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RÉSUMÉ
Introduction. Les fracture-luxations de cheville (FLC) sont des lésions graves qui mettent en jeu le pronostic fonctionnel de l’articulation. Ce travail avait pour but d’étudier les formes anatomo-cliniques, les aspects thérapeutiques et évolutifs des FLC en contexte de ressources limitées. Patients et méthodes. Les données d’une cohorte rétrospective de tous les patients ayant été reçus et suivis CHU Aristide-Le-Dantec pour FLC sur une période de six ans (Janvier 2009 à Janvier 2015) ont été récoltées et analysées. Les variables d’intérêt étaient démographiques, radio-cliniques et thérapeutiques. Le délai de consolidation et les complications ont été rapportés, avec un recul moyen de 27,2 ± 18.3 mois. Résultats. Cinquante-deux patients âgés en moyenne de 37,2 ± 11,1 ans ont été inclus. Concernant les formes cliniques, les fractures étaient bimalléolaires, équivalent-bimalléolaires et trimalléolaires dans 26 (50%), 12 (23,10%) et 8 (15,3%) cas respectivement. La luxation talo-crurale associée était latérale dans 26 (50%) cas, postérieure dans 18 (34,6%) cas. La FLC était ouverte dans 16 (30,8%) cas. Le traitement était chirurgical chez 33 (63,4%) patients. La principale indication chirurgicale était l’embrochage de la malléole latérale associée à l’haubanage de la malléole médiale chez 15 (45,4%) patients. La réduction anatomique des fractures et le recentrage du talus étaient obtenus dans 26 (50%) et 34 (65,4%) cas respectivement. Le délai moyen de consolidation était de 76,7 ± 28,2 jours. La principale complication chronique était l’arthrose talo-crurale, retrouvée chez 22 (42.3%) patients. Conclusion. Les FLC constituent une urgence traumatologique grave, aux formes cliniques variées, avec 73% de complications chroniques dans notre milieu.
ABSTRACT
Introduction. Ankle fracture-dislocations (AFD) are serious injuries that affect the functional prognostic of the joint. The aim of our work was to report the clinical features, the therapeutic and evolutionary aspects of AFD in a resource-limited setting. Patients and Methods. Data from a retrospective cohort of consecutive patients admitted and followed for AFD at the Aristide-Le-Dantec teaching hospital for a six years period (January 2009 – January 2015) were collected and analyzed. We studied demographic, clinical and therapeutic data. The delay of consolidation and the occurrence of complications was also reported, at an average follow-up period of 27.2 ± 18.3 months. Results. Fifty-two patients, aged 37.2 ±11.1 years were included. Regarding the clinical features, bimalleolar fracture were observed in 26 (50%) cases, followed by equivalent-bimalleolar and trimalleolar fractures in 12(23.1%) and 8(15.3%) cases respectively. Associated tibio-tarsal dislocation was lateral in 26(50%) cases and posterior in 18(34.6%) cases. Open AFD was found in 16 (30.8%) cases. The treatment was surgical in 33 (63.4) patients. The main surgical modality was pinning of the lateral malleolus and tension band wiring of the medial malleolus in 15(45.4%) patients. Anatomical reduction of the fractures and centering of the talus were achieved in 26(50%) and 34(65.4%) patients respectively. The bone consolidation was achieved at an average delay of 76.7 ± 28.2 days. The main chronic complication was early posttraumatic ankle osteoarthritis, found in 22(42.3%) patients. Conclusion. AFD are severe trauma emergency with various clinical presentations, and 73% of chronic complications in our setting.
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References
- Sculco PK, Lazaro LE, Little MM, et al. Dislocation is a risk factor for poor outcome after supination external rotation type ankle fractures. Arch Orthop Trauma Surg 2016;136:9-15.
- Lavini F, Maluta T, Carpeggiani G, et al. A new approach to local DCO in ankle fracture dislocations: external fixation with diaphyseal unicortical screws applied by local anaesthesia. Musculoskelet Surg 2017;101:229-235.
- Payne R, Kinmont JC, Moalypour SM. Initial management of closed fracture-dislocations of the ankle. Ann R Coll Surg Engl 2004;86:177-181.
- Ross A, Catanzariti AR, Mendicino RW. The hematoma block: a simple, effective technique for closed reduction of ankle fracture dislocations. J Foot Ankle Surg 2011;50(4):507-9.
- White BJ, Walsh M, Egol KA, Tejwani NC. Intra-articular block compared with conscious sedation for closed reduction of ankle fracture-dislocations. A prospective randomized trial. J Bone Joint Surg Am 2008;90(4):731-4.
- Leeds HC, Ehrlich MG. Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am 1984;66:490-503.
- Obada B, Serban A, Turcu R. The Role of the Radiological Parameters in the Diagnosis of the Ankle Joint Fractures. ARS Medica Tomitana 2014;2:77-81.
- Azouz M, Rhanim AK, Mhamdi Y, et al. Pure tibiotalar dislocation: about a case with review of the literature. Pan Afr Med J 2014;19:249.
- Agoumi O, El Mrini A, Boutayeb F. Luxation tibio-talienne pure : A propos d’un cas avec revue de littérature. Méd. Chir. Pied 2006;22:30-31.
- Warner SJ, Schottel PC, Hinds RM, Helfet DL, Lorich DG. Fracture-Dislocations Demonstrate Poorer Postoperative Functional Outcomes Among Pronation External Rotation IV Ankle Fractures. Foot Ankle Int 2015;36:641-647.
- Bois AJ, Dust W. Posterior fracture dislocation of the ankle: technique and clinical experience using a posteromedial surgical approach. J Orthop Trauma, 2008;22(9):629-36.
