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Comparison of two versus three-screw fixation for biplanar chevron medial malleolar osteotomy

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to compare the clinical outcomes and complications of using two versus three screws to fix the biplanar chevron medial malleolar osteotomy (MMO).

Patients and methods

A retrospective review was conducted on 43 patients (46 ankles) who underwent biplanar chevron MMO to treat talus osteochondral lesions. Of these, MMO was fixed with two parallel screws placed perpendicular to the osteotomy plane in 16 ankles, while in the remaining 30 ankles, MMO was secured with two parallel screws plus an additional third screw inserted parallel to the tibial plafond. Patients were divided into two groups based on the fixation method and clinical outcomes, union and malunion rates, and complications were compared.

Results

Demographic and clinical characteristics such as age (p: 0.411), gender distribution (p: 0.119), affected side (p: 0.126), lesion grades (p: 0.056), and lesion sizes (p: 0.310), immobilization (p: 0.119) and weight-bearing periods (p: 0.252) were statistically similar across both groups. Initial malreduction were observed in five cases within the three-screw group and one case in the two-screw group (p: 0.307). However, neither group exhibited any progressive step-off or gap in the follow-up radiographs, and osteotomy union was achieved in all patients. Delayed union was observed in one patient from the three-screw group. Significant improvements in American Orthopedic Foot and Ankle Society scores were observed in both groups, with no functional discrepancies evident at the final follow-up (p: 0.488).

Conclusions

The study found no significant differences in union rates, complications, or clinical outcomes between two and three-screw fixation methods for medial malleolar osteotomies (MMO). Both methods allowed for effective MMO fixation without loss or displacement post-surgery, suggesting their safety and efficacy.

Level of evidence

Level III, retrospective comparison.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

MMO:

Medial malleolar osteotomy

AMIC:

Augmented marrow-stimulation cartilogenesis

AOFAS:

American orthopedic foot and ankle society

TOL:

Talus osteochondral lesion

PACS:

Patient archiving and communication systems

ROM:

Range of motion

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Funding

No funds have been received for this study.

Author information

Authors and Affiliations

  1. Vocational School of Health Services, Sanko University, Gaziantep, Turkey

    Faruk Aykanat

  2. Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, University of Health Sciences, Varlık Mah., Kazım Karabekir Cd., 07100, Antalya, Muratpasa, Turkey

    Omer Faruk Egerci, Fırat Dogruoz, Aliekber Yapar & Ozkan Kose

  3. Orthopedics and Traumatology Clinic, Medikum Private Hospital, Antalya, Turkey

    Mehmet Barıs Ertan

Authors
  1. Faruk Aykanat
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  2. Omer Faruk Egerci
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  5. Mehmet Barıs Ertan
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  6. Ozkan Kose
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Contributions

Study conception and design: FA, OK, AY Acquisition of data: OFE, MBE, FD Analysis and interpretation of data: OK, FA, AY, Drafting of the manuscript: FA, OK, AY, OFE, FD Critical revision: OK, FA, MBE, OFE, FD and AY (Initials of authors’ names). All authors read and accepted the final version of the manuscript.

Corresponding author

Correspondence to Ozkan Kose.

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Conflict of interest

Authors have no conflict of interest to declare.

Ethical approval

The Institutional Review Board approved the study protocol (Date/Issue: 2023/25.05–7/22).

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Informed consent was provided by the participants.

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Aykanat, F., Egerci, O.F., Dogruoz, F. et al. Comparison of two versus three-screw fixation for biplanar chevron medial malleolar osteotomy. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03933-7

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