Characteristic and treatment of ankle fracture combined with Tillaux-Chaput and Voikmann frac-tures

Abstract

Objective To explore the clinical characteristics and operative methods of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures. Methods The data of 15 patients who were suffered the ankle fracture combined with the simultaneous fractures of Tillaux-Chaput and Volkmann be- tween September 2005 and January 2012 were analyzed. There were 8 males and 7 females with an average age of 27.3 years （range, 16-57 years）. All had medial malleolar and fibular fracture with Tillaux-Chaput and Volkmann tubercle avulsed fracture. X-ray film shows that there were 8 cases in which the patients had Tillaux-Chaput fracture, among whom 7 were diagnosed by CT scan. Classified by Lauge-Hansen system, an- kle fracture could be divided into pronation-external rotation type in 4 cases, and pronation-abduction type in 11 cases. The fracture of fibula and the Volkmann tubercle were treated through the posterolateral approach. The fibular fracture was fixed with plate. The medial malleolar fracture was explored from medial curve ap- proach. Tillaux-Chaput fracture was treated by the microtubule cut. All patients were assessed with the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society （AOFAS）. Results All patients were followed up for 8-20 months （average, 12.5 months）. The fracture healed 12-36 weeks later in all the 15 patients, with an average of 23.5 weeks. Twelve patients walked normally and 3 with mild claudi- cation in the last follow-up. The AOFAS score was average 85.4 points, 9 were excellent, 4 were good, 2 were fair, with the good-excellent rate being 86.7% （13/15）. The movement of ankle joint limited in 3 pa- tients, tenderness occurred when weight bearing in 3 patients. Conclusion The ankle fracture include the simultaneous fractures of Til]aux-Chaput and Volkmann were more seen in the type of pronation-abduction. It is often misdiagnosis by the photograph; CT scan should be helpful to find the fracture fragments. The exact reduction and stable fixation were needed in the treatment of the ankle fracture combined with Tillaux-Cha- put and Volkmann fractures. Inferior tibia fibular screw was not routinely used in this fracture. Key words: Ankle joint; Fractures; Fracture fixation, internal