- Varango G, Kodo M, Bamba I, Lambin Y. Les fracture-luxations de la cheville: Facteurs pronostics (à propos de 25 cas). Rev Mar Chir Orthop Traumatol 1997;6.
- Hastie GR, Divecha H, Javed S, Zubairy A. Ankle injury manipulation before or after X-ray--does it influence success? Injury 2014;45:583-585.
- Wicks L, Faroug R, Richler-Potts D et al. Should pre-manipulation radiographs be obtained in ankle fracture-dislocations? Foot 2018;36:10-14.
- Abraham A. Emergency treatment of ankle fracture dislocations - a reliable technique for early reduction. Ann R Coll Surg Engl 2003;85:427.
- Willett K, Keene DJ, Mistry D et al. Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults: A Randomized Clinical Trial. Jama 2016;316:1455-1463.
- Lindsjo U. Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res 1985;28-38.
- Xing W, Wang Y, Sun L et al. Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. Medicine 2018;97:e12079.
- Wang Z, Tang X, Li S et al. Treatment and outcome prognosis of patients with high-energy transsyndesmotic ankle fracture dislocation-the "Logsplitter" injury. J Orthop Surg Res 2017;12:3.
- Regier M, Petersen JP, Hamurcu A et al. High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases. Injury 2016;47:757-761.
- Klumpp R, Compagnoni R, Zeppieri M, Trevisan CL. The Cuneo and Picot fracture-dislocation of the ankle: A case report and review of the literature. Foot 2018;37:11-15.
- Regan DK, Gould S, Manoli A, Egol KA. Outcomes Over a Decade After Surgery for Unstable Ankle Fracture: Functional Recovery Seen 1 Year Postoperatively Does Not Decay With Time. J Orthop Trauma 2016;30:236-241.
- Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B. Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg Am 2010;92:279-286.
References
Sculco PK, Lazaro LE, Little MM, et al. Dislocation is a risk factor for poor outcome after supination external rotation type ankle fractures. Arch Orthop Trauma Surg 2016;136:9-15.
Lavini F, Maluta T, Carpeggiani G, et al. A new approach to local DCO in ankle fracture dislocations: external fixation with diaphyseal unicortical screws applied by local anaesthesia. Musculoskelet Surg 2017;101:229-235.
Payne R, Kinmont JC, Moalypour SM. Initial management of closed fracture-dislocations of the ankle. Ann R Coll Surg Engl 2004;86:177-181.
Ross A, Catanzariti AR, Mendicino RW. The hematoma block: a simple, effective technique for closed reduction of ankle fracture dislocations. J Foot Ankle Surg 2011;50(4):507-9.
White BJ, Walsh M, Egol KA, Tejwani NC. Intra-articular block compared with conscious sedation for closed reduction of ankle fracture-dislocations. A prospective randomized trial. J Bone Joint Surg Am 2008;90(4):731-4.
Leeds HC, Ehrlich MG. Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am 1984;66:490-503.
Obada B, Serban A, Turcu R. The Role of the Radiological Parameters in the Diagnosis of the Ankle Joint Fractures. ARS Medica Tomitana 2014;2:77-81.
Azouz M, Rhanim AK, Mhamdi Y, et al. Pure tibiotalar dislocation: about a case with review of the literature. Pan Afr Med J 2014;19:249.
Agoumi O, El Mrini A, Boutayeb F. Luxation tibio-talienne pure : A propos d’un cas avec revue de littérature. Méd. Chir. Pied 2006;22:30-31.
Warner SJ, Schottel PC, Hinds RM, Helfet DL, Lorich DG. Fracture-Dislocations Demonstrate Poorer Postoperative Functional Outcomes Among Pronation External Rotation IV Ankle Fractures. Foot Ankle Int 2015;36:641-647.
Bois AJ, Dust W. Posterior fracture dislocation of the ankle: technique and clinical experience using a posteromedial surgical approach. J Orthop Trauma, 2008;22(9):629-36.
Varango G, Kodo M, Bamba I, Lambin Y. Les fracture-luxations de la cheville: Facteurs pronostics (à propos de 25 cas). Rev Mar Chir Orthop Traumatol 1997;6.
Hastie GR, Divecha H, Javed S, Zubairy A. Ankle injury manipulation before or after X-ray--does it influence success? Injury 2014;45:583-585.
Wicks L, Faroug R, Richler-Potts D et al. Should pre-manipulation radiographs be obtained in ankle fracture-dislocations? Foot 2018;36:10-14.
Abraham A. Emergency treatment of ankle fracture dislocations - a reliable technique for early reduction. Ann R Coll Surg Engl 2003;85:427.
Willett K, Keene DJ, Mistry D et al. Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults: A Randomized Clinical Trial. Jama 2016;316:1455-1463.
Lindsjo U. Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res 1985;28-38.
Xing W, Wang Y, Sun L et al. Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. Medicine 2018;97:e12079.
Wang Z, Tang X, Li S et al. Treatment and outcome prognosis of patients with high-energy transsyndesmotic ankle fracture dislocation-the "Logsplitter" injury. J Orthop Surg Res 2017;12:3.
Regier M, Petersen JP, Hamurcu A et al. High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases. Injury 2016;47:757-761.
Klumpp R, Compagnoni R, Zeppieri M, Trevisan CL. The Cuneo and Picot fracture-dislocation of the ankle: A case report and review of the literature. Foot 2018;37:11-15.
Regan DK, Gould S, Manoli A, Egol KA. Outcomes Over a Decade After Surgery for Unstable Ankle Fracture: Functional Recovery Seen 1 Year Postoperatively Does Not Decay With Time. J Orthop Trauma 2016;30:236-241.
Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B. Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg Am 2010;92:279-286.