Clinical Study On The Proportion Of Posterior Malleolus Fracture And The Selection Of Treatment

Objective: To explore the proportion of posterior malleolus fracture to guide the selection of treatment.Methods: A retrospective analysis of 102 patients with posterior ankle fractures admitted in the First Affiliated Hospital of Fujian Medical University from January 2008 to December 2015,Grouped by the size of the posterior malleolus fracture.45 patients with the proportion of posterior malleolar fractures greater than 25% were divided into group A.Among them,38 patients treated with surgery were divided into group A1 and the rest were divided into group A2 by conservative treatment.18 patients with the proportion of posterior malleolar fractures between 20% and 25% were divided into group B.11 patients were divided into group B1 by surgery and non-surgical patients were divided into group B2.The proportion of posterior malleolar fractures less than 20% of the 39 patients were divided into group C,15 patients were divided into group C1 and non-surgical treatment 24 cases were divided into group C2.The scores of Olerud-Molander ankle fracture function,VAS score,fracture healing time and joint surface flatness were compared between A1 and A2,B1 and B2,C1 and C2,respectively.Results: Olerud-Molander’s ankle fracture function score,VAS score,fracture healing time and articular surface smoothness were significantly higher in the operation group(A1)than in the non-operation group(A2)when the proportion of the posterior malleolar fracture was larger than 25% of tibial articular surface(P <0.05).When the proportion was between 20 and 25%,the functional score of Olerud-Molander’s ankle fracture was lower in the operation group than in the non-operation group(P <0.05),and the difference was statistically significant(P <0.05)(P <0.05).There was no significant difference in VAS score between the two groups(P = 0.13> 0.05).When the proportion was less than 20%,compared with the non-operation group,Olerud-Molander’s ankle fracture function score,VAS score and articular surface smoothness were slightly better than those in the non-operation group,but the difference was not statistically significant(P>0.05).The time of fracture healing was significantly shorter than that of non-operation group,the difference was statistically significant(P = 0 <0.05);Conclusion:(1)When the proportion of the posterior malleolus fracture block was larger than 25% of tibial articular surface,the internal fixation surgery should be preferred;When the proportion was between 20 and 25%,,you can try to close the fracture,and change to internal fixation surgery if it unable to achieve articular surface formation;When the proportion was less than 20%,The selection of treatment can be combined with their actual situation;(2)To maximize the articular surface formation,it is recommended that the proportion of posterior malleolus fracture should be 20% as the boundaries of the implementation of internal fixation surgery.