Functional outcomes after ankle fracture-dislocation: a systematic review

IF 2 3区医学 Q2 ORTHOPEDICS Archives of Orthopaedic and Trauma Surgery Pub Date : 2025-01-11 DOI:10.1007/s00402-024-05643-5

Helena F. Barber, Zachary D. Randall, Matthew J. Strok, Jake H. Goldfarb, Lauren Yaeger, Marschall B. Berkes

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Abstract

Introduction

Ankle fractures represent a significant portion of orthopedic injuries, with fracture dislocations tending to have worse outcomes. Logsplitter fractures represent a subset of fracture dislocations in which the talus is axially wedged in the tibiofibular joint. We aim to comprehensively investigate and report on the complications and functional outcomes associated with ankle fracture-dislocations.

Materials and Methods

Following PRISMA guidelines, a medical librarian conducted a literature search in Embase, Ovid Medline, Scopus, Cochrane Central Register of Controlled Trials, and The Cochrane Database of Systematic Reviews. Studies examining ankle fracture-dislocations and reporting on functional or employment outcomes were included. Excluded were non-English studies, abstracts, conference proceedings, letters, perspective pieces, reviews, editorials, and case reports or series with fewer than five patients. Data on functional outcomes were extracted and reported using descriptive statistics. A comparative analysis of AOFAS scores between Logsplitter and ankle fracture-dislocations was conducted using pooled means and independent t-tests.

Results

A total of 21 studies involving 810 cases of ankle fracture-dislocations were included. The pooled mean AOFAS score across 13 studies was 81.5, indicating “good” outcomes, while Logsplitter injuries had a significantly lower mean score of 75.8 compared to 82.9 for other ankle fracture-dislocations (p = 0.016). Complications included wound infection (7.3%), posttraumatic osteoarthritis (29.2%), nonunion/malunion (12.6%), and malunion. No studies reported on employment outcomes.

Conclusions

Ankle fracture-dislocations are high-energy injuries that affect a younger population compared to non-dislocated ankle fractures. Their functional outcomes resemble those of pilon fractures more than common ankle fractures. Logsplitter injuries are a subset of fracture dislocations that occur in even younger patients, with worse functional outcomes. This information can guide perioperative discussion and expectations for functional recovery. Additional studies are needed to evaluate the impact of these injuries on return to employment.

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踝关节骨折脱位后的功能结局：系统回顾

踝关节骨折是骨科损伤的重要组成部分，骨折脱位往往有较差的预后。Logsplitter骨折是骨折脱位的一个子集，其中距骨轴向楔入胫腓骨关节。我们的目的是全面调查和报道与踝关节骨折脱位相关的并发症和功能结局。材料和方法根据PRISMA指南，一位医学图书管理员在Embase、Ovid Medline、Scopus、Cochrane Central Register of Controlled Trials和Cochrane system Reviews数据库中进行了文献检索。研究检查踝关节骨折脱位并报告功能或就业结果。排除非英语研究、摘要、会议记录、信件、透视片、评论、社论、病例报告或少于5例患者的系列。功能结果的数据提取和报告使用描述性统计。采用合并均值和独立t检验对Logsplitter和踝关节骨折脱位的AOFAS评分进行比较分析。结果共纳入21篇研究，涉及踝关节骨折脱位810例。13项研究的综合平均AOFAS评分为81.5分，表明“良好”的结果，而Logsplitter损伤的平均评分为75.8分，明显低于其他踝关节骨折脱位的82.9分（p = 0.016）。并发症包括伤口感染（7.3%）、创伤后骨关节炎（29.2%）、不愈合/不愈合（12.6%）和不愈合。没有关于就业结果的研究报告。结论踝关节骨折脱位是一种高能量损伤，与非脱位的踝关节骨折相比，影响的人群更年轻。他们的功能结果更类似于头枕骨折，而不是普通的踝关节骨折。劈裂伤是骨折脱位的一个子集，发生在更年轻的患者中，功能预后更差。这些信息可以指导围手术期的讨论和对功能恢复的期望。需要进一步的研究来评估这些伤害对重返就业的影响。

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

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).