How well do we reduce ankle fractures intra-operatively: A retrospective 1 year review using Pettrone's criteria

Introduction: Ankle fractures are a common injury and considered to be part of the ‘bread & butter’ of orthopaedic trauma surgery. The management of these injuries forms part of the AO Principles course, which is mandatory for application for a specialty training number in trauma & orthopaedics. It has also been used for the technical skills assessment for the national selection process for England. The implication is that ankle fracture fixation is an easy procedure and well within the competencies of all trauma & orthopaedic surgeons. Previous studies demonstrate that most cases of osteoarthritis of the ankle (78%) are post-traumatic in nature (1). Further analysis of this group of patients demonstrates that 48% of patients with post-traumatic ankle arthritis had malleolar fractures. This equates to 37.4% of all patients presenting with ankle arthritis having had a ‘simple’ ankle fracture in the past which as previously mentioned is assumed to be well within the competencies of orthopaedic surgeons to fix. (1) Our study was inspired by an abstract from the BOFAS annual meeting proceedings from University Hospital Aintree (UHA) (2). Using Pettrone’s criteria, they found a 32.5% mal-reduction rate in their study group of ankle fractures, which required open reduction internal fixation. (2,3)

引言：踝关节骨折是一类常见损伤，被视为创伤骨科外科的基础常规手术之一。此类损伤的诊疗是AO创伤原则培训课程（AO Principles course）的教学内容，该课程是申请创伤骨科专科培训资质的必修课程，也曾用于英格兰地区创伤骨科医师全国选拔考核的技术能力评估环节。这一背景也使得业界普遍认为，踝关节骨折内固定术是一项操作简便的手术，完全处于所有创伤骨科医师的执业能力范畴之内。既往研究显示，78%的踝关节骨性关节炎病例为创伤后继发（1）。对该类患者的进一步分析表明，48%的创伤后踝关节关节炎患者曾发生踝部骨折；这相当于所有踝关节关节炎患者中，有37.4%的个体既往曾罹患“单纯性”踝关节骨折——而正如前文所述，这类骨折的内固定术被认为完全处于骨科医师的能力胜任范围之内（1）。本研究的灵感源自安特里大学医院（University Hospital Aintree, UHA）在英国骨科足踝学会（BOFAS）年度会议论文集上发表的一篇摘要（2）。该研究采用佩特罗内标准（Pettrone’s criteria），对需行切开复位内固定术的踝关节骨折患者队列进行分析后发现，其复位不良率达32.5%（2,3）。