Homeopathic Ankle Dislocation for Treatment of Unstable Trimalleolar Fractures Involving Posterior Die-Punch Fragment: A Retrospective Cohort Study

Abstract

Objectives: Unstable trimalleolar fractures are relatively complex and more difficult to manage if die-punch fracture is present. We aimed to evaluate the curative effect of homeopathic ankle dislocation on the unstable trimalleolar fractures involving posterior die-punch fragments.

Methods: A total of 124 patients diagnosed with unstable trimalleolar fractures combined with post-die punch fragment between June 2008 and June 2020 were retrospectively included. Patients who received homeopathic ankle dislocation were named as the experimental group, and patients who accepted conventional treatment were control group. The fracture healing time, wound healing, American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS), visual analogue scale (VAS), the Kellgren–Lawrence arthritis grading scale (KLAGS) and short-form 36 score (SF-36) scores were collected. Student t-test was used for fracture healing time. Wound healing and SF-36 were compared using the Mann–Whitney test. Repeated measurement analysis of variance (ANOVA) was used for AOFAS and VAS. χ²-test was used for KLAGS.

Results: AOFAS showed statistically significant differences between the two groups (p = 0.001). In non-weight-bearing and weight-bearing conditions, VAS scores were significant different between the two groups, and there was an interaction between group and time point (p < 0.001). The experimental group was superior to the control group in terms of physical function (p = 0.022), role-physical (p = 0.018), general health (p = 0.001) and social function (p = 0.042). The operation time of experimental group was shorter than that of control group (p < 0.001).

Conclusion: Homeopathic ankle dislocation is used for the unstable trimalleolar fractures involving posterior die-punch fragment, which can provide better functional outcomes while shortening the operation time and recovery period.

Keywords

Ankle joint instability / Die-punch fragment / Homeopathic ankle dislocation method / Trimalleolar fractures

References

[1] SunC, FeiZ, PengX, Li C, ZhouQ, DongQ, et al. Posterior locking plate fixation of Bartoníček type IV posterior malleolar fracture: a focus on die-punch fragment size. J Foot Ankle Surg. 2022;61:109–116.

[2] LiD, LiuY, LiD, TangW, YinQ. Identification of a novel three-column classification for double-column die-punch fractures of the distal radius. Exp Ther Med. 2020;19:1871–1877.

[3] MuccioliC, Hidalgo Diaz JJ, PizzaC, GouzouS, FaccaS, LiverneauxP. Comparison of a standard locking screw versus a double-threaded cortical compression screw for fixation of die-punch fragments in distal radius fractures with volar plating. Hand Surg Rehabil. 2020;39:30–35.

[4] WangZ, YuanC, ZhuG, GengX, ZhangC, Huang J, et al. A retrospective study on the morphology of posterior malleolar fractures based on a CT scan: whether we ignore the importance of fracture height. Biomed Res Int. 2020;2020:2903537.

[5] BrietJP, Hietbrink F, SmeeingDP, DijkgraafMGW, Verleisdonk EJ, HouwertRM. Ankle fracture classification: an innovative system for describing ankle fractures. J Foot Ankle Surg. 2019;58:492–496.

[6] GardnerMJ, Streubel PN, McCormickJJ, KleinSE, Johnson JE, RicciWM. Surgeon practices regarding operative treatment of posterior malleolus fractures. Foot Ankle Int. 2011;32:385–393.

[7] BoszczykA, Fudalej M, KwapiszS, KlimekU, Maksymowicz M, KordasiewiczB, et al. Ankle fracture - correlation of Lauge-Hansen classification and patient reported fracture mechanism. Forensic Sci Int. 2018;282:94–100.

[8] RodriguezEK, KwonJY, HerderLM, Appleton PT. Correlation of AO and Lauge-Hansen classification systems for ankle fractures to the mechanism of injury. Foot Ankle Int. 2013;34:1516–1520.

[9] HansenST. Functional reconstruction of the foot and ankle. Philadelphia: Lippincott Williams & Wilkins; 2000.

[10] BartoníčekJ, RammeltS, Tuček M, NaňkaO. Posterior malleolar fractures of the ankle. Eur J Trauma Emerg Surg. 2015;41:587–600.

[11] AmorosaLF, BrownGD, GreisbergJ. A surgical approach to posterior pilon fractures. J Orthop Trauma. 2010;24:188–193.

[12] ToplissCJ, Jackson M, AtkinsRM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br. 2005;87:692–697.

[13] YangY, HeW. Combined posteromedial and posterolateral approaches for 2-part posterior malleolar fracture fixation. Foot Ankle Int. 2020;41:1234–1239.

[14] CampbellST, DeBaunMR, KlewenoCP, Nork SE. Simultaneous posterolateral and posteromedial approaches for fractures of the entire posterior Tibial plafond: a safe technique for effective reduction and fixation. J Orthop Trauma. 2022;36:49–53.

[15] WeberM. Trimalleolar fractures with impaction of the posteromedial tibial plafond: implications for talar stability. Foot Ankle Int. 2004;25:716–727.

[16] KitaokaHB, Alexander IJ, AdelaarRS, NunleyJA, Myerson MS, SandersM. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349–353.

[17] XieW, LuH, ZhanS, Liu Y, XuH. Outcomes of posterior malleolar fractures with intra-articular impacted fragment. Arch Orthop Trauma Surg. 2021;143:141–147.

[18] HolzerN, SalvoD, MarijnissenAC, VinckenKL, AhmadAC, SerraE, et al. Radiographic evaluation of posttraumatic osteoarthritis of the ankle: the Kellgren-Lawrence scale is reliable and correlates with clinical symptoms. Osteoarthr Cartil. 2015;23:363–369.

[19] DehghanN, McKeeMD, JenkinsonRJ, Schemitsch EH, StasV, NauthA, et al. Early Weightbearing and range of motion versus non-Weightbearing and immobilization after open reduction and internal fixation of unstable ankle fractures: a randomized controlled trial. J Orthop Trauma. 2016;30:345–352.

[20] BaumbachSF, Böcker W, PolzerH. Open reduction and internal fixation of posterior malleolus fractures. Oper Orthop Traumatol. 2021;33:112–124.

[21] Vacas-SánchezE, Olaya-González C, Abarquero-DiezhandinoA, Sánchez-MorataE, Vilá-RicoJ. How to address the posterior malleolus in ankle fractures? A decision-making model based on the computerised tomography findings. Int Orthop. 2020;44:1177–1185.

[22] TschudiS, Wittauer M, HirschmannA, EckardtH. Avoiding pitfalls in ankle fracture-dislocations: a case report of a dislocated tibialis posterior tendon causing persistent ankle subluxation. Foot Ankle Surg. 2021;27:700–709.

[23] XingW, WangY, SunL, WangL, KongZ, Zhang C, et al. Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. Medicine (Baltimore). 2018;97:e12079.

[24] ZhangK, CuiR, GuY, WangD, YanJ, YinZ, et al. Posteroanterior lag screws versus posterior buttress plate fixation of posterior malleolar fragments in spiral Tibial shaft fracture. J Foot Ankle Surg. 2020;59:768–773.

[25] GandhamS, Millward G, MolloyAP, MasonLW. Posterior malleolar fractures: a CT guided incision analysis. Foot (Edinb). 2020;43:101662.

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