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Less is more: lag screw only fixation of lateral malleolar fractures

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Abstract

Displaced fractures of the lateral malleolus are typically treated with plate osteosynthesis with or without the use of lag screws, and immobilisation in a plaster cast for up to 6 weeks. Fixation through a smaller incision with less metal, such as lag screw only fixation, would theoretically lead to decreased infection rates and less irritation caused by hardware. The purpose of this study was to evaluate the benefits and success of lag screw only fixation of the lateral malleolus in non-comminuted oblique fractures of the lateral malleolus. A total of 25 patients who had non-comminuted unstable oblique fractures of their lateral malleolus that had been surgically fixed with lag screws only were retrospectively evaluated. All patients were younger than 60 years of age. Evaluation of the success of fixation, complications, resultant mobility and patient satisfaction was based on information gathered from chart reviews, X-ray findings and a standardised questionnaire based on the AOFAS Foot and Ankle Outcomes Questionnaire. These results were compared to an age-matched group of 25 consecutive patients treated with plate osteosynthesis. Of the 25 patients fixed with lag screws, nine had an unstable fracture of the lateral malleolus only, ten were bimalleolar fractures and six were trimalleolar. Eighteen patients were treated with two lag screws, and seven were treated with three lag screws. The bi- and trimalleolar fractures were treated with standard partially threaded cancellous screws. None of the lag screw-only group lost reduction. There were no documented wound infections in the lag screw group as compared to three deep infections in the plate group. Lag screw-only patients reported no palpable hardware as compared to 50% of the plate group. AOFAS scores at a mean of 12 months post-operative were similar in both groups. Lag screw only fixation of the lateral malleolus is a safe and effective method that has a number of advantages over plate osteosynthesis, in particular less soft tissue dissection, less prominent, symptomatic and palpable hardware and a reduced requirement for secondary surgical removal.

Résumé

La fixation des fractures déplacées de la malléole externe est habituellement traitée par une plaque d’ostéosynthèse avec ou sans vis malléolaires et immobilisation par un plâtre, pendant six semaines. La fixation par une petite incision avec un matériel moins invasif et une fixation avec vis malléolaires isolées peut théoriquement diminuer le taux d’infection et diminuer la gène au niveau du matériel. Le propos de cette étude est d’évaluer les bénéfices et le succès des vis malléolaires isolées dans les fractures obliques de la malléole externe. 25 patients avec une fracture oblique instable de la malléole externe ont été traités chirurgicalement par des vis malléolaires avec une évaluation rétrospective. Tous les patients étaient âgées de moins de 60 ans et, évalués, sur le plan clinique radiographique et par un questionnaire standardisé de l’AOFAS du pied et de la cheville. Enfin, le questionnaire devait évaluer le succès de la fixation, les complications, la morbidité et la satisfaction des patients. Ces résultats ont été comparés à un groupe de 25 patients consécutifs traités par plaques. Résultats : sur les 25 patients traités par vis malléolaire, 9 avaient une fracture instable de la malléole externe, 10 une facture bi-malléolaire et 6 une tri-malléolaire. 18 ont été traités avec deux vis malléolaires et 7 avec trois vis malléolaires. Les fractures bi et tri-malléolaires ont été traitées de façon standard par des vis spongieuses. Aucune des vis malléolaires n’a entraîné de pertes de réduction. Il n’y a pas eu d’infection dans le groupe vis malléolaires alors qu’il y a eu trois infections profondes avec le groupe traité par ostéosynthèse par plaques. Les vis malléolaires isolées n’ont pas entraîné de gêne alors que 50% des patients traités par plaques présentent une gêne à ce niveau là. Le score de l’AOFAS à 12 mois a été similaire dans les deux groupes. En conclusion, l’utilisation de vis malléolaires isolées est un procédé sûr de fixation de la malléole externe et présente des avantages par rapport à l’ostéosynthèse par plaque notamment en ce qui concerne un abord mini invasif, l’absence de gêne au niveau du matériel et une ablation de matériel facilitée.

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References

  1. Ahl T, Dalen N, Lundberg A, Bylund C (1993) Early mobilization of operated on ankle fractures. Prospective, controlled study of 40 bimalleolar cases. Acta Orthop Scand 64:95–99

    Article  PubMed  CAS  Google Scholar 

  2. Bajwa AS, Gantz DE (2005) Cerclage wire and lag screw fixation of the lateral malleolus in supination and external rotation fractures of the ankle. J Foot Ankle Surg 44:271–275

    Article  PubMed  Google Scholar 

  3. Bankston AB, Anderson LD, Nimityongskul P (1994) Intramedullary screw fixation of lateral malleolus fractures. Foot Ankle Int 15:599–607

    PubMed  CAS  Google Scholar 

  4. Bhandari M, Sprague S, Hanson B, Busse JW, Dawe DE, Moro JK, Guyatt GH (2004) Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study. J Orthop Trauma 18:338–345

