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《The Journal of Traditional Chinese Orthopedics and Traumatology》 2016-01
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Study on the structural relationship of supination-extorsion-type trimalleolar fractures

CHEN Cheng;CHENG Yongzhong;CHENG Hao;HOU Wangyang;WEN Jianmin;CAI Jingyi;Wangjing Hospital of China Academy Of Chinese Medical Sciences;  
Objective: To explore the relationship between different anatomic structures in supination- extorsion- type trimalleolar fractures. Methods: Forty- one patients with supination- extorsion- type trimalleolar fractures were selected and the anteroposterior and lateral X-rays films were taken. The outward displacement distance,posterior displacement distance and shortening distance of lateral malleolus,downward displacement distance and outward displacement distance of medial malleolus,upward displacement distance of posterior malleolus and talar tilt angle were measured on the X-rays films by using Image Pro Plus 6. 0 software,and the correlations between the displacement distance of medial,lateral and posterior malleolus and talar tilt angle were analyzed. Results: The outward displacement distance,posterior displacement distance and shortening distance of lateral malleolus,downward displacement distance and outward displacement distance of medial malleolus,upward displacement distance of posterior malleolus and talar tilt angle were 3. 50 + /- 2. 09 mm,3. 09 + /-2. 02 mm,5. 26 + /- 3. 36 mm,6. 03 + /- 5. 07 mm,2. 91 + /- 3. 09 mm,2. 66 + /- 2. 30 mm and 5. 09 + /- 4. 25 degrees respectively. The results of correlation analysis showed that talar tilt angle was positively correlated with the outward displacement distance and shortening distance of lateral malleolus and downward displacement distance and outward displacement distance of medial malleolus( r = 0. 430,P =0. 050; r = 0. 666,P = 0. 000; rs= 0. 561,P = 0. 000; rs= 0. 360,P = 0. 021),and was not correlated with posterior displacement distance of lateral malleolus and upward displacement distance of posterior malleolus( r =- 0. 115,P = 0. 473; rs= 0. 174,P = 0. 276). The talar tilt angle was chosen as the dependent variable( Y),while the outward displacement distance( X1) and shortening distance( X2) of lateral malleolus and downward displacement distance( X3) and outward displacement distance( X4) of medial malleolus were chosen as independent variable to establish the regression equation Y = 0. 269 + 0. 462 × X3+ 0. 597 × X2- 0. 379 × X4. The standardized coefficients of downward displacement distance of medial malleolus,shortening distance of lateral malleolus and outward displacement distance of medial malleolus were0. 551,0. 472 and- 0. 275 respectively. Conclusion: The displacement of talus is significantly correlated with the displacement of fracture fragments of medial malleolus and lateral malleolus in the supination- extorsion- type trimalleolar fractures,and the most significant correlation exists between the downward displacement of fracture fragments of medial malleolus and displacement of talus. Above closed correlation should be utilized adequately to obtain better results of manual reduction in the treatment of supination- extorsion- type trimalleolar fractures.
【Fund】: 国家自然科学基金项目(81273785);; 2012年北京市科学技术委员会首都十大危险疾病科技成果推广项目(Z121100005512013)
【CateGory Index】: R687.3
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