PURPOSE OF THE STUDY The aim of the study was to assess treatment outcomes in patients undergoing K-wire transfixation of unstable ankle fractures and compare the results with those of patients in whom it was possible to perform primary one-stage osteosynthesis. MATERIAL AND METHODS Between 2009 and 2012, a total of 358 patients (191 women and 167 men) had surgery for unstable ankle fracture. At 1-year follow-up, their subjective feelings, objective findings and ankle radiographs were evaluated. The fractures were categorised according to the Weber classification. A patient group treated by one-stage osteosynthesis, a group with definitive transfixation and a group of patients in whom temporary transfixation was converted to definitive osteosynthesis were assessed and compared. RESULTS The group treated by one-stage osteosynthesis included 278 patients with an average age of 47 years; the group of 20 patients with definitive transfixation had an average age of 67 years, and the group of 60 patients who had temporary transfixation with subsequent conversion to internal osteosynthesis were 55 years on average. In the group with one-stage osteosynthesis, 223 (80%) ankle fractures on post-injury radiographs were associated with minor joint dislocations and 55 (20%) with major dislocations. On the other hand, the radiographs of the patients treated by temporary transfixation and delayed open reduction with internal fixation showed major dislocations in 38 (63%) and minor dislocations in the rest of the patients (37%); the difference between the two groups was statistically significant (p<0.001). Posterior malleolar fractures were most frequent in the group with temporary transfixation (60%) and least frequent in the group with primary osteosynthesis (44%); also this difference was statistically significant (p=0.032). At one-year follow-up, in the group with one-stage osteosynthesis, 220 patients (79%) had no radiographic signs of posttraumatic ankle osteoarthritis while, in the group with temporary transfixation, no radiographic evidence of ankle osteoarthritis was recorded in 25 (42%) patients. While tibiofibular synostosis was recorded in only few patients (9%) of the group with one-stage osteosynthesis, it showed a high occurrence in the group with temporary transfixation (35%). The patients with one-stage osteosynthesis (188/68%) had a higher proportion of excellent outcomes measured on the Olerund-Molander ankle scoring scale than the other two groups (temporary transfixation, 47%; definitive transfixation,10%); in both cases the difference was significant (p < 0.001 and p = 0.003, respectively). DISCUSSION In this study the morphological and clinical aspects of surgically treated ankle fractures were assessed. The patients with one-stage osteosynthesis were compared with those treated by temporary or definitive transfixation. The majority of patients undergoing temporary transfixation had a fractured posterior margin of the tibia and major ankle joint dislocation, which suggested serious injuries to bone and ligament structures. Generally, the use of only two K-wires inserted through the calcaneus and talus into the distal tibia is recommended. Patients with K-wire transfixation usually require a longer hospital stay because of the serious nature of their injuries. CONCLUSIONS The therapy of choice for unstable ankle fractures is one-stage osteosynthesis. Temporary transfixation is an effective method of primary management when an unstable fracture cannot be treated by definitive osteosynthesis at the early stage due to local or general health conditions of the patient. The temporary transfixation provides good alignment of the ankle joint necessary for successful healing of soft tissues. A higher occurrence of post-traumatic ankle osteoarthritis, ossification and distal tibiotalar synostosis found in the patients treated by temporary transfixation is more related to serious types of ankle fractures the patient had suffered than to the method itself. Key words: unstable ankle fracture, soft tissue condition, indications for transfixation, treatment outcome.
- MeSH
- časové faktory MeSH
- fraktury kotníku radiografie chirurgie MeSH
- kostní dráty * MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- počítačová rentgenová tomografie MeSH
- retrospektivní studie MeSH
- tříštivé fraktury radiografie chirurgie MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE OF THE STUDY The study presents the evaluation and comparison of two groups of patients surgically treated for ankle fractures at our department in 2007 and in 2010, respectively. Our analysis included patients' age, the mechanism of injury, fracture morphology and the method of osteosynthesis. The aim of the comparison was to ascertain recent trends in the development of the selected characteristics. MATERIAL AND METHODS The 2007 group comprised 62 patients, 31 men and 32 women, the 2010 group had 123 patients, 55 men and 68 women. The ankle fractures were classified according to the Weber and Lauge-Hansen systems. The selected characteristics were analysed in each group and the results were compared to obtain information on changes during the interval of 4 years. The data were evaluated using the methods of descriptive statistics; categorical data were analysed by the chi-square test with the level of significance set at 5%. RESULTS The average age was 44 years in men and 59 in women in the 2007 group and 40 years in men and 56 in women in the 2010 group; in the whole patient group, the average age decreased from 52 years in 2007 to 47 years in 2010. Based on the Weber classification, the incidence of fractures in 2007 and 2010 was as follows; type A, 5% in both years; type B, 68% and 72%; type C, 27% and 23%. There was no significant difference between the groups in the incidence of either type B or type C fractures (p = 0.823 and p = 0.659, respectively). The majority of fractures were caused by low-energy mechanisms. High-energy injuries due to falls from a height or traffic accidents did not exceed 6 %. In men, who sustained sports-related injury more often, fractures were found in 23% and 16% in 2007 and 2010, respectively; this difference approached statistical significance (p = 0.050). Most of the fibular fractures were managed by plate osteosynthesis, often in combination with lag screws. Medial malleolar fractures were usually fixed with two cancellous screws, or with a screw and a K-wire. The number of surgical inspections of the medial structures of an injured ankle with no medial malleolar fracture decreased from 68% in 2007 to 37% in 2010. Osteosynthesis of a fractured posterior margin of the distal tibia was carried out in 7% of the patients in 2007 and in 23% in 2010. DISCUSSION The morphological and epidemiological characteristics described were selected to obtain a comprehensive notion of the patients studied. Only the patients who had surgery were included. An increase in the number of ankle fractures managed surgically during a four-year period of our study was due to a growing number of patients and the fact that surgery was indicated more frequently because stricter criteria for assessment of post-reduction findings or secondary displacement were adopted. In surgical treatment, the recent trend preferring primary osteosynthesis to transfixation or external fixation has been evident because it allows for early rehabilitation and return to normal activities. CONCLUSIONS The number of ankle fractures treated by primary osteosynthesis grew between 2007 and 2010. There was also an increase in the number of fractured posterior margins of the distal tibia managed by osteosynthesis. The results of the Weber and Lauge-Hansen classifications were in agreement with the relevant literature data. In the majority of cases the ankle fracture occurred as a single trauma.
