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

To investigate the preoperative application effect of reverse traction technique in trimalleolar fracture-dislocation of the ankle.

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.

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).

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.