Maisonneuve fracture associated with a bimalleolar ankle fracture-dislocation: a case report

The Maisonneuve fracture consists of a proximal fibular fracture with associated syndesmotic ligament disruption and injury to the medial ankle structures. The accepted mechanism of injury is an external rotation force applied to the ankle with the foot in either supination or pronation. Because most Maisonneuve fractures involve complete syndesmotic disruption, operative treatment is usually indicated. A case report is presented of an unusual fracture pattern-i.e., that of a distal fibular fracture with lateral ankle dislocation associated with a Maisonneuve fracture. To our knowledge, only two other similar cases are reported in the English literature.     

Posterior Tibial Tendon Rupture Associated With Anterolateral Distal Tibial and Medial Malleolar Fracture and a Novel Pattern of Tibiofibular Syndesmotic Injury: A Case Report and Review of the Literature

A posterior tibial tendon (PTT) rupture associated with ankle fractures is a very rare condition. Ankle pronation and external rotation (PER) movement are the typical traumatic mechanism. This injury is frequently overlooked preoperatively. Early diagnosis and treatment are very important to prevent the serious consequences related to functional PTT insufficiency on biomechanics of the foot. Few cases have been described in the literature that highlight the relationship between PTT rupture and PER type ankle fracture with a medial malleolar fracture. We present a case of a complete PTT rupture in a closed atypical ankle fracture in which a medial malleolar fracture was associated with a very large fragment from the anterolateral distal tibia (Tillaux-Chaput fragment) and a concomitant avulsion fracture from the anteromedial portion of the fibula (Lefort-Wagstaffe fragment), with a novel pattern never described before.     

False negative rate of syndesmotic injury in pronation-external rotation stage IV ankle fractures

Background:

To investigate false negative rate in the diagnosis of diastasis on initial static anteroposterior radiograph and reliability of intraoperative external rotational stress test for detection of concealed disruption of syndesmosis in pronation external rotation (PER) stage IV (Lauge-Hansen) ankle fractures.

Materials and Methods:

We prospectively studied 34 PER stage IV ankle fractures between September 2001 and September 2008. Twenty (59%) patients show syndesmotic injury on initial anteroposterior radiographs. We performed an intraoperative external rotation stress test in other 14 patients with suspicious PER stage IV ankle fractures, which showed no defined syndesmotic injury on anteroposterior radiographs inspite of a medial malleolar fracture, an oblique fibular fracture above the syndesmosis and fracture of the posterior tubercle of the tibia.

Results:

All 14 fractures showed different degrees of tibiofibular clear space (TFCS) and tibiofibular overlapping (TFO) on the external rotation stress test radiograph compared to the initial plain anteroposterior radiograph. It is important to understand the fracture pattern characterstic of PER stage IV ankle fractures even though it appears normal on anteroposterior radiographs, it is to be confirmed for the concealed syndesmotic injury through a routine intraoperative external rotational stress radiograph.     

Traumatic rupture of the tibialis posterior tendon after ankle fracture: a case report

Degenerative tears of the posterior tibial tendon associated with chronic disease are well documented in the literature. Traumatic ruptures of this tendon, however, are much less common and consequently have received little attention. An association has been shown between pronation-external rotation ankle fractures and tears of the tendons that cross the medial aspect of the ankle, most commonly the posterior tibial tendon. In the present case report, we share our unique experience of an open-ankle fracture associated with the traumatic rupture of the posterior tibial tendon. This injury illustrates that soft-tissue injury must always be suspected concomitantly in the treatment of certain fractures on the basis of both mechanism of injury and fracture pattern.     

Relationship between fracture morphology of lateral malleolus and syndesmotic stability after supination-external rotation type ankle fractures

