Preoperative application effect of reverse traction technique in trimalleolar fracture-dislocation of ankle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Mingli ¹ , YANG Yue ² , CHEN Zonglin ¹ , LIN Yihuang ¹ , YANG Rongyuan ¹ ,  LI Honghan ¹

1. Department of Orthopedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P. R. China;
2. School of Clinical Medicine, Fujian Medical University, Fuzhou Fujian, 350004, P. R. China;

Corresponding?author：

LI Honghan, Email: lhh1706@fjmu.edu.cn

Keywords：

Trimalleolar fracture; ankle dislocation; reverse traction; calcaneal traction

DOI：

10.7507/1002-1892.202603053

Video：

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Objective To investigate the preoperative application effect of reverse traction technique in trimalleolar fracture-dislocation of the ankle. Methods A retrospective analysis was conducted on the clinical data of 37 patients with trimalleolar fracture-dislocation of the ankle, who were admitted between January 2020 and June 2024 and met the selection criteria. Upon admission, 18 patients underwent reverse traction (reverse traction group) and 19 patients underwent calcaneal traction (calcaneal traction group); open reduction and plate fixation were performed after the soft tissue condition improved. There was no significant difference (P>0.05) in the baseline data between groups, including age, gender, body mass index, and cause, affected side, and Lauge-Hansen classification of fracture. Outcome indicators were evaluated and compared between groups, including visual analogue scale (VAS) scores before traction, immediately after traction, and before internal fixation, preoperative waiting time, total hospital stay, duration of internal fixation surgery, preoperative Internal Fixation Comfort Questionnaire (ICQ) scores, the incidence of external fixation-related complications during traction, and the American Orthopedic Foot and Ankle Society (AOFAS) score. Results The ICQ scores, as well as the VAS scores at immediate after traction and before internal fixation, were all significantly better in the reverse traction group than in the calcaneal traction group (P<0.05). The incidence of external fixation-related complications was significantly lower in the reverse traction group (0) than in the calcaneal traction group (31.6%) (P<0.05). There was no significant difference between groups (P>0.05) in terms of preoperative waiting time, duration of internal fixation surgery, or total hospital stay. Imaging examination showed that the ankle dislocation was reduced following reverse traction. Patients in both groups successfully underwent internal fixation surgery and were followed up (16.1±1.8) months. All fractures of the two groups achieved bony union with no significant difference in fracture healing time and AOFAS scores at last follow-up (P>0.05). Conclusion For patients with trimalleolar fracture-dislocation of the ankle, the use of reverse traction upon admission can significantly alleviate pain and improve quality of life, with fewer traction-related complications.

Citation： CHEN Mingli, YANG Yue, CHEN Zonglin, LIN Yihuang, YANG Rongyuan, LI Honghan. Preoperative application effect of reverse traction technique in trimalleolar fracture-dislocation of ankle. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(8): 1234-1240. doi: 10.7507/1002-1892.202603053 Copy