    Article  PubMed  Google Scholar 

  5. Bostman OM (1998) Osteoarthritis of the ankle after foreign-body reaction to absorbable pins and screws: a three-to nine-year follow-up study. J Bone Joint Surg Br 80:333–338

    Article  PubMed  CAS  Google Scholar 

  6. Brown OL, Dirschl DR, Obremskey WT (2001) Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma 15:271–274

    Article  PubMed  CAS  Google Scholar 

  7. Bucholz RW, Henry S, Henley MB (1994) Fixation with bioabsorbable screws for the treatment of fractures of the ankle. J Bone Joint Surg Am 76:319–324

    PubMed  CAS  Google Scholar 

  8. Carragee EJ, Csongradi JJ, Bleck EE (1991) Early complications in the operative treatment of ankle fractures. Influence of delay before operation. J Bone Joint Surg Br 73:79–82

    PubMed  CAS  Google Scholar 

  9. DiStasio AJ II, Jaggears FR, DePasquale LV, Frassica FJ, Turen CH (1994) Protected early motion versus cast immobilization in postoperative management of ankle fractures. Contemp Orthop 29:273–277

    PubMed  Google Scholar 

  10. Dogra AS, Rangan A (1999) Early mobilisation versus immobilisation of surgically treated ankle fractures. Prospective randomised control trial. Injury 30:417–419

    Article  PubMed  CAS  Google Scholar 

  11. Frokjaer J, Moller BN (1992) Biodegradable fixation of ankle fractures. Complications in a prospective study of 25 cases. Acta Orthop Scand 63:434–436

    PubMed  CAS  Google Scholar 

  12. Godsiff SP, Trakru S, Kefer G, Maniar RN, Flanagan JP, Tuite JD (1993) A comparative study of early motion and immediate plaster splintage after internal fixation of unstable fractures of the ankle. Injury 24:529–530

    Article  PubMed  CAS  Google Scholar 

  13. Hoiness P, Engebretsen L, Stromsoe K (2001) The influence of perioperative soft tissue complications on the clinical outcome in surgically treated ankle fractures. Foot Ankle Int 22:642–648

    PubMed  CAS  Google Scholar 

  14. Johanson NA, Liang MH, Daltroy L, Rudicel S, Richmond J (2004) American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg Am 86-A:902–909

    PubMed  Google Scholar 

  15. Kim SK, Oh JK (1999) One or two lag screws for fixation of Danis-Weber type B fractures of the ankle. J Trauma 46:1039–1044

    Article  PubMed  CAS  Google Scholar 

  16. Lamontagne J, Blachut PA, Broekhuyse HM, O’Brien PJ, Meek RN (2002) Surgical treatment of a displaced lateral malleolus fracture: the antiglide technique versus lateral plate fixation. J Orthop Trauma 16:498–502

    Article  PubMed  Google Scholar 

  17. Lee YS, Huang CC, Chen CN, Lin CC (2005) Operative treatment of displaced lateral malleolar fractures: the Knowles pin technique. J Orthop Trauma 19:192–197

    Article  PubMed  Google Scholar 

  18. Lehtonen H, Jarvinen TL, Honkonen S, Nyman M, Vihtonen K, Jarvinen M (2003) Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study. J Bone Joint Surg Am 85-A:205–211

    PubMed  Google Scholar 

  19. Leyes M, Torres R, Guillen P (2003) Complications of open reduction and internal fixation of ankle fractures. Foot Ankle Clin 8:131–147

    Article  PubMed  Google Scholar 

  20. Olerud C, Molander H, Olsson T, Hagstedt B (1986) Ankle fractures treated with non-rigid internal fixation. Injury 17:23–27

    Article  PubMed  CAS  Google Scholar 

  21. Rukavina A (1998) The role of fibular length and the width of the ankle mortise in post-traumatic osteoarthrosis after malleolar fracture. Int Orthop 22:357–630

    Article  PubMed  CAS  Google Scholar 

  22. Thordarson DB, Motamed S, Hedman T, Ebramzadeh E, Bakshian S (1997) The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am 79:1809–1815

    CAS  Google Scholar 

  23. Tornetta P III, Creevy W (2001) Lag screw only fixation of the lateral malleolus. J Orthop Trauma 15:119–121

    Article  PubMed  Google Scholar 

  24. van Laarhoven CJ, Meeuwis JD, van der Werken C (1996) Postoperative treatment of internally fixed ankle fractures: a prospective randomised study. J Bone Joint Surg Br 78:395–399

    PubMed  Google Scholar 

  25. Weber M, Krause F (2005) Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures: the effect of plate and screw position. Foot Ankle Int 26):281–285

    PubMed  Google Scholar 

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Correspondence to Paul B. McKenna.

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McKenna, P.B., O’Shea, K. & Burke, T. Less is more: lag screw only fixation of lateral malleolar fractures. International Orthopaedics (SICO 31, 497–502 (2007). https://doi.org/10.1007/s00264-006-0216-6

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  • DOI: https://doi.org/10.1007/s00264-006-0216-6

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