Experience of percutaneous hollow nailing for posterior ankle fractures
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In complex ankle fractures, there are various methods to treat posterior ankle fractures. Some people use a transmedial ankle incision to treat posterior ankle fractures, but most of the posterior ankle fractures are related to the inferior tibiofibular union, and the distance is farther through the medial approach; some people dislocate the ankle to the lateral side to treat the posterior ankle, which causes heavy damage to the soft tissues around the ankle joint and causes soft tissue swelling and even talar necrosis after surgery. We used a trans-fibular surgical approach with 4.0 mm hollow nail to fix the posterior ankle fracture and achieved good clinical results. [Objective] To investigate the management of posterior ankle fractures in ankle fractures. Method】Experimental group: 18 patients with posterior ankle fractures requiring treatment treated in our hospital from 2005 to 2008, the patients also had combined external ankle fractures, including 9 cases of posterior external rotation type fractures, 7 cases of anterior external rotation type fractures, and 2 cases of undifferentiable fractures. Control group: 58 patients with posterior ankle fractures who were admitted to our hospital for surgery at the same time. The posterior lateral ankle approach (gatellier and chastang) was chosen to reveal the fibular fracture, cut the lower posterior tibiofibular ligament, turned the distal end of the external ankle fracture downward to reveal the posterior ankle fracture, and after repositioning, 1-2 hollow nail guide pins were driven percutaneously into the lateral Achilles tendon to fix the posterior ankle fracture, after making sure the fracture was firmly fixed. The 4.0 mm hollow nail was screwed in via the guide pin. The outer ankle fracture was repositioned, the outer ankle was fixed with plate screws and the lower tibiofibular was fixed with a tension nail. The medial ankle fracture was fixed in the same way as the other methods. The operative time was 60-85 minutes, all under a tourniquet. The tension screw was removed 8 weeks after surgery. Afterwards, he could walk with weight and abandon the crutches at 12 weeks. The postoperative follow-up was 18 months. The follow-up included the operation time, postoperative swelling time of the affected foot, postoperative wound healing, weight-bearing time, and fracture healing time. [Results] The experimental group showed significant differences in mean operative time, postoperative swelling time, wound healing, and time to walk on the ground compared with the control group. Conclusion】Transfibular approach for ankle fracture is a safe and reliable method with simple surgical method, little postoperative patient injury, and early weight bearing. Zhang Qingming, Department of Orthopedics, Xuanwu Hospital, Capital Medical University