Open reduction and internal fixation via the para-Achilles tendon approach for the treatment of posterior malleolus sandwich fractures

doi:10.12307/2023.783

Abstract

Abstract: BACKGROUND: Accurate reduction of ankle fractures under direct vision has become a common understanding among foot and ankle surgeons. How to fully expose free or compressed fragments of the posterior ankle remains one of the most challenging problems.
OBJECTIVE: To explore the clinical efficiency of the para-Achilles tendon approach in exposing and repositioning the posterior malleolus sandwich fracture.
METHODS: A retrospective study was made for 26 patients with posterior malleolus sandwich fracture treated with open reduction and internal fixation via para-Achilles tendon approach from January to December 2020 in The Second People’s Hospital of Dalian. 21 of 26 cases were managed with the lateral approach of Achilles tendon and 5 cases were managed with the medial approach of Achilles tendon. There were 19 males and 7 females, with the age of 24-69 years, averagely 38.6 years. The operation time and postoperative complications were recorded. The fracture reduction condition was evaluated by Burwell-Charnley imaging standard. Before operation, 3 months after operation and last follow-up, visual analog scale score, ankle plantar flexion and dorsiflexion and American Orthopedic Foot & Ankle Society Ankle Hind Score were used to evaluate the treatment effect.
RESULTS AND CONCLUSION: (1) All 26 patients were followed up for an average of 14.6 months (range 13-18 months). The operation time was 52-85 minutes (average 64.2 minutes). (2) Part of the skin edge of the lateral malleolus incision was necrotic in one patient and healed completely after a dressing change. Incision healing of the other patients was in one stage. (3) Through Burwell-Charnley imaging standard, anatomical reductions were obtained in 24 of 26, and good reductions were in 2 of 26, with an excellent and good rate of 100%. (4) At the last follow-up, the visual analog scale score (1.19±0.40) was significantly lower than the preoperative score (6.81±0.80) (P < 0.01). Ankle plantar flexion (33.5±5.02)° and ankle plantar back stretch (17.23±0.99)° were significantly increased compared with preoperative data (14.58±2.50)° and (5.81±1.02)° (P < 0.01). American Orthopedic Foot & Ankle Society Ankle Hind Score was improved to (89.31±3.62) points compared to preoperative (46.00±5.45) points (P < 0.01). The results were excellent in 23 patients and good in 3 patients, with an excellent and good rate of 100%. (5) It is concluded that the open reduction and internal fixation via the para-Achilles tendon approach for the treatment of posterior malleolus sandwich fracture were efficient with decreased operation time, satisfying fracture reduction, fewer complications, satisfactory motion range, and functional recovery.

Key words: ankle injury, posterior malleolus sandwich fracture, fracture fixation, internal fixation, surgical approach

CLC Number:

Zheng Jiafa, Song Xiufeng, Li Hongzhi, Zhou Jinming, Guan Shengyi, Yu He. Open reduction and internal fixation via the para-Achilles tendon approach for the treatment of posterior malleolus sandwich fractures[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(6): 934-938.

Figures/Tables 5

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