Cerrahi Tedavi uygulanmış Ayak Bileği Kırıklarının Klinik, Radyolojik ve Fonksiyonel Sonuçlarının Değerlendirilmesi

Abstract

Amaç: Ayak bileği vücudun yürüme fonksiyonunda önemli bir eklemdir. Deplase ve stabil olmayan kırıkların ve eklem uyumunun konservatif yöntemlerle sağlanamadığı durumlarda cerrahi tedavi gerekir. Cerrahi tedavinin temel amacı, normal bir tibiotalar eklem ilişki için talusun ayak bileği içindeki anatomik pozisyonunu sağlamaktır. Gereç ve Yöntem: Ocak 2006-Ekim 2015 tarihleri arasında polikliniğimize başvuran, ayak bileği kırığı tanısı alan ve cerrahi tedavi uygulanan 73 hasta retrospektif olarak sağlam ayak bileği ile karşılaştırıldı. Bulgular: Ameliyat olan hastalardan; 34'ünde bimalleol kırığı (%46.58), 8'inde (%10.96) trimalleol kırığı, 14'ünde lateral malleol kırığı (%19.18), 13'ünde medial malleol kırığı (%17.81), 1’inde posterior malleol kırığı ile birlikte ayak bileği çıkığı (%1.37) ve 1’inde de medial malleol kırığı ile birlikte arka malleol kırığı vardı (%1.37). Lauge Hansen sınıflamasına göre en sık SER (Supinasyon Eksternal Rotasyon) kırık tipi (14 olgu) (%19.18), ardından ikinci en sık PER (Pronasyon Eksternal Rotasyon) kırık tipi (14 olgu) (%19.18) görüldü. Danis - Weber sınıflamasına göre en sık Tip C (21 vaka) (% 52.50) ve ikinci en sık Tip B (14 vaka) (% 35,00) görüldü. Kaynama süresi kırık tipine göre incelendiğinde istatistiksel olarak anlamlı farklılık gözlenmedi (p=0,064). Sonuç: Ayak bileği kırıklarında cerrahi tedavi uygulanacaksa fibula uzunluğu sağlanmalı, eklem yüzeyinin anatomik olarak redükte edilmesi amacıyla rijit iç tespit yapılmalı ve ayak bileği hareketlerine erken başlanmalıdır.

Keywords

• Yetişkin
• Ayak Bileği Kırığı
• Cerrahi Tedavi

Evaluation of Clinical, Radiological and Functional Outcomes of Surgically Treated Ankle Fractures

Abstract

Objective: The ankle is an important joint in the walking function of the body. Surgical treatment is required in cases where displaced and unstable fractures and joint compatibility cannot be achieved by conservative methods. The main goal of surgical treatment is to restore the anatomical position of the talus within the ankle for a normal tibiotalar joint relationship. Methods: 73 patients who were admitted to our outpatient clinics between January 2006 and October 2015, who were diagnosed with ankle fracture and underwent surgical treatment, were retrospectively evaluated and compared with the intact ankle. Results: Of the patients who had surgery; Bimalleol fracture in 34 (46.58%), trimalleol fracture in 8 (10.96%), lateral malleolar fracture in 14 (19.18%), medial malleolar fracture in 13 (17.81%), with posterior malleolar fracture in 1 ankle dislocation (1.37%) and 1 had posterior malleolar fracture with medial malleolus fracture (1.37%). According to the Lauge Hansen classification, the most common type of SER (Supination External Rotation) fracture (14 cases) (19.18%), followed by the second most common PER (Pronation External Rotation) fracture type (14 cases) (19.18%). According to the Danis - Weber classification, Type C (21 cases) (52.50%) was the most common and Type B (14 cases) (35.00%) was the second most common. When the union time was analyzed according to the fracture type, no statistically significant difference was observed (p=0.064). Conclusions: If surgical treatment is applied in ankle fractures the length of the fibula should be ensured, rigid internal fixation should be made with the aim of anatomical reduction of the joint surface, and ankle movements should be started early.

