| Purpose:To observe the effect of TCM manipulation combined with Modified Splint External Fixation for the treatment of old age ankle supination-eversion ankle fracture and dislocation.Material and method : Retrospective analyze 38 patients diagnosed with supination-eversion ankle fracture and dislocation in the department orthopedics of Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,from October 2014 to December 2017.Among the patients,4 were lost to follow-up,1 failed in manipulationsetting and changed to Surgical treatment.Finally,there were 33 patients remained(33 ankles in total).There were 17 males and 16 females;the average age was69.12±6.46(60-83),and the median was 67.Injury side: Left 16 cases,Right 17 cases;Lange-Hanson classification,I: 5 cases,II: 10 cases,III: 9 cases,IV: 9 cases,all of them were closed fractures.In this observation,all of the patients had different Internal medicine diseases,andfailed to meet the anesthesia criteria during the preoperative evaluation.All the patients were treated by manual reduction combined with modified splint external fixation.After the fracture reduction,the patients were given with basic treatment.The efficacy of the therapy was evaluated by observing the patient’s postoperative reduction,fracture healing,range of ankle joint motion at 6 months,9 months,and 12 months afterfracture reduction,AOFAS score,and VAS pain score.Results: 1.The reduction of type I and II fractures could be satisfied.The fractures of type III and IV could be restored,and the end of fractures contact area were more than 1/3.The alignment could be satisfied.There was no angular deformity after the end of the treatmend.In patients with type IV,the posterior malleolar fracture was displaced to the proximal end without exceeding 1 mm.,and no distal displacement was observed;2.Clinical healed of the fractures: After 6 weeks,all the patients in this observation showed that continuous callus got through the end of fracture,and reached the clinical healing.Bone healing criteria at the last follow-up3.The range of ankle joint motion: the follow-up of 9 months and 12 months after operation was significantly higher than that of 6 months after operation.The average metatarsal flexion activity was 38.76°±3.15°,and the average range of dorsal extension was26.09°±1.21°12months after operation.4.Ankle joint function: the AOFAS scores of 6 months,9 months and 12 months after removal of splint were 53.48 ±6.22,83.57 ±4.00 and 92.84 ±5.14,respectively.the AOFAS scores of 6 months,9 months and 12 months after operation have significance in statistics with comparison(P < 0.01).The excellent and good rate was 90.91% 12 months after operation.5.Pain condition: the VAS scores of 6 months,9 months and 12 months were 3.03±0.88、1.81±0.92、0.62±0.40,respectively,which werestatistically significantcomparing with those before operation(P < 0.01).Conclusion: 1.The fracture and dislocation of ankle joint with supination-eversion typewere repaired by manipulation,and the curative effect of modified splint fixation was accurate.2.Improved external fixation with splint can effectively relieve joint pain symptoms and improve the function of affected limbs.This method is effective for the elderly who suffer from serious medical diseases and can not be treated surgically.3.The improved splint is convenient for the reexamination and adjustment of fracture,and it is beneficial to fracture healing without the need of open reduction and secondary operation to remove the internal fixation,and at the same time,it allow patients to exercise early.The invention has the characteristics of light weight,low manufacturing cost and the like,and is worthy of being popularized clinically. |
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