족관절 골절의 임상적 고찰

Abstract

The ankle joint is a weight bearing hinge joint which plays an important role biomechanically. This joint is vulnerable to injury by external force on the functional and anatomical position. When the ankle joint is fractured, involvement of the articular surface and ligamentous injury around the joint are susceptable, especially of the lateral malleolus. It becomes very important to make an accurate diagnosis and then to attain reduction of the fracture and stability of the joint. It also requires accurate diagnosis and treatment for the diasthesis of the distal tibio-fibular joint. Unless there is a definite understanding and diagnosis of the trauma mechanism and proper treatment, se¬vere functional impairment may occur relatively greater than that indicated by the degree of injury. The authors studied the mechanism of injury, the method of treatment, and the mutual relation¬ship with the result of 56 cases where follow-up study was possible out of 79 cases of ankle joint fracture which were admitted to the Department of Orthopedics, Dong San Medical Center, Kei¬myung University School of Medicine during the period of January 1975 to December, 1981. The follow-up studies on these 56 cases of ankle joint fracture were conducted with results as follows : 1. Of the occurrence ratio by sex, there were more male patients than female with 44 male(78.6 %) and the average age of the patients was 34.6. Most of the patients were in the ages between 20 and 30. 2. Most of the external injuries were caused by traffic accidents, 33 cases(58.9%)，and the rest as a result of stumbling 13 cases(23.2%), industrial accidents 7 cases(12.5%), athletic injuries 2 cases(3.6%), and injuries by falling down. 3. Fracture type by classical Lauge Hansen resulted in 20 cases of Supination-External rotation and Pronation-External rotation respectively with the highest percentage(71.4 %). The rest of the cases were in the order of 9 cases of Supination-Abduction (14.4%), 5 cases of Pronation-Ab- duction(8.9%), and 3 cases which did not fall under any classification of Lauge-Hansen. 4. The period of cast immobilization and full weight bearing indicated that the operative treat¬ment took comparatively shorter period of healing than that of conservative treatment. 5. The operative treatment proved to be more effective where there was a greater degree of Su-pination-External rotation and Pronation-External rotation. 6. In those cases where there was transfixation of the diasthesis of the distal tibio-fibular joint, it was shown to be important to remove screw before weight bearing was permitted. 7. When operative fixation was used for the fracture of Pronation-External rotation type, it pro¬ved preferable to transfix the distal tibiofibular diasthesis through one of the holes in the plate for the fixation of the lateral malleolus.