvers that are helpful in the consistent execution of this technique are also mentioned.     

复杂闭合性踝关节骨折的治疗

目的　探讨复杂闭合性踝关节骨折的治疗方法。　方法　将 82例 85侧AO Danis Weber分型中的B、C型踝关节骨折的患者 ,随机分为两组。A组 3 0例 3 3侧采用闭合复位石膏外固定 ,B组 5 2例 5 2侧采用开放复位内固定治疗。比较两组患者踝关节疼痛、肿胀、功能恢复情况。　结果　参照Teenny和Wiss评分系统 ,A组的优良率为 3 6% ,B组的优良率为 70 % ,B组疗效优于A组 (P <0 .0 5 )。　结论　开放复位内固定是治疗复杂踝关节骨折的有效方法。