BackgroundSyndesmotic injury with supination-external rotation (SER)-type ankle fractures are well known for the serious damages to the osseous and soft tissue envelope. However, the Lauge-Hansen classification system does not provide sufficient information related to syndesmotic injury. In this study, we aimed to investigate factors for preoperative detection of syndesmotic injury according to fracture patterns in SER III and IV ankle fractures by using radiography and computed tomography (CT).MethodsAll operative SER III and IV ankle fractures treated by a single surgeon from 2009 to 2015 were enrolled in a retrospective database. Based on computed tomographic evidence and intra-operative Cotton test, stable and unstable groups of the ankle factures were divided.ResultsA total of 52 patients with SER III, 75 patients with SER IV, and 27 patients with SER IV equivalent ankle fractures were identified, with 106 in the unstable syndesmosis group (68.8%) and 48 patients in the stable syndesmosis group (31.2%). Medial space widening and fragment angle of the fibular posterior cortex were significant predictors. The cutoff values of these factors were 4.4 mm and 32.8 degrees, respectively.ConclusionsCT was superior to simple radiography in predicting syndesmotic injury at the preoperative period in SER-type III and IV. Medial space widening and fragment angle of the fibular posterior cortex, as predictive factors, showed significant correlations. In particular, sharper fragment angle of the posterior cortex indicated higher probability of instability that remained after fracture fixation.     

Tibial shaft fracture and ankle joint injury

OBJECTIVE: Detection of tibial fractures in which a concomitant ankle injury may exist. DESIGN: Prospective study. SETTING: Department of Trauma Surgery, University Hospital. PATIENTS: 43 (20.1%) of 214 patients with a tibial fracture were found to have an associated injury of the ankle joint. INTERVENTION: Analysis of all patients with tibial fractures regarding typical mechanisms of injuries and typical radiographic criteria for concomitant injuries of the ankle joint. MAIN OUTCOME MEASURES: Primary x-rays were analyzed looking for spiral fractures of the tibia or proximal fibular fractures or an intact fibula, typically associated with syndesmotic injury. The assessment of patients was based on radiological findings and functional recovery. RESULTS: 45 ankle injuries in 43 patients were found. There were distal fibular fractures in 14, Maisonneuve fractures in 13, isolated ruptures of the syndesmosis in 3, fractures of the posterior malleolus in 8, and fractures of the medial malleolus in 7 of the cases. In 38 of the 43 patients, the distal tibiofibular syndesmosis was ruptured, and 88.4% of the tibia injuries were spiral fractures located in the distal third. Of the 38 patients who could be followed, 31 were categorized according to the Phillip's Score as very good, 3 as good, 2 as satisfactory, and 2 as unsatisfactory after an average of 19.8 months (12-26). CONCLUSION: Due to the obvious injury of the tibia, the potential instability of the ankle joint is often overlooked, and the risk of development of secondary osteoarthritis is often consequently underestimated. Added attention should be paid to the ankle in the following tibial fracture cases: pronation-eversion trauma, spiral fracture of the tibia, proximal fibular fracture, or intact fibula. Using these markers, we were able to diagnose 20.1% of combined injuries compared to our retrospective study in 1999, in which only 13.6% of these injuries could be detected (Pearson r=0.1305, not significant).     

Evaluation of Lauge-Hansen Designation of Weber C Fractures

Associations between Weber C ankle fractures and pronation external rotation (PER) injuries of the Lauge-Hansen classification have often been incorrectly correlated. The purpose of the present study was to evaluate the Lauge-Hansen designation of Weber C fractures by establishing the proportion of Weber C fractures that are supination external rotation (SER), supination adduction (SA), pronation abduction (PA), PER, and hyperplantarflexion variant fractures. A clinical database of operative ankle fractures treated by the senior author (D.G.L.) was reviewed. The inclusion criteria were patient age older than 16 years, preoperative ankle radiographs, and Weber C fracture designation. A total of 132 patients met the inclusion criteria, and the proportion of PA, PER, SER, SA, and variant fractures among the Weber C fractures was analyzed. PA fractures accounted for 0.8% (n = 1), PER fractures 56.8% (n = 75), SER fractures 35.6% (n = 47), and hyperplantarflexion variant fractures 6.8% (n = 9) of the 132 Weber C fractures. Patients with Weber C-PER fractures were more commonly male (p = .005) and younger (p = .003) and demonstrated a greater fibular fracture height (p < .001) than those with Weber C-SER and Weber C-variant fractures. Our study quantitatively demonstrated that not all Weber C fractures occur secondary to pronation injuries. This distinction is important, because all pronation injuries will demonstrate medial ankle injury, but SER and variant fractures might not. We therefore recommend careful evaluation of the fibular fracture characteristics, including the direction of fracture propagation and the distance from the tibial plafond, when classifying Weber C fractures using the Lauge-Hansen system, because correct classification is vital in preparation for appropriate operative treatment.     