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2.	Chidda A, Soares S, Tannast M, et al. Long-term outcomes after a trimalleolar fracture involving the posterior malleolar fragment: an 11-year follow-up[J/OL]. Arch Orthop Trauma Surg, 2025, 145(1): 346. doi: 10.1007/s00402-025-05959-w.
3.	Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures[J]. Foot Ankle Surg, 2018, 24(1): 34-39.
4.	Vosoughi AR, Glazebrook M. Interposition of tibialis posterior and flexor digitorum longus tendons resulted in irreducible ankle fracture-dislocation[J]. J Foot Ankle Surg, 2017, 56(3): 697-701.
5.	李庭, 孫志堅, 柴益民, 等. ERAS理念下踝關節骨折診療方案優化的專家共識[J]. 中華骨與關節外科雜志, 2019, 12(1): 3-12.
6.	Spek RWA, Smeeing DPJ, van den Heuvel L, et al. Complications after surgical treatment of geriatric ankle fractures[J]. J Foot Ankle Surg, 2021, 60(4): 712-717.
7.	Guryel E, McEwan J, Qureshi AA, et al. Consensus on managing open ankle fractures in the frail patient[J]. Bone Jt Open, 2024, 5(3): 236-242.
8.	Gurau TV, Gurau G, Musat CL, et al. Epidemiology of injuries in professional and amateur football men (Part Ⅱ)[J/OL]. J Clin Med, 2023, 12(19): 6293. doi: 10.3390/jcm12196293.
9.	Barber HF, Randall ZD, Strok MJ, et al. Functional outcomes after ankle fracture-dislocation: a systematic review[J/OL]. Arch Orthop Trauma Surg, 2025, 145: 117. doi: 10.1007/s00402-024-05643-5.
10.	高博, 楊靈, 汪紅, 等. 跟骨牽引與外固定架臨時固定分步延期治療C型Pilon骨折的病例對照研究[J]. 中國骨傷, 2020, 33(3): 203-208.
11.	Aloraibi S, Gladman J, Godfrey D, et al. Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study[J/OL]. BMC Geriatr, 2021, 21(1): 332. doi: 10.1186/s12877-021-02265-z.
12.	張英澤. 順勢復位固定微創治療脛骨平臺骨折[J]. 中華骨科雜志, 2023, 43(22): 1473-1476.
13.	陳明禮, 陳宗霖, 李洪瀚, 等. 反向牽引裝置在高能量脛骨平臺骨折術前的應用效果[J]. 中國修復重建外科雜志, 2024, 38(7): 830-835.
14.	Ramadi A, Beaupre LA, Heinrichs L, et al. Recovery and return to activity 1 year after ankle fracture managed with open reduction and internal fixation: a prospective longitudinal cohort study[J/OL]. Foot Ankle Orthop, 2022, 7(2): 24730114221091806. doi: 10.1177/24730114221091806.
15.	Cao MM, Zhang YW, Hu SY, et al. A systematic review of ankle fracture-dislocations: Recent update and future prospects[J/OL]. Front Surg, 2022, 9: 965814. doi: 10.3389/fsurg.2022.965814.
16.	Buyukkuscu MO, Basilgan S, Mollaomeroglu A, et al. Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations[J]. Foot Ankle Surg, 2022, 28(2): 235-239.
17.	袁文杰, 陸大明, 徐雪平, 等. 經腓骨后外側入路和經腓骨入路內固定術治療旋后外旋型Ⅳ度踝關節骨折的療效比較[J]. 中華骨與關節外科雜志, 2023, 16(2): 164-168.
18.	Pflüger P, Braun KF, Mair O, et al. Current management of trimalleolar ankle fractures[J]. EFORT Open Rev, 2021, 6(8): 692-703.
19.	Amarasena DK, Nath U, Das A, et al. Does fragment-specific fixation provide better functional outcomes following trimalleolar ankle fractures?[J]. Foot Ankle Spec, 2026, 19(2): 219-224.
20.	Lampridis V, Gougoulias N, Sakellariou A. Stability in ankle fractures: Diagnosis and treatment[J]. EFORT Open Rev, 2018, 3(5): 294-303.
21.	劉廣偉, 成永忠, 祝建飛, 等. 旋前-外旋型三踝骨折逆移位手法復位有限元分析[J]. 醫用生物力學, 2018, 33(6): 523-528.
22.	中華醫學會骨科學分會足踝外科學組, 中國中西醫結合學會骨傷科專業委員會足踝專家工作委員會, 蘆浩, 等. 后踝骨折診療專家共識[J]. 中華骨與關節外科雜志, 2025, 18(5): 385-393.
23.	Edelstein A, McDonald J, Lee W. The impact of surgical timing in ankle fracture on postoperative wound complications: a critical 24-hour cutoff point through systematic review and meta-analysis[J/OL]. Arch Orthop Trauma Surg, 2025, 145(1): 269. doi: 10.1007/s00402-025-05896-8.
24.	Sauro KM, Smith C, Ibadin S, et al. Enhanced recovery after surgery guidelines and hospital length of stay, readmission, complications, and mortality: a meta-analysis of randomized clinical trials[J/OL]. JAMA Netw Open, 2024, 7(6): e2417310. doi: 10.1001/jamanetworkopen.2024.17310.
25.	徐江, 肖淑利, 楊志金, 等. 骨創傷術后下肢腫脹怎么辦[J]. 創傷外科雜志, 2022, 24(12): 960-961.

