A comparative study of the clinical efficacy of supination-adduction type II ankle fracture surgery based on the medial pilon fracture concept versus the ankle fracture concept

Zhida Ma,Nan Zhu,Liujie Zheng,Junfeng Zhan,Jinxin Li,Yao Hu,Wei Liu,Juehua Jing

doi:10.1186/s12891-021-04818-0

Zhida Ma, Nan Zhu + Show 6 more

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https://doi.org/10.1186/s12891-021-04818-0

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Abstract

BackgroundA supination-adduction (SAD) ankle fracture is a special type of ankle fracture that results in collapse of the distal tibial articular surface; as such, orthopaedic surgeons require greater awareness of this type of fracture. The severity of this injury lies between that of an ordinary ankle fracture and a pilon fracture, and the treatment of such fractures based on the ankle fracture concept leads to extremely high rates of postoperative complications and a poor prognosis. In this retrospective study, we aimed to explore the treatment of SAD fractures based on the pilon fracture concept.MethodsWe retrospectively analysed the clinical data of 67 patients with Lauge-Hansen supination-adduction type II (SAD-II) ankle fractures, most of whom had a 44-A AO classification. Patients underwent surgical treatment at the Second Affiliated Hospital of Anhui Medical University from January 2009 to June 2019. The patients were divided into two groups based on the surgical concept employed: 43 patients were included in the ankle fracture surgical concept group, and 24 patients were included in the medial pilon fracture surgical concept group. The therapeutic effect was evaluated based on the Burwell-Charnley radiological reduction standard, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and postoperative visual analogue scale (VAS) pain score 1 year after surgery using regression with adjustment for confounding factors.ResultsAll 67 patients were followed up. Twenty-four patients were treated according to the medial pilon fracture concept, and forty-three patients were treated according to the ankle fracture concept. The AOFAS score 1 year after surgery in the medial pilon group (89.83 ± 2.77) was higher than that in the ankle fracture group (83.63 ± 7.97) (p < 0.05). The VAS score 1 year after surgery in the medial pilon fracture group (1.17 ± 0.96) was significantly better than that in the ankle fracture group (2.28 ± 0.96) (p < 0.05).ConclusionPatients with Lauge-Hansen SAD-II ankle fractures treated based on the medial pilon fracture surgical concept had better postoperative outcomes than those treated based on the ankle fracture surgical concept.Level of evidenceLevel III, retrospective cohort study.

Highlights

Ankle fractures are common fractures that result from lower limb trauma, accounting for 7% of all fractures [1, 2]
Of SAD fractures, supinationadduction type II (SAD-II) fractures are characterized by loss of ankle stability
Multivariate regression analysis showed that the operation mode affects the American orthopaedic foot and ankle society (AOFAS) score 1 year after surgery independently (Table 3)

Summary

Introduction

Ankle fractures are common fractures that result from lower limb trauma, accounting for 7% of all fractures [1, 2]. A supination-adduction (SAD) ankle fracture is a special type of ankle fracture that results in collapse of the distal tibial articular surface; as such, orthopaedic surgeons require greater awareness of this type of fracture. The severity of this injury lies between that of an ordinary ankle fracture and a pilon fracture, and the treatment of such fractures based on the ankle fracture concept leads to extremely high rates of postoperative complications and a poor prognosis. We aimed to explore the treatment of SAD fractures based on the pilon fracture concept

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