Fracture of the tibia with additional injury of the ankle joint. A frequent and undervalued combination

Summary There are 2 types of a combined tibia fracture and ankle injury: in Type I the tibia fracture extends directly into the ankle joint, in Type II the tibia fracture goes along with a fracture of the fibula and disruption of the fibular-tibial syndesmosis. This type of fracture must be distinguished from a pilon tibiale fracture. The typical mechanism for this combined tibia and ankle injury is the indirect torsional trauma with pronation-eversion. From 1995 to 1997 188 patients with fractures of the tibia were treated by internal fixation in our Trauma Department. 27 of these patients (13.6 %) had a combined tibia and ankle injury. Most of the tibia fractures were located in the distal third, a spiral fracture (16 patients) or a comminuted fracture (6 patients), and another group extending directly into the ankle (5 patients). The ankle lesion was a distal fibular fracture (Weber Typ B + C) in 14 patients, a proximal fibular fracture (Type maisoneuve) in 6 patients, a postero-lateral fragment in 11 cases and a fracture of the medial melleolus in 10 cases. A disrupture of the anterior tibio-fibular syndesmosis was seen in 18 patients, 3 times as an isolated lesion of the ankle joint without fracture of the fibula. The osteosynthesis of the tibia fracture was performed with an unreamed tibia nail in 20 patients, with elastic-biologic plate fixation in 6 and with external fixation in 1 patient. The fibula fractures were stabilized by small fragment titaneum plates, the dorsolateral fragment and the medial malleolus were stabilized by lag-screws, the tibio-fibular ligament was sutured and, in a few cases only, held in place by a positioning screw. The outcome was controlled after 20,7 month according to the Phillip's Score (1996). We found not more than one pour results. It must be considered, that most of the combined injuries of the tibia and the ankle joint concerning 13,6 % of all tibia shaft fractures are usually not recognized and may result in an arthrosis of the ankle joint. The attention should be focused to the ankle joint in any spiral fractures of the distal tibia after indirect trauma, especially with a proximal fibular fracture or an intact fibula. Additional X-ray examination of the ankle joint is recommended during internal fixation of the tibia. Posttraumatic arthrosis of the ankle joint can be prevented by diagnosis and adequate anatomical reconstruction of the additional ankle joint injury.      

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.     

Fracture of the tibia with additional injury of the ankle joint. A frequent and undervalued combination Eine h?ufige, aber wenig beachtete Kombination

There are 2 types of a combined tibia fracture and ankle injury: in Type I the tibia fracture extends directly into the ankle joint, in Type II the tibia fracture goes along with a fracture of the fibula and disruption of the fibular-tibial syndesmosis. This type of fracture must be distinguished from a pilon tibiale fracture. The typical mechanism for this combined tibia and ankle injury is the indirect torsional trauma with pronation-eversion. From 1995 to 1997 188 patients with fractures of the tibia were treated by internal fixation in our Trauma Department. 27 of these patients (13.6 %) had a combined tibia and ankle injury. Most of the tibia fractures were located in the distal third, a spiral fracture (16 patients) or a comminuted fracture (6 patients), and another group extending directly into the ankle (5 patients). The ankle lesion was a distal fibular fracture (Weber Typ B + C) in 14 patients, a proximal fibular fracture (Type maisoneuve) in 6 patients, a postero-lateral fragment in 11 cases and a fracture of the medial melleolus in 10 cases. A disrupture of the anterior tibio-fibular syndesmosis was seen in 18 patients, 3 times as an isolated lesion of the ankle joint without fracture of the fibula. The osteosynthesis of the tibia fracture was performed with an unreamed tibia nail in 20 patients, with elastic-biologic plate fixation in 6 and with external fixation in 1 patient. The fibula fractures were stabilized by small fragment titaneum plates, the dorsolateral fragment and the medial malleolus were stabilized by lag-screws, the tibio-fibular ligament was sutured and, in a few cases only, held in place by a positioning screw. The outcome was controlled after 20,7 month according to the Phillip's Score (1996). We found not more than one pour results. It must be considered, that most of the combined injuries of the tibia and the ankle joint concerning 13,6 % of all tibia shaft fractures are usually not recognized and may result in an arthrosis of the ankle joint. The attention should be focused to the ankle joint in any spiral fractures of the distal tibia after indirect trauma, especially with a proximal fibular fracture or an intact fibula. Additional X-ray examination of the ankle joint is recommended during internal fixation of the tibia. Posttraumatic arthrosis of the ankle joint can be prevented by diagnosis and adequate anatomical reconstruction of the additional ankle joint injury.     

