A Study Of The Clinical Outcomes Of Closed Reduction Andlntcrnal Fixation Of Ankle Joint Fracture

Aim: to evaluate the clinical significance of minimal-invasive surgery in thetreatment of ankle joint fracture. The clinical outcome was compared between closedreduction and internal fixation operation and open reduction and internal fixationoperation through a comparative study of the ankle joint function in order to provideclinical evidence for the application of minimal invasive surgery in the treatment ofankle joint fracture.Methods:48cases of ankle joint fracture admitted to the department of bonesurgery of Weihai municipal hospital from March2011to March2012were studiedby retroperspective case-control study. All patients admitted to this research wereproved to be qualified by the admitting standards and accepted regular follow up. Thepatients were divided into two groups, with24patients accepted closed reduction andinternal fixation operation and24open reduction and internal fixation operationrespectively. All the patients achieved standards of clinical recovery after thetreatment and accepted6-12-month follow up studies after the surgery (8months inaverage). Outcome observation, AOFAS evaluation of the ankle joint function andincidence of complications were carried out during the study, followed by a statisticalanalysis in order to analyze the outcome the two distinct treatments.Results: AOFAS evaluation of the ankle joint function indicated equallysignificant clinical outcome, achieving83.3%and87.5%in patients accepted closedreduction and internal fixation operation and open reduction and internal fixationoperation respectively. Treatment of medial, lateral, double and triple ankle bonefracture by closed reduction and internal fixation operation achieved an excellent andgood rate of100%,100%,85.7%,71.4%respectively. And Treatment of medial,lateral, double and triple ankle bone fracture by open reduction and internal fixationoperation achieved an excellent and good rate of100%,100%,87.5%,66.7%. For each type of fracture of the ankle joint, the excellent and good rate was over66%inpatients treated either by closed reduction and internal fixation operation or openreduction and internal fixation operation. In patients treated by closed reduction andinternal fixation operation,14cases achieved excellent,6cases good,3cases generaland1case bad, averaging83.7士11.5after the treatment,83.3%of excellent andgood. In patients treated with open reduction and internal fixation operation,16casesachieved excellent,5cases good,3cases general and0case bad, averaging86.5士7.6after the treatment,87.5%of excellent and good. And the excellent and good ratesof both groups were over80%. T-test analysis of the average rating of the treatingeffects suggested no statistical significance, with X2=0.167and P=0.683, suggestingthat there is no significant difference between the two treatments. Statistical analysisof the complications of the two groups indicated a lower incidence of complicationsin patients treated with closed reduction and internal fixation that those treated byopen reduction and internal fixation, X2=4.181，P=0.041. Meanwhile the length of theincision of closed reduction and internal fixation is obviously shorter than that ofopen reduction and internal fixation.Conclusion:1. With proper reduction and effective internal fixation, both closed reductionand internal fixation operation and open reduction and internal fixation operationachieved equally good clinical effect regardless of the type of fracture.2. The incidence of complications is lower in patients treated with closedreduction and internal fixation that those treated by open reduction and internalfixation.3. The length of the incision of closed reduction and internal fixation isobviously shorter than that of open reduction and internal fixation.4. The surgeons can choose according to the patients’ situation and requesttreatment with less traumatic injury during surgery, faster recovery, and moreacceptable for patients, without concerning the negative effects on the prognosis ofclosed reduction and internal fixation.