Ankle syndesmotic ligaments avulsion fractures: incidence in adult population.

IF 2.8 3区医学 Q1 ORTHOPEDICS Journal of Orthopaedic Surgery and Research Pub Date : 2024-10-12 DOI:10.1186/s13018-024-05156-2

Xiang Yao, Chong Wang, Weijie Pan, Yicong Chao, Jilei Tang

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引用次数: 0

Abstract

Background: Distal tibiofibular syndesmosis injury is often associated with ankle fractures in adults. Injuries to the anterior/posterior inferior tibiofibular ligament (AITFL/PITFL) may present as a mid-substance tear or as an avulsion at insertion. Tibial and fibular avulsion of the AITFL is known as Tillaux fracture and Wagstaffe fracture, respectively. Tibial avulsion of the PITFL is referred to as a Volkmann fracture, and fibular avulsion of the PITFL is still undefined and has not been reported yet. The aim of this study is to summarize the incidence of these four avulsions, that is, tibial and fibular avulsions of the AITFL and PITFL.

Method: Radiography and computed tomography (CT) imaging data of all adult patients with ankle fractures treated at our hospital between November 2010 and March 2023 were retrospectively analyzed. All ankle fractures were classified according to the Weber-AO and Lauge-Hansen classification systems by two experienced radiologists and two surgeons. The incidence of the four avulsions of the AITFL/PITFL was determined.

Results: In total, 1,770 ankle fractures in 1,758 patients were included in this study. The total incidence of avulsions at the four insertions of the AITFL/PITFL (occurring at one, two, or three insertions) was found to be 26.3% (465/1,770). Volkmann fracture had the highest incidence (19.9%, 353/1,770), and it was followed by Tillaux fracture (5.3%, 93/1,770), Wagstaffe fracture (3.3%, 59/1,770), and fibular avulsion of the PITFL (0.5%, 8/1,770). It is noteworthy that fibular avulsion of the PITFL has been reported here for the first time. The incidence of avulsion at one insertion was 23.6% (418/1770) and 2.7% (47/1770) at multiple insertions.

Conclusion: In adult ankle fractures, avulsion occurs at the four insertions of the AITFL/PITFL in more than 25% of patients. The tibial insertion of the PITFL had the highest incidence of avulsion among the four insertions, while the fibular insertion of the PITFL had the lowest. The four types of avulsions can be isolated or in association with other avulsions. Future research studies on these four types of avulsion fractures would help in accurate diagnosis, decision-making and treatment of ankle Syndesmosis injuries.

Level of evidence: Level III, retrospective cohort study.

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踝关节巩膜韧带撕脱性骨折：成人发病率。

背景：成人胫腓骨远端联合韧带损伤通常与踝关节骨折有关。胫腓前/后下韧带（AITFL/PITFL）的损伤可能表现为中段撕裂或插入处撕脱。AITFL 的胫骨和腓骨撕脱分别称为 Tillaux 骨折和 Wagstaffe 骨折。PITFL 的胫骨撕脱被称为 Volkmann 骨折，而 PITFL 的腓骨撕脱仍未确定，尚未见报道。本研究旨在总结这四种撕脱的发生率，即 AITFL 和 PITFL 的胫骨和腓骨撕脱：方法：回顾性分析 2010 年 11 月至 2023 年 3 月期间在我院接受治疗的所有成年踝关节骨折患者的 X 射线和计算机断层扫描（CT）成像数据。所有踝关节骨折均由两名经验丰富的放射科医生和两名外科医生根据 Weber-AO 和 Lauge-Hansen 分类系统进行分类。结果：本研究共收录了 1758 名患者的 1770 例踝关节骨折。结果发现，AITFL/PITFL四个插入处（发生在一个、两个或三个插入处）撕脱的总发生率为26.3%（465/1,770）。Volkmann 骨折的发生率最高（19.9%，353/1,770），其次是 Tillaux 骨折（5.3%，93/1,770）、Wagstaffe 骨折（3.3%，59/1,770）和 PITFL 的腓骨撕脱（0.5%，8/1,770）。值得注意的是，PITFL的腓骨撕脱是首次报道。一次插入的撕脱发生率为23.6%（418/1770），多次插入的撕脱发生率为2.7%（47/1770）：结论：在成人踝关节骨折中，超过 25% 的患者会在 AITFL/PITFL 的四个插入处发生撕脱。在四个插入点中，PITFL 的胫骨插入点发生撕脱的比例最高，而 PITFL 的腓骨插入点发生撕脱的比例最低。这四种类型的撕脱可能是孤立的，也可能与其他撕脱同时发生。未来对这四种类型的撕脱性骨折的研究将有助于准确诊断、决策和治疗踝关节Syndesmosis损伤：证据等级：三级，回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.