ZHANG Kaiting 1 , LI Zhuo 1 , JIE Ke 2 , XU Jingcheng 1 , ZOU Baoli 1 , MO Fangdong 1 , ZOU Yunxuan 2 , ZHU Yongzhan 2
  • 1. The Eighth Clinical School of Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510006, P. R. China;
  • 2. Department of Foot and Ankle Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan Guangdong, 528051, P. R. China;
ZHU Yongzhan, Email: zhuyz@fstcm.com.cn
Ankle joint; osteoarthritis; supramalleolar osteotomy; lateral hinge fracture; risk factor
10.7507/1002-1892.202403022
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Objective  To evaluate the influence of lateral hinge fracture (LHF) on the early effectiveness of supramalleolar osteotomy (SMO) and to explore the related risk factors for LHF. Methods  A total of 39 patients (39 feet) with varus-type ankle osteoarthritis treated with SMO between January 2016 and December 2022 were analyzed retrospectively. There were 10 males and 29 females, aged from 41 to 71 years (mean, 57.7 years). According to Takakura stage, there were 6 feet in stage Ⅱ, 19 feet in stage Ⅲa, and 14 feet in stage Ⅲb. The LHF was recognized by the immediate postoperative X-ray film. The osteotomy healing time and the changes of pain visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and tibiotalar angle (TT) before and after operation were compared between patients with and without LHF. The age, gender, affected side, body mass index, Takakura stage, preoperative VAS score, preoperative AOFAS score, preoperative TAS, preoperative TLS, preoperative TT, SMO correction angle, osteotomy distraction, distance from medial osteotomy to ankle joint line (MD), and distance from lateral osteotomy to ankle joint line (LD) were compared between with and without LHF patients, and further logistic regression analysis was used to screen the risk factors of LHF during SMO. Results  All patients were followed up 12-54 months (mean, 27.1 months). During operation, 13 feet developed LHF (group A) and 26 feet did not develop LHF (group B). X-ray film reexamination showed that 1 patient in group A complicated with tibial articular surface cleft fracture had delayed osteotomy and healed successfully after plaster fixation; the osteotomy of other patients healed, and there was no significant difference in healing time between the two groups (P>0.05). At last follow-up, there were significant differences in VAS score, AOFAS score, TAS, TLS, and TT of the two groups when compared with preoperative ones (P<0.05), but there was no significant difference in the changes of above indicators before and after operation between the two groups (P>0.05). The differences in SMO correction angle, osteotomy distraction, and LD between with and without LHF patients were significant (P<0.05), and further logistic regression analysis showed that excessive LD was the risk factor of LHF during SMO (P<0.05). Conclusion  Too high or too low lateral hinge position during SMO may lead to LHF, but as long as appropriate treatment and rehabilitation measurements are taken, the early effectiveness is similar to that of patients without LHF.

Citation： ZHANG Kaiting, LI Zhuo, JIE Ke, XU Jingcheng, ZOU Baoli, MO Fangdong, ZOU Yunxuan, ZHU Yongzhan. Influence and risk factors of lateral hinge fracture on early effectiveness of supramalleolar osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(6): 742-747. doi: 10.7507/1002-1892.202403022 Copy

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