Abstract
Background Few studies exist on the predictive factors of tibial fractures with hidden posterior ankle fractures. Objective To study the incidence and predictive factors of tibial fractures with occult posterior ankle fractures. Methods Tibial fracture patients were prospectively selected who were admitted to our hospital from January 2016 to May 2021 and their general clinical data, X-ray images, CT images, and other imaging data were collected and then divided them into posterior malleolus fracture group and nonposterior malleolus fracture group according to the presence or absence of posterior malleolus fractures. Multivariate regression analysis and receiver operating curves (ROC) were performed to analyze the influencing factors of tibial fracture with occult posterior ankle fracture. Results CT showed that 25 (13.44%) patients had occult posterior ankle fractures among 186 patients with tibial fracture. There was no significant difference in gender, age, and locations of tibial fracture between the two groups (P > 0.05). There were statistical differences in the types, locations, and lengths of patients with tibial fracture but without posterior malleolus fractures. The length of the tibia fracture group was significantly lower than the tibia with posterior ankle fracture group (P < 0.05). Logistics regression analysis showed that tibial fracture with occult posterior ankle fracture was not significantly correlated with gender, age, and location of tibial fracture (P > 0.05), but was significantly correlated with tibial fracture type, location, and length (HR = 1.830, P=0.035; HR = 5.161, P=0.004; HR = 1.126, P=0.030). The ROC curve showed that the AUC of length of tibial fracture with occult posterior ankle fracture was 0.599. The YD index suggested that the best cut point for the prediction of tibial fracture with occult posterior ankle fracture was above 13.18%. The sensitivity and specificity of spiral tibial fracture and distal 1/3 tibial fracture for prediction were 88.00% and 63.35%, 92.00%, and 58.39%, respectively, which was significantly higher than that of tibial fracture length (P < 0.05). Conclusion Patients with tibial fractures have a higher incidence of occult posterior ankle fractures. Spiral tibial fractures and distal 1/3 tibial fractures have a higher predictive value for tibial fracture with occult posterior ankle fractures and can help clinical detection as soon as possible, which is a more accurate and appropriate treatment.
Highlights
Tibia fractures and malleolus fractures are common in clinical practice
Effectively mastering the epidemiological status of tibial fracture combined with occult posterior ankle fracture and effectively identifying the high-risk population of tibial fracture combined with occult posterior ankle fracture by mastering the high-risk factors of tibial fracture combined with occult posterior ankle fracture is of great significance to improve the prognosis of patients with tibial fracture combined with occult posterior ankle fracture. e present study recruited 186 patients with tibial fractures, performed ankle CT image detection, assessed the incidence of tibial fractures with Journal of Healthcare Engineering occult posterior ankle fractures, and recorded the clinical data of patients to identify the predictive impact of tibial fractures with occult posterior ankle fractures
According to the presence or absence of posterior malleolus fractures, they were divided into posterior malleolus fracture group (25 cases) and posterior malleolus fracture group (161 cases). ere was no statistical difference in gender, age, and tibial fracture orientation between the two groups of patients (P > 0.05). ere were statistical differences in the types, locations, and fracture lengths of tibial fractures
Summary
Tibia fractures mostly presented with spiral fractures of the lower 1/3 segment, and tibial fracture is a common fracture type in clinic [1], frequently combined with occult posterior ankle fracture, which seriously affects the patient’s lower limb function. Logistics regression analysis showed that tibial fracture with occult posterior ankle fracture was not significantly correlated with gender, age, and location of tibial fracture (P > 0.05), but was significantly correlated with tibial fracture type, location, and length (HR 1.830, P 0.035; HR 5.161, P 0.004; HR 1.126, P 0.030). Spiral tibial fractures and distal 1/3 tibial fractures have a higher predictive value for tibial fracture with occult posterior ankle fractures and can help clinical detection as soon as possible, which is a more accurate and appropriate treatment
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