The Treatment of Malleolar Fractures of the Ankle Joint by Eijirou Adachi, Hisao Endo, Tatsuhiko Hemmi, Masami Takahashi, Kouji Fujii and Tadanori Oga
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1 The Treatment of Malleolar Fractures of the Ankle Joint by Eijirou Adachi, Hisao Endo, Tatsuhiko Hemmi, Masami Takahashi, Kouji Fujii and Tadanori Ogata Department of Orthopaedic Surgery, Health Insurance Naruto Hospital, Tokushima, Japan This fracture is variously classified, whereas, the therapeutic problems can be summarized in the following 3 items. 1. In terms of medial versus lateral malleolus, which should be considered to be more important? 2. Counter measures against severe damage of articular surface like trimalleolar fracture. 3. Cases possiblely resulting in osteoarthrosis of the ankle in future as predicted from an early stage. The purpose of this study is to devise therapeutic means fully considering the problematic points of injury of malleolus. The above cases were treated based on the following ideas. 1. For malleolar fracture, priority was given to the lateral malleolus rather than the medial malleolus, and the lateral malleolar fracture should be made reduction and fixation certain. 2. For the case possiblely causing severe contracture of the ankle joint after reduction of severe damage of malleolar site and trimalleolar fracture, calcaneus pin traction should be added.
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5 1004 足関節 果部 骨折の治療 る.本 骨 折 は 分 類 も さ る こ と な が ら,治 し て,1.内 療 法 の問題 と 果 と 外 果 で は ど ち ら を 重 視 す べ きか,2. 三果 骨 折 の よ うに関節 面 の損傷 の大 きい場 合 の対処 方 法,3.果 部 粉 砕 骨 折 の 場 合,が あ る. わ れ わ れ の 足 関 節 果 部 骨 折 の 治 療 法.1,内 果よ り 外 果 を 重 視2)4),特 に 外 果 は 確 実 に 整 復 固 定 を す る.2. 複 雑 な果部 骨 折 や三 果 骨 折 は整 復術 後 に も踵 骨牽 引 を 追 加 す る方 法 で あ る.こ の よ う な理 念 で 加 療 し 以 下 の 結 果 を得 た. 分 類 と 治 療 成 績1)3).対 て はsubjectiveで Fair 象 は41例 で あ っ た.結 はGoodが 5例(12%)で,Poorは はGood な か っ た.objectiveで 31例(75%),Fair (5%)で 8例(20%),Poor あ っ た(表1).す jectiveも 果と し 大 部 分 で36例(88%), 2例 な わ ちsubjectiveもob- か な りの 成 績 を得 る こ と が で き た. 代 表例 症 例1. 65才 男.Pronation-Eversion あ る(図1).図2は 図11症 例4.術 後 stage 手 術 後 の も の で あ る.外 復 に 意 を用 い た.図3は3年7ヶ 月 の も の で あ る.評 価 は 軽 度 の 運 動 痛 の た めsubjectiveはFair, tiveに は 跛 行 あ りPoorで 症 例2. objec- あ る. 56才 女.Supination-Eversion あ る(図4).踵 3で 側 果 の整 stage 4で 骨 牽 引 で で きる限 りの整 復 を行 な った 上 で 手 術 を 行 な っ た(図5).図6は1年6ヶ 像 で あ る.自 覚 症 状 は 殆 ど な く,評 月 の側 面 価 はGoodで あ る. 正 坐 も 可 能 で あ る. 症 例3. 58才 女.Supination-Eversion 三 果 骨 折 で あ る(図7).手 stage 術 に際 して は,特 の 整 復 に 意 を 用 い た(図8).図9は5年10ヶ で あ る.症 4で に外 側壁 月の もの 状 は 全 く な く正 坐 も可 能 で あ る. 症 例4.34才 男.関 節 面 の 損 傷 が著 し い(図10).整 復 手 術 を行 な っ た 上 で 再 度 踵 骨 牽 引 を追 加 し た(図11). 2年11ヶ 月 の 現 在,症 jectiveに もobjectiveに 状 は ほ と ん ど な く,評 もGoodで あ る.正 価 はsub坐 も可 能 能 で あ る(図12). 考 案 足 関 節 果 部 骨 折 は 関 節 内 骨 折 で あ る.関 節骨 折 の 治 療 の原 点 は解 剖 学 的 整復 と早期 の 自動運 動 で あ る と さ 図12症 例4.検 れ る.こ 診時 は,ま の理 念 を足 関節 果 部 骨折 の治療 に適 応 す るに ず 解 剖 学 的 整 復 を は か る必 要 が あ る.こ 題 と な る の が,内 28 果 と 外 果 で は,ど の際問 ち ら を よ り正 確 に
6 1) Burwell, H. N, and Charnley, A. D.: The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J. Bone and Joint Surg., 47-B: , ) Lauge-Hansen, N.: Fractures of the ankle: U. Combined experimental-surgical and experimentalroentogenologic investigation. Arch. Surg., 60: , ) Isadore, G.: The key role of the lateral malleolus in displaced fractures of the ankle. J. Bone and Joint Surg., 59-A: ,1977.
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