Keywords

• ankle fracture
• Adult
• surgical treatment

References

1. 1. Breederveld RE, Straaten J. Immediate or delayed operative treatment of fractures of ankle. Injury 1988; 19 (6): 436-8.
2. 2-Gehr J, Friedl W. Intramedullary locked fixation and compression nail (IP-XSNail): treatment of ankle joint fractures. Oper Orthop Traumatol 2006 Jun; 18 (2): 155-70.
3. 3-Roberts RS. Surgical treatment of displaced ankle fractures. Clin Orthop Relat Res. 1983 Jan-Feb; 172: 164-70.
4. 4-Harish S, Vince AS, Patel AD. Routine radiography following ankle fracture fixation: a case for limiting its use. Injury 1999 Dec; 30 (10): 699-701.
5. 5-Lindsjö U. Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop 1985; 199: 28-38.
6. 6-Kennedy JG, Johnson SM, Collins AL, Dallo VP, McManus WF, Hynes DM, et al. An evaluation of the Weber classification of ankle fractures. Injury 1998; 29: 577-80.
7. 7-Harper MC, Hardin G. Posterior malleolar fractures of the associated with lateral rotationabduction injuries. J Bone Joint Surg Am. 1988; 70 (9): 1348-56.
8. 8-Ahl T, Dalen N, Selvik G. Ankle fractures. A clinical and roentgenographic stereophotogrammetric study. Clin Orthop Relat Res. 1989 Aug; 245: 246-55.

