Reduction of Posterior Malleolus Fractures With Open Fixation Compared to Percutaneous Treatment.

Autor:	Haws BE; Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA., Karnyski S; Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA., DiStefano DA; Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA., Soin SP; Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA., Flemister AS; Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA., Ketz JP; Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA.
Jazyk:	angličtina
Zdroj:	Foot & ankle orthopaedics [Foot Ankle Orthop] 2023 Sep 28; Vol. 8 (3), pp. 24730114231200485. Date of Electronic Publication: 2023 Sep 28 (Print Publication: 2023).
DOI:	10.1177/24730114231200485
Abstrakt:	Background: Operative decision making between approaches to posterior malleolus reduction remains a challenge. The purpose of this study is to compare the quality of reduction between percutaneous and open reduction of posterior malleolus fractures and to identify factors associated with malreduction. Methods: Operatively managed ankle fractures that included posterior malleolus fixation were reviewed. Fracture characteristics were determined on preoperative CT scans. Initial postoperative radiographs were used to measure reduction of the posterior malleolus articular surface and graded as satisfactory (<2 mm step-off) or malreduced (≥2 mm step-off). Final postoperative PROMIS scores and 1-year complications were compared between percutaneous and open cohorts. A multivariate stepwise regression model was used to evaluate predictors for malreduction. Results: A total of 120 patients were included. Open reduction was performed in 91 (75.8%) compared with 29 (24.2%) who underwent percutaneous reduction. Malreduction (≥2-mm articular step-off) occurred in 11.7% of patients. Malreduction rates were significantly higher with percutaneous fixation than open fixation (24.1% vs 7.7%, P  = .02). Multiple fragments and those with ≥5 mm of displacement demonstrated higher malreduction rates with percutaneous fixation ( P  < .05 for both), whereas single fragments and those with <5 mm of displacement experienced similar malreduction rates with percutaneous or open fixation. Initial displacement ≥5 mm (relative risk [RR] = 3.8, 95% CI = 1.2-11.5, P  = .02) and percutaneous treatment (RR = 4.1, 95% CI = 1.6-10.5, P  < .01) were identified as independent risk factors for malreduction. There were no significant differences in 1-year complication rates or final PROMIS scores between groups. Conclusion: Open reduction of the posterior malleolus may lead to improved fracture reduction compared to percutaneous reduction without significant increase in complications. Open fixation improves reduction among fractures with multiple fragments or ≥5 mm of displacement, whereas fractures with a single fragment or <5 mm of displacement achieve similar reductions regardless of approach. Initial displacement ≥5 mm and percutaneous reduction are independent risk factors for malreduction. Level of Evidence: Level III, therapeutic. Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online. (© The Author(s) 2023.)
Databáze:	MEDLINE
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