J Korean Foot Ankle Soc.  2023 Sep;27(3):87-92. 10.14193/jkfas.2023.27.3.87.

Comparative Study of Surgical Treatment for Concomitant Ankle Joint Injury in Tibia Shaft Fracture

• Park J
• Lee S
• Lee H
• Kim GL
• Chang J
• Hahm H

• KMID: 2545986
• DOI: http://doi.org/10.14193/jkfas.2023.27.3.87

Abstract

Purpose
Concomitant ankle injuries associated with tibial shaft fractures can affect postoperative ankle joint pain and various postoperative ankle complications. This study compared the clinical outcomes between surgical treatment and conservative treatment of concomitant ankle injuries associated with tibial shaft fractures.
Materials and Methods
From January 2015 to June 2020, a retrospective study was conducted on 118 tibia shaft fractures at the orthopedics department of the hospital. Associated ankle injuries were analyzed using plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative stress exams. The clinical outcomes were compared using the pain visual analog scale (pain VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score (AOFAS score), and Karlsson–Peterson ankle score (KP score).
Results
Seventy-two (61.02%) of the 118 cases were diagnosed with associated ankle injuries. Fifty-six cases underwent surgery for the ankle injury, and 16 cases underwent conservative treatment. The clinical results (according to the pain VAS score, AOFAS score, the KP score) were 1.79±1.26, 94.48±4.03, and 94.57±3.60, respectively, in the surgical treatment group, and 3.00±1.03, 91.06±3.02, and 91.25±3.31, respectively, in the conservative treatment group.
Conclusion
Surgical treatment showed better clinical outcomes than conservative treatment in concomitant ankle injury in tibia fractures. Therefore, surgical treatment produces better clinical outcomes than conservative treatment in concomitant ankle injuries in tibia fractures. Hence to improve the clinical outcomes, more attention is needed on ankle joint injury in tibial shaft fractures for selecting suitable surgical treatments for those patients.

Keyword

Tibial shaft fracture; Ankle injury; Associated injury; Surgical treatment; Outcome comparison

Figure

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  Figure 1 (A) Preoperative tibia anteroposterior (AP) image of a 40-year-old female with an oblique pattern fracture at the distal portion of tibia and fibula. (B) Preoperative ankle AP image of the same patient. Fracture line extended to the distal tibiofibular joint space was found. (C) Axial computed tomography image demonstrates a minimally displaced posterior malleolar fracture and a comminuted lateral malleolar fracture (circle). (D) Axial magnetic resonance image reveals the anterior talofibular ligament rupture (white arrow).

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  Figure 2 (A) Preoperative tibia anteroposterior (AP) image of a 58-year-old male with a spiral fracture at the distal one third of the tibia and proximal fibula. Linear fracture line extend to the ankle joint was exist. (B) Axial computed tomography imaging reveals a large, nondisplaced posterior malleolus fracture contiguous with the shaft fracture (circle). (C) Postoperative tibia AP image. Open reduction and internal fixation was done by using plate & screws at medial side of tibia. (D) Standing AP view of both lower extremities which was taken at 1-year follow-up after surgery showed that ankle valgus deformity had been occurred.

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