9. 9-Tabak AY, Günel U, Tasbas BA, Uçaner A, Ömeroglu H, Biçimoglu A. Surgical treatment and its results in ankle fractures. Arthroplasty Arthroscopic Surgery 1999; 10 (2): 165–9.
10. 10-. Boggs LR. Isolated posterior malleolar fractures. Am J Emerg Med 1986; 4: 334-6.
11. 11-Mandracchia DM, Mandracchia VJ, Buddecke DE Jr. Malleolar fractures of the ankle..A comprehensive review. Clin Podiatr Med Surg 1999; 16 (4): 679-723.
12. 12-Tornetta P 3rd, Creevy W. Lag screw only fixation of the lateral malleolus. J Orthop Trauma 2001; 15: 119-21.
13. 13-. Rittmann, WW., Schibli, M., Matter, P., Allgöwer, M .: Open Iractures long term results in 200 concetutive. your hand. Orthop. 138: 140, 1979.
14. 14. Joy, G., Patzakis, MJ .: Precise evaluation of the reduction ofsevere ankle 'raetures, J.Bone and Joint Surg. SS-AI 979-993, 1974.
15. 15-. Carragee EJ, Csongradi JJ, Bleck EE. Early complications in the operative treatment of ankle fractures. Influence of delay before operation. J Bont Join surgery 1991 Jan; 73 (1): 79-82.
16. 16-. Fogel GR, Morrey BF. Delayed open reduction and fixation of ankle fractures. Clin Orthop Relat Res. 1987 Feb; (215): 187-95.
17. 17-Ebraheim NA, Elgafy H, Padanilam T. Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury. Clin Orthop Relat Res. 2003 Apr; 409: 260-7.
18. 18-Nasell H, Bergman B, Tomkvist H. Functional outcome and quality of life in patients with type B ankle fractures: A two year follow-up study. J Orthop Trauma 1999; 13: 363.
19. 19-. Stark E, Tornetta P 3rd, Creevy WR. Syndesmotic ins¬tability in Weber B ankle fractures: a clinical evaluation. J Orthop Trauma 2007; 21 (9): 643-646.
20. 20-van den Bekerom MP, Lamme B, Hogervorst M, Bolhu¬is HW. Which ankle fractures require syndesmotic stabili¬zation? J Foot Ankle Surg 2007; 46 (6): 456-463.
21. 21-McCormack RG, Leith JM Ankle fractures in diabetics. Complications of surgical management. J Bone Joint Surg (Br) 1998; 80 (4): 689-92.
22. 22-Browner, Jupiter, Levine, Trafton WB. Skeletal Trauma. Philadelphia Saunders Company, 2003; 2307-74.
23. 23-Mak KH, Chan KM. Leung PC, Ankla fracture treated with the AO principle-an experience with 116 cases. Injury 1985; 16: 265-72.
24. 24-Bray TJ, Endicott M, Capra SE. Treatment of open ankle fractures. Immediate internalfixation versus closed immobilization and delayed fixation. Clin Orthop Relat Res. 1988 Mar; 240: 47-52.
25. 25-Pankovich AM. Fractures of the fibula at the distal tibiofibular syndesmosis. Clin Orthop Relat Res 1979; 143: 138-47.fibulaat the distal tibiofibular syndesmosis. Clin Orthop Relat Res 1979; 143: 138-47.
26. 26-Tornetta P 3rd, Ostrum RF, Trafton PG. Trimalleolar ankle fracture. J Orthop Trauma 2001; 15: 588-90.
27. 27-. Işık Ç, Tecimel O, Akmeşe R, Fırat A, Tahta M, Bozkurt M, Danis-Weber Type A and B lateral malleolus fractures comparing the results of plate-screw and tension band technique Acta Orthop Traumatol Turc 2013; 47 (1): 27- 31
28. 28-Marsh JL, Saltzman CL. Ankle Fractures. In: Bucholz RW, Heckman JD, CourtBrown CM (Eds). Rockwood and Green's Fractures in Adults. 6th edition, Lippincott, Philadelphia, Vol.2, 2006: 2148-24.
29. 29-Sanders D. Fractures of the ankle and tibial plafond. In: Lieberman JR, editor AAOS comprehensive orthopae reviev.2009.p.659-76.
30. 30-Broos PL, Bisschop AP. Operative treatment of ankle fractures in adults: correlation between types of fracture and final result. Injury 1991; 22: 403-6.
31. 31-de Souza LJ, Gustilo RB, Meyer TJ. Results of operative treatment of displaced lateral rotation-abduction fractures of the ankle. J Bone Joint Surg Am. 1985 Sep; 67 (7): 1066-74.
32. 32-Yılmaz E, Karakurt L, Serin E, Bulut M. Our surgical treatment results in ankle fractures. Acta Orthop Traumatol Turc. 2002; 36: 242-247.
33. 33-. Ricci WM, Tornetta P, Borrelli J Jr. Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws. J Orthop Tr. 2012 Oct; 26 (10): 602-6.
34. 34-Koval KJ, Zuckerman JD. Fractures and Dislocations Handbook (Turkish translation). Turkish translation Editor: Başbozkurt, M. 4th edition, Günes Publishing House, Ankara, 2013.
35. 35-. Boggs LR. Isolated posterior malleolar fractures. Am J Emerg Med 1986; 4: 334-6.
36. 36-. McDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle. An end result study. Clin Orthop Relat Res 1977; 122: 37-45.
37. 37-Wei SY, Okereke E, Winiarsky R, Lotke PA. Nonoperatively treated displaced bimalleos and trimalleolar fractures: a 20-year follow-up. Foot Ankle Int 1999; 20: 404-7.
38. 38-. Joy, G., Patzakis, MJ .: Precise evaluation of the reduction ofsevere ankle 'raetures, J.Bone and Joint Surg. SS-AI 979-993, 1974.
39. 39-Vander Griend R, Michelson JD, Bone LB. Ankle fractures. J Bone Joint Surg (Am) 1996; 78: 1772-83.
40. 40-Wilson FC. Fractures of the ankle: pathogenesis and treatment. J South Orthop Assoc 2000; 9: 105-15.
41. 41-Jaskulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. J Trauma 1989; 29: 1565-70.
42. 42-De Vries JS, Wijgman AJ, Sierevelt IN, Schaap GR. Longterm results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg 2005; 44: 211-7.
43. 43-Harper MC, Hardin G. Posterior malleolar fractures of the ankle associated with lateral rotation-abduction injuries. Results with and without internal fixation. J Bone Joint Surg Am 1988; 70: 1348-56.
44. 44-Gardner MJ, Brodsky A, Briggs SM, Nielson JH, Lorich DG. Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res 2006; 447: 165-71.
45. 45-.Warner SJ, Fabricant PD, Garner MR, Schottel PC, Helfet DL, Lorich DG.The Measurement and Clinical Importance of Syndesmotic Reduction After Operative Fixation of Rotational Ankle Fractures. J Bone Joint Surg Am. 2015 Dec 2; 97 (23): 1935-44.
46. 46-Schaffer JJ, Manoli A. The Antiglade plate for distal fibular fixation. A Biomechanical comparison with fixation with a lateral plate. J Bone Joint Surg 1987; 69: 596-604.
47. 47-Katiöz H, BOMBACI H, GÖRGEÇ M, Treatment of trimalleolar fractures. Is osteosynthesis needed in posterior malleolar fractures measuring less than 25% of the joint surface Acta Orthop Traumatol Turc. 2003; 37 (4): 299-303.
48. 48- Khaled Koujan 1 , Ahmed Y. Saber 2 Bimalleolar Ankle Fractures, Review, In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. 2020 Sep 10.
49. 49- Brianna R Fram 1 , Ryan G Rogero , Gerard Chang , James C Krieg , Steven M Raikin , Immediate Weight Bearing and Range of Motion After Internal Fixation of Selected Malleolar Fractures: A Retrospective Non-Inferiority Controlled Study, J Orthop Trauma 2020 Nov 9 doi: 10.1097 / BOT.0000000000002003. Online ahead of print.