- MeSH
- dospělí MeSH
- fraktury kostí chirurgie patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- poranění kotníku chirurgie patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Úvod: Zlomeniny v oblasti ruky a zápěstí jsou jedny z nejčastějších zlomenin. V našem souboru tvořily tyto fraktury 32 %. Jejich léčba není vždy jednoduchá a i přes naši snahu může dojít k různému stupni reziduálního omezení funkce ruky. V naší prospektivní studii jsme se zaměřili na zjištění epidemiologických údajů pacientů s poraněním ruky ošetřených na naší klinice v průběhu jednoho roku, na četnost a typ poranění jednotlivých kostí a na způsob jejich ošetření. Metoda a materiál: Sledovaný soubor tvořilo 242 pacientů ošetřených pro zlomeninu ruky či zápěstí v roce 2008. Jednalo se o 61 žen (25 %) a 181 mužů (75 %). Průměrný věk souboru byl 35,1 let (rozmezí 15-91 let). V prospektivní studii jsme do databázového formuláře zaznamenávali z karty pacienta základní epidemiologické ukazatele (pohlaví a věk), dále mechanizmus úrazu, lokalizaci poranění na skeletu ruky, typy poranění a počet fragmentů. Získané údaje jsme vyhodnotili deskriptivními statistickými metodami, pohlavní distribuce byla zhodnocena ?2- testem na 5% hladině významnosti. Výsledky: Poranění se nejčastěji vyskytovala u mužů do 35 let. Nejčastějším mechanizmem úrazu byl prostý pád (59,5 %). Nejvíce ošetřených bylo shodně v srpnu a říjnu (29). Nejméně zlomenin v oblasti ruky a zápěstí jsme zaznamenali v květnu. Nejčastější poraněnou kostí na ruce byl V. metakarp - celkem 65 (7krát společně se čtvrtým metakarpem) (26,4 %). Skafoideum bylo druhou nejvíce poraněnou kostí, celkem 17 zlomenin (6,8 %). Diskuze: V literatuře jsme našli jen ojedinělé práce týkající se epidemiologických studií poranění zápěstí a ruky. Převážná část literárních údajů v souladu s naším pozorováním udává vyšší frekvenci poranění kostí ulnární strany ruky, většina zlomenin v oblasti ruky a zápěstí se vyskytuje u mužů do třiceti let věku, nejčastější zlomeninou zápěstí je skafoideum.
Introduction: Hand and wrist fractures range among the most common fractures. In the authors´ sample these fractures represented 32 %. The treatment of such fractures is not always easy, and despite the doctor's efforts they can result in different degrees of residual dysfunction of the hand. In their prospective study, the authors focused on the findings from epidemiological data of patients with hand injuries treated in the authors' clinic during one year, on the frequency and type of bone injury and methods of treatment. Method and material: A group of 242 patients was treated for a broken arm or wrist in 2008. This included 61 women (25%) and 181 men (75%). The average age was 35.1 years (age group 15-91 years). In their prospective study, the authors recorded the basic epidemiological characteristics (gender and age), as well as the mechanism of injury, localization of the fracture on the hand skeleton, types of injuries and the number of fragments in a database form. The collected data were evaluated using descriptive statistical methods; gender distribution was evaluated by the ?2 test at 5% significance level. Results: The injuries occurred most frequently in men under 35 years of age. The most common mechanism of injury was a simple fall (59.5%). The highest number of patients was treated in August as well as in October (29 each). The lowest number of hand and wrist fractures was recorded in May. The most commonly injured bone was the fifth metacarpus - a total of 65 cases (7 times in conjunction with the fourth metacarpal bone) (26.4%). The skafoideum bone was the second most frequently injured bone - 17 fractures (6.8%). Discussion: In the literature the authors found only several articles relating to epidemiological studies of wrist and hand injuries. Most of the literature is consistent with the authors´ observations of a higher frequency of ulnar bone injuries of the hand, with the majority of fractures of the hand and wrist occurring in men to thirty years of age, and the most frequently broken bone of the wrist being the skafoideum bone.
- Klíčová slova
- skafoideum, metakarp, Trabecular Titanium,
- MeSH
- dospělí MeSH
- epidemiologické studie MeSH
- fraktury kostí etiologie klasifikace terapie MeSH
- interpretace statistických dat MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- poranění ruky etiologie klasifikace terapie MeSH
- poranění zápěstí etiologie klasifikace terapie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- rozložení podle pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