Traumatic rupture of the tibialis posterior tendon after closed ankle fractures: A report of two cases

Summary We report two cases of posttraumatic complete rupture of the tibialis posterior tendon that occurred during closed fractures of the medial malleolus. A low located fracture of the medial malleolus and an intense forced pronation, external rotation and dorsiflexion of the foot have been involved in the physiopathogeny of that rupture. At each intervention, the tibialis posterior tendon had been disrupted above the upper edge of the groove of the medial retinaculum of the ankle. After tendon suture concomitant with osteosynthesis, the evolution was favourable. Failing to appreciate this tendon rupture, although rare, can be at the origin of residual pains and a functional deficit of foot reversion.     

Compatibility of Lauge-Hansen Classification Between Plain Radiographs and Magnetic Resonance Imaging in Ankle Fractures

We evaluated the accuracy of the predictive injury sequences of the Lauge-Hansen (L-H) classification using magnetic resonance imaging (MRI) in patients with ankle fractures and determined the possible causes of mismatch. Sixty-five patients with ankle fractures who had a complete series of anteroposterior, lateral, and oblique radiographs and ankle MRI studies available were included. The fracture pattern was assigned by 2 senior orthopedic surgeons according to the L-H classification system. The syndesmotic ligaments, lateral collateral ligaments, and medial deltoid complex ligaments were evaluated on the preoperative MRI scans. Comparisons were performed between the predicted ankle ligamentous injury based on the radiographic L-H classification and preoperative MRI analysis. Of the 65 feet in 65 patients, 50 feet (76.9%) were classified as having a supination-external rotation (SER) fracture, 6 feet (9.2%) as having a pronation-external rotation fracture, 4 feet (6.2%) as having a supination adduction fracture, and 2 feet (3.1%) as having a pronation abduction fracture. The overall compatibility of the radiologic classification with the MRI classification was 66.1%. In the evaluation of 50 feet with the MRI SER designation, maximum compatibility was found for stage 4 (77.3%). The main cause for the discrepancy in the SER designation was missing the presence of deltoid ligament disruption on the plain radiographs, especially in the stage 2 and 3 SER fracture pattern. In the evaluation of deltoid complex injuries, all injuries were localized to the anterior part of the medial deltoid complex. The validity of the L-H classification system was low. A new classification system is needed to address the medial malleolus fracture or deltoid complex injuries without posterior injury. Also, stress radiographs could be added to standard radiographs for the classification to address deltoid complex injuries.     

Arthroscopic findings in Maisonneuve fractures

Background A Maisonneuve fracture consists of a proximal fibular fracture with associated syndesmotic ligament disruption and injury to the medial ankle structures. The treatment outcome is good in most cases, although poor results have also been reported. The purpose of this study was to investigate intra-articular lesions in Maisonneuve fractures. Methods The subjects consisted of four patients (four ankle joints) who had suffered a Maisonneuve fracture and had undergone surgical treatment between June 2005 and November 2005. The mean age was 24. 2 years. At the time of surgery, we performed ankle arthroscopy and determined the presence of tibiofibular syndesmosis disruption, cartilaginous damage, and ligament damage. Lesions of the articular cartilage were graded by depth as determined by inspection and probing. Results All four of the cases had cartilaginous damage to the medial section of the talar dome. Lateral lesions were not observed. Chondral debris and hemarthrosis were noted in virtually all cases, and each ankle had a tear on the anterior inferior tibiofibular ligament and interosseous tibiofibular ligament. No patients had a tear of the posterior inferior tibiofibular ligament. Conclusions Arthroscopy was useful in identifying associated intra-articular lesions in Maisonneuve fractures.     