1. Patel S, Dionisopoulos SB. Current concepts in ankle fracture management[J]. Clin Podiatr Med Surg, 2024, 41(3): 519-534.
2. Chidda A, Soares S, Tannast M, et al. Long-term outcomes after a trimalleolar fracture involving the posterior malleolar fragment: an 11-year follow-up[J/OL]. Arch Orthop Trauma Surg, 2025, 145(1): 346. doi: 10.1007/s00402-025-05959-w.
3. Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures[J]. Foot Ankle Surg, 2018, 24(1): 34-39.
4. Vosoughi AR, Glazebrook M. Interposition of tibialis posterior and flexor digitorum longus tendons resulted in irreducible ankle fracture-dislocation[J]. J Foot Ankle Surg, 2017, 56(3): 697-701.
5. 李庭, 孫志堅, 柴益民, 等. ERAS理念下踝關節骨折診療方案優化的專家共識[J]. 中華骨與關節外科雜志, 2019, 12(1): 3-12.
6. Spek RWA, Smeeing DPJ, van den Heuvel L, et al. Complications after surgical treatment of geriatric ankle fractures[J]. J Foot Ankle Surg, 2021, 60(4): 712-717.
7. Guryel E, McEwan J, Qureshi AA, et al. Consensus on managing open ankle fractures in the frail patient[J]. Bone Jt Open, 2024, 5(3): 236-242.
8. Gurau TV, Gurau G, Musat CL, et al. Epidemiology of injuries in professional and amateur football men (Part Ⅱ)[J/OL]. J Clin Med, 2023, 12(19): 6293. doi: 10.3390/jcm12196293.
9. Barber HF, Randall ZD, Strok MJ, et al. Functional outcomes after ankle fracture-dislocation: a systematic review[J/OL]. Arch Orthop Trauma Surg, 2025, 145: 117. doi: 10.1007/s00402-024-05643-5.
10. 高博, 楊靈, 汪紅, 等. 跟骨牽引與外固定架臨時固定分步延期治療C型Pilon骨折的病例對照研究[J]. 中國骨傷, 2020, 33(3): 203-208.
11. Aloraibi S, Gladman J, Godfrey D, et al. Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study[J/OL]. BMC Geriatr, 2021, 21(1): 332. doi: 10.1186/s12877-021-02265-z.
12. 張英澤. 順勢復位固定微創治療脛骨平臺骨折[J]. 中華骨科雜志, 2023, 43(22): 1473-1476.
13. 陳明禮, 陳宗霖, 李洪瀚, 等. 反向牽引裝置在高能量脛骨平臺骨折術前的應用效果[J]. 中國修復重建外科雜志, 2024, 38(7): 830-835.
14. Ramadi A, Beaupre LA, Heinrichs L, et al. Recovery and return to activity 1 year after ankle fracture managed with open reduction and internal fixation: a prospective longitudinal cohort study[J/OL]. Foot Ankle Orthop, 2022, 7(2): 24730114221091806. doi: 10.1177/24730114221091806.
15. Cao MM, Zhang YW, Hu SY, et al. A systematic review of ankle fracture-dislocations: Recent update and future prospects[J/OL]. Front Surg, 2022, 9: 965814. doi: 10.3389/fsurg.2022.965814.
16. Buyukkuscu MO, Basilgan S, Mollaomeroglu A, et al. Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations[J]. Foot Ankle Surg, 2022, 28(2): 235-239.
17. 袁文杰, 陸大明, 徐雪平, 等. 經腓骨后外側入路和經腓骨入路內固定術治療旋后外旋型Ⅳ度踝關節骨折的療效比較[J]. 中華骨與關節外科雜志, 2023, 16(2): 164-168.
18. Pflüger P, Braun KF, Mair O, et al. Current management of trimalleolar ankle fractures[J]. EFORT Open Rev, 2021, 6(8): 692-703.
19. Amarasena DK, Nath U, Das A, et al. Does fragment-specific fixation provide better functional outcomes following trimalleolar ankle fractures?[J]. Foot Ankle Spec, 2026, 19(2): 219-224.
20. Lampridis V, Gougoulias N, Sakellariou A. Stability in ankle fractures: Diagnosis and treatment[J]. EFORT Open Rev, 2018, 3(5): 294-303.
21. 劉廣偉, 成永忠, 祝建飛, 等. 旋前-外旋型三踝骨折逆移位手法復位有限元分析[J]. 醫用生物力學, 2018, 33(6): 523-528.
22. 中華醫學會骨科學分會足踝外科學組, 中國中西醫結合學會骨傷科專業委員會足踝專家工作委員會, 蘆浩, 等. 后踝骨折診療專家共識[J]. 中華骨與關節外科雜志, 2025, 18(5): 385-393.
23. Edelstein A, McDonald J, Lee W. The impact of surgical timing in ankle fracture on postoperative wound complications: a critical 24-hour cutoff point through systematic review and meta-analysis[J/OL]. Arch Orthop Trauma Surg, 2025, 145(1): 269. doi: 10.1007/s00402-025-05896-8.
24. Sauro KM, Smith C, Ibadin S, et al. Enhanced recovery after surgery guidelines and hospital length of stay, readmission, complications, and mortality: a meta-analysis of randomized clinical trials[J/OL]. JAMA Netw Open, 2024, 7(6): e2417310. doi: 10.1001/jamanetworkopen.2024.17310.
25. 徐江, 肖淑利, 楊志金, 等. 骨創傷術后下肢腫脹怎么辦[J]. 創傷外科雜志, 2022, 24(12): 960-961.

Chinese Journal of Reparative and Reconstructive Surgery

Preoperative application effect of reverse traction technique in trimalleolar fracture-dislocation of ankle

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