Patient demographics.

Background Ankle fractures are among the most common types of fractures in the orthopaedic field, and the Lauge-Hansen classification is commonly used to categorize rotational ankle fractures. This study evaluated and compared the clinical and radiological outcomes of surgically treated supination external rotation (SER) and pronation external rotation (PER) injuries of grades III or IV. Methods We retrospectively reviewed and enrolled 104 patients who underwent open reduction and internal fixation for SER or PER injuries classified as Grades III or IV between January 2016 and December 2021, all performed at a single center. Of these, 72 belonged to the SER group and 32 to the PER group. The average postoperative follow-up durations were 31.3 months (range, 24 to 74) for the SER group and 32.1 months (range, 24 to 71) for the PER group. Clinical and radiological outcomes were assessed 24 months after surgery and compared between the two groups. Details of concomitant surgical procedures performed and postoperative complications were also evaluated. Results All clinical outcome variables, including the Foot and Ankle Outcome Score, Visual Analog Scale for pain, and ankle range of motion, were comparable between the two groups. Similarly, no statistically significant differences were observed in the development of post-traumatic arthritis or in the frequency of syndesmotic widening 24 months postoperatively. However, the time required for fibular union was significantly longer in the PER group, taking 5.6 ± 2.2 months compared to 3.4 ± 1.3 months in the SER group on average (p < 0.001). Conclusions Our study demonstrated that both types of rotational ankle fractures can achieve equivalent clinical and radiological outcomes with surgical treatment. Given the prolonged time to fibular union in the PER group, careful monitoring during postoperative follow-up is required.背景 踝关节骨折是骨科领域最常见的骨折类型之一，Lauge-Hansen分型（Lauge-Hansen classification）是临床常用的旋转性踝关节骨折分类方法。本研究旨在评估并比较手术治疗Ⅲ或Ⅳ级旋后外旋型（supination external rotation, SER）与旋前外旋型（pronation external rotation, PER）踝关节骨折的临床与影像学结局。 方法 本研究回顾性纳入2016年1月至2021年12月期间于单中心接受切开复位内固定治疗的Ⅲ或Ⅳ级SER或PER型踝关节骨折患者共104例，其中旋后外旋型组（SER组）72例，旋前外旋型组（PER组）32例。SER组患者术后平均随访时长为31.3个月（范围：24~74个月），PER组为32.1个月（范围：24~71个月）。本研究于术后24个月评估两组的临床与影像学结局并进行对比，同时分析了伴随手术操作细节及术后并发症发生情况。 结果 两组患者的各项临床结局指标均无显著差异，包括足踝结局评分（Foot and Ankle Outcome Score）、疼痛视觉模拟评分（Visual Analog Scale）及踝关节活动范围。同样，术后24个月时，两组创伤后关节炎的发生率及下胫腓联合增宽的发生频率均无统计学差异。但PER组的腓骨愈合时间显著更长，平均为5.6±2.2个月，而SER组平均为3.4±1.3个月（p<0.001）。 结论 本研究表明，两种类型的旋转性踝关节骨折经手术治疗后均可获得相当的临床与影像学结局。鉴于PER组患者的腓骨愈合时间更长，术后随访期间需加强监测。