踝关节旋后外旋、旋前外旋Ⅳ型骨折三角韧带修复效果比较

目的比较旋后外旋(SER)Ⅳ型、旋前外旋(PER)Ⅳ型踝关节骨折三角韧带断裂修复治疗的治疗效果。 方法回顾性分析首都医科大学宣武医院骨科于2016年1月至2018年1月收治的SER、PER Ⅳ型踝关节骨折患者。纳入标准：三角韧带断裂;随访超过1年。排除标准：年龄≥70岁、踝关节存在陈旧性损伤、内踝骨折、同侧下肢其他部位骨折、开放性骨折、无法配合功能锻炼、病理性骨折。按照纳入排除标准,共有68例纳入本研究,SER组47人,PER组21人。评估两组患者术后1年后的踝关节美国足踝外科协会(AOFAS)评分、生活质量(QOL)评分,采用t检验比较两组之间的差异。 结果SER组患者的踝关节功能恢复情况优于PER组(t＝8.314,P<0.05);SER组的躯体健康优于PER组患者(t＝0.766,P<0.05)、但精神健康方面两组患者基本一致(t＝0.452,P>0.05),合计SF-36的总分后,发现两组患者的QOL无明显差异(t＝0.172,P>0.05)。 结论踝三角韧带断裂行修复后,SER Ⅳ型骨折患者的踝关节功能恢复情况、躯体QOL比PER Ⅳ型患者好,但是两组患者的精神健康QOL、总体QOL基本一致。     

Ankle Fracture with a Complex Injury Mechanism and Misleading Hook Test Result: A Case Report

Ankle fractures and their mechanisms of injury can be complex. We report a case of a patient with an uncertain mechanism of injury and an uncommon combination of lower extremity fractures, which fit the criteria for a Lauge-Hansen classification pronation-external-rotation fracture, Maisonneuve fracture, Wagstaffe fracture, and posterior pilon fracture. Plain radiographs and computed tomography scan revealed Chaput tubercle avulsion fractures, an anterior distal fibular fracture fragment, multiple lateral malleolar fractures, a posterior malleolar fracture fragment with proximal displacement, a die-punch fragment between the posterior malleolar fragment and the tibia, a proximal fibular fracture, and possible ankle syndesmotic diastasis. Intraoperative hook test was negative after fixation of the fractures, so syndesmotic fixation was not performed. At 3-month follow-up, plain radiographs showed obvious syndesmotic diastasis. At 1-year follow-up, symptoms persisted and syndesmotic fusion was recommended but declined by the patient. This case demonstrates that both ankle fractures and their mechanisms of injury can be remarkably complex and confusing, posterior pilon fractures can occur along with pronation-external-rotation ankle fractures, syndesmotic fixation should be considered for all patients with Maisonneuve fractures, reliance on the hook test for surgical management decisions may not always be reliable, and there exists a need for a more accurate and reliable intraoperative test to determine the presence of ankle syndesmotic injury.     

The association between medial malleolar fracture geometry,injury mechanism,and syndesmotic disruption

BackgroundPrecise correlations between medial malleolar fracture geometry and fracture mechanism have not been thoroughly described. This study sought to determine the prevalence of different medial malleolar fracture types and to elucidate the association between fracture geometry and fracture mechanism.MethodsThe records of 112 medial malleolar ankle fractures were reviewed. For each fracture, the direction of the fracture line in the medial malleolus (transverse, oblique, vertical, or comminuted), the Lauge-Hansen classification, and the presence or absence of syndesmotic injury was recorded. Bivariate correlation analysis was performed to determine if correlations existed.ResultsTransverse fractures were the most prevalent type of medial malleolar fracture [n = 64 (57%)], and they correlated with supination-external rotation injuries. These were followed by oblique fractures [29 (26)], which correlated with pronation-external rotation injuries [29 (26)], and vertical fractures [7 (6)], which correlated with supination-adduction injuries [9 (8)]. Comminuted fractures [12 (11)] and pronation-abduction injuries [22 (20)] did not correlate with any other categories. Syndesmotic injuries were correlated with transverse fractures, bimalleolar fractures, and pronation-external rotation injuries.ConclusionMedial malleolar fractures can be divided into four fracture types: transverse fractures, which correlated with supination-external rotation injuries; oblique fractures, which correlated with pronation-external rotation injuries; vertical fractures, which correlated with supination-adduction injuries; and comminuted fractures, which did not correlate with a particular type of injury. Syndesmotic injury was positively correlated with transverse fractures of the medial malleolus, bimalleolar fractures, and pronation-external rotation injuries. These findings suggest that medial malleolar fracture geometry can provide valuable information for the clinician when classifying and managing ankle fractures.     

