Abstract
Introduction
The most important factor in the treatment of ankle joint fractures is stable anatomical reconstruction of the syndesmosis and joint surface. In the course of this, attention must be paid to soft-tissue damage with the risk of deep infections. Early functional therapy and exercise tolerance must be called for. The choice of surgical access route, in particular in the case of critical arterial circulation, and the possible irritation of the soft tissue by the osteosynthesis material prompted us to seek alternative osteosynthesis techniques.
Material and methods
Following a preclinical study and very good initial results with the XS nail in the treatment of patella and olecranon fractures, this was now also used for ankle joint fractures at the medial malleolus and lateral malleolus. In the period from 5/2000 to 1/2002, 194 ankle joint fractures were treated using the XS nail. These were predominantly Weber B, C and bimalleolar fractures. In the case of ankle joint fractures, osteosynthesis was carried out following precise open fracture repositioning. In the case of isolated fibula fractures, early loading was allowed within 1 week; in the case of bimalleolar fractures, there was immediate partial loading with 20 kg for 4 weeks, after which they were subjected to full loading. Where there was an additional Volkmann fracture, we allowed only immediate partial loading with 10 kg for 6 weeks. All 194 patients were observed prospectively, and 162 (83.5%) could be followed up after 15 months. The results were classified according to the scale described by Olerud.
Results
It has been possible to follow up 162 patients, with an average age of 49.7 years. There were 62 (38.3%) Weber B and 45 (27.8%) Weber C fractures. In 55 (34.0%) cases, bimalleolar fractures were present. According to the Olerud score, 95 (58.6%) of the patients had an excellent outcome, 54 (33.3%) a good one, 9 (5.5%) a fair one and 4 (2.5%) an unsatisfactory outcome. In 3 cases a threaded wire dislocation occurred, without complications. Two mesh graft transplants were necessary; otherwise, there were no soft-tissue problems requiring review. One pseudarthrosis was seen.
Conclusion
The XS nail which is introduced here fulfils the requirements made of an implant as regards maximum protection of soft tissue, secure fracture fixation and early exercise tolerance, including ankle fractures. No implant dislocation, no deep infection and no re-osteosynthesis were observed. Its advantages over conventional techniques lie precisely in the treatment of complex fractures and for patients with poor bone, vascular and soft-tissue situations.
Similar content being viewed by others
References
Blotter RH, Connolly E, Wasan A, Chapman MVV (1999) Acute complications in the operative treatment of isolated ankle fractures in patients with diabetes mellitus. Foot Ankle Int 20:687–694
Cedell CA (1967) Supination-outward rotation injuries of the ankle. Dissertation. Acta Orthop Scand [Suppl] 110
Destot E (1911) Traumatisme du pied et rayons X malleoles, astragale, calcaneum, avant-pied. Masson, Paris
Friedl W (1998) Zuggurtungsnagelsystem für axiale Kompressionsosteosynthese der Patella. 62 Jahrestag der Deut. Ges. für Unfallchirurgie e.V.: 721
Gehr J, Friedl W (2001) Probleme der Zuggurtungsosteosynthese von Patellafrakturen und deren Konsequenzen für weitere Implantatentwicklungen. Der XS-Nagel. Der Chirurg 72:1309–1318
Henke G (1964) Vergleichende Ergebnisse der konservativen und operativen Knochenbruchbehandlung unter Berücksichtigung der Einteilung nach Niels Lauge Hansen. Dissertation, Basel
Hughes JL, Weber H (1979) Evaluation of ankle fractures. Clin Orthop 138:111
Learch WJ, Fordyce MJ (1994) Audit of ankle fracture fixation in the elderly. J R Coll Surg Edinb 39:124–127
Lindsjö U (1981) Operative treatment of ankle fractures. Acta Orthop Scand [Suppl] 52
Lindsjö U (1985) Operative treatment of ankle fracture-dislocations. Clin Orthop 199:28–38
Low CK, Pang HY, Wong HP, Low YP (1997) A retrospective evaluation of operative treatment of ankle fractures. Ann Acad Med Singapore 26:172–174
McCormack RG, Leith JM (1998) Ankle fractures in diabetics. Complications of surgical management. J Bone Joint Surg Br 80:689–692
Nonnemann HC, Plötsch J (1993) Verrenkungsbrüche des oberen Sprunggelenkes. Klassifizierung-Behandlung-Ergebnisse. Aktuell Traumatol 23:183
Olerud C, Molander H (1984) A scale for symptom evaluation after ankle fractures. Arch Orthop Trauma Surg 103:190–194
Ponzer S, Nasell H (1999) Functional outcome and quality of life in patients with type B ankle fractures: a two-year follow-up study. J Orthop Trauma 13:363–368
Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 58:356–357
Richter J, Schulze W, Muhr G (1999) Stabile Knöchelbrüche. Indikation zur Operation oder konservativer Therapie? Orthopäde 28:493–499
Riede UN, Schenk R, Willenegger H (1971) Gelenkmechanische Untersuchungen zum Problem der posttraumatischen Arthrosen im oberen Sprunggelenk. Langenbecks Arch Klein Chir 328:258–271
Schweiberer L, Seiler H (1978) Spätergebnisse bei operativ behandelten Malleolarfrakturen. Unfallheilkunde 81:195–202
Sinisaari I et al (1996) Metallic or absorbable implants for ankle fractures: a comparative study of infections in 3111 cases. Acta Orthop Scand 67:16–18
Tassler H (1981) Behandlungsprinzipien bei drittgradigen offenen Frakturen des distalen Unterschenkels. Unfallheilkunde 84:509
Weber BG (1966) Die Verletzungen des oberen Sprunggelenkes. Huber, Bern
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gehr, J., Neber, W., Hilsenbeck, F. et al. New concepts in the treatment of ankle joint fractures. Arch Orthop Trauma Surg 124, 96–103 (2004). https://doi.org/10.1007/s00402-003-0606-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-003-0606-9