Zur Diagnostik der Bandverletzungen des oberen Sprunggelenks

Solitary rupture of ligaments of the upper ankle mostly are caused by injury of supination, more seldom by injury of pronation. The anterior and posterior syndesmosis may be damaged by forced rotation of the foot, if the foot is fixed in 90 degrees or in dorsal extension. Diagnosis of rupture of the fibular ligaments bases on physical examination and is completed by x-ray examination: pressed x-ray pic tures in two levels, whereby beside the angle between tibia and talus and beside the anterior displacement of foot the increasing distance between talus and the tip of the fibula is of special importance. It is given account of 390 own cases within one year. Damage of the deltoid ligament and the anterior and posterior syndesmosis is diagnosed by physical examination and pressed x-ray pictures respectively arthrography. The diagnosis of these injuries is the precondition for sufficient treatment     

Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures

BACKGROUND: Isolated distal fibular fractures most commonly result from a supination-external rotation injury of the ankle. Deltoid ligament ruptures can also be associated with these injuries, resulting in an unstable ankle fracture due to incompetent lateral and medial restraints. We hypothesized that a gravity stress radiograph is equivalent to a manual stress radiograph for the detection of deltoid ligament injury in association with an isolated fibular fracture. METHODS: All patients presenting to a level-1 trauma hospital emergency department with an isolated fibular fracture were screened. Ankle stability was determined on the basis of radiographic measurements of the medial clear space and talar shift. A manual stress radiograph and a gravity stress radiograph of the injured ankle were made for each patient. The manual stress radiograph was used to determine whether the ankle was stable or unstable. RESULTS: A total of twenty-five patients (thirteen with a supination-external rotation type-II fracture and twelve with a supination-external rotation type-IV-equivalent injury) were enrolled in the study. In the type-II group, the average medial clear space was 4.15 and 4.26 mm on the manual and gravity stress radiographs, respectively (p = 0.50). In the type-IV group, the average medial clear space was 5.21 and 5.00 mm on the manual and gravity stress radiographs, respectively (p = 0.69). CONCLUSIONS: The gravity stress radiograph is equivalent to the manual stress radiograph for determining deltoid ligament injury in association with an isolated distal fibular fracture, and thus it can be used to determine ankle stability in patients who present with an isolated distal fibular fracture.     

三角韧带深层损伤是否影响旋前外旋型踝关节骨折的中期临床疗效

目的了解三角韧带深层损伤对PER型踝关节骨折中期临床疗效的影响。方法回顾性研究2013年1月至2014年12月北京积水潭医院创伤骨科手术治疗的50例PERⅢ度或Ⅳ度骨折患者。其中男37例,女13例;年龄16~68岁,平均30.2岁。根据踝关节内侧损伤类型分为两组:未修复组为内踝三角韧带深层损伤且无内踝骨折患者,未行三角韧带修复手术,共28例;对照组为内踝丘上骨折且三角韧带深层完整患者,行内踝丘上骨折切开复位内固定,共22例。两组患者均行腓骨骨折切开复位内固定和下胫腓螺钉固定。比较两组患者术后6个月以上影像学检查的内踝间隙和下胫腓间隙,以及中期随访的美国足踝外科协会的(AOFAS)的踝-后足评分和疼痛视觉模拟评分(VAS)。结果两组患者的性别、年龄、出现踝关节半脱位或脱位时的表现方式差异有统计学意义(P<0.05)。两组患者在损伤暴力程度、腓骨骨折线高度、是否完全脱位、后踝骨折率、后踝固定率、内固定物取出率、手术时间等差异均无统计学意义(P>0.05)。38例完成术后6个月影像学检查,21例未修复组的内踝间隙为3.7 mm,下胫腓间隙为4.5 mm;17例对照组的内踝间隙为3.4 mm;下胫腓间隙为4.4 mm。术后约3年时随访,未修复组和对照组的平均AOFAS评分分别为98.3分和94.6分,平均VAS评分分别为0.4分和1.5分。术后约5年时随访,未修复组和对照组的平均AOFAS评分分别为97.1分和93.6分,平均VAS评分分别为0.5分和1.2分。对于年龄<45岁的患者,术后约3、5年时随访的AOFAS评分、VAS评分与三角韧带完整与否均无相关性(P>0.05)。年龄与术后5年随访时AOFAS评分(P=0.021)相关。结论对于PER型Ⅲ、Ⅳ度踝关节骨折,在腓骨骨折及下胫腓螺钉固定后,残留三角韧带深层损伤不会影响45岁以内患者的中期疗效。