Abstract
Introduction: Bimalleolar fractures are very common in ankle injuries because of increased incidence of road traffic accidents and industrial trauma. Anatomical reduction and stable internal fixation is important for good outcomes.
Aim & Objectives: To study functional outcomes of Bimalleolar fracture treated with CCS and DFALP; To achieve anatomical/near anatomical fracture reduction, stable internal fixation and early mobilization of the ankle.
Materials and Methods: We have evaluated functional and radiological outcomes of 20 patients treated with closed / open reduction with internal fixation used Cannulated Cancellous Screw (CCS) for medial malleolus and Distal Fibular
Anatomical Locking Plate (DFALP) for Lat malleolus .Lauge Hansens classification was used for fracture evaluation. Baird and Jackson Scoring system was used to evaluate functional outcomes.
Results: In this prospective study, 20 cases of Bimalleolar fractures of ankle were selected by exclusion and inclusion criteria and treated with CCS and DFALP. Most common mode of injury was supination external rotation injury accounts for 45 % (9 cases). All cases were treated surgically with closed / open reduction with internal fixation. All cases of medial malleoli fracture were treated with cannulated cancellous screw and all cases of lateral malleoli fractures were treated with distal fibular anatomical locking plate by minimally invasive procedures. We found excellent results in 55% (11 cases), good results 25% (5 cases), fair results in 15% (3 cases) and poor result in 5% (1 case).
Conclusion: In this study, after analysing our functional and radiological outcomes and has been compared with other published result and found that Cannulated Cancellous Screws (CCS) and distal fibular anatomical locking plate (DFALP) give excellent results. From this study it is concluded that CCS and DFALP are the good implants and ideal treatment modalities for Bimalleolar fracture of ankle.
Level 1 evidence: Prospective study
Keywords: Bimalleolar fracture, CCS, DFALP, SER.
References
- Burwell HN and Charnley AD(1965). The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg; 47B:634- 660.
- Colton CL.( 1971) The treatment of Dupuytrens fracture dislocation of the ankle. J Bone Joint Surg,; 53B: 63-71
- Roberts SR[34] (1983) . Surgical treatment of displaced ankle fractures. ClinOrtop, 172: 164- 170.
- DeSouza LJ, Gustilo RB, Meyer TJ.(1985) Results of operative treatment of displaced external rotation – abduction fractures of the ankle. J Bone Joint Surg, 67A:1066- 1074.
- Baird RA and Jackson ST.(1987) Fracture of the distal part of fibula with associated disruption of the deltoid ligament. J Bone Joint Surg, 69A: 1346- 52.
- Daly PJ, Fitzgerald RH, Melton LJ, Listrup DM.(1987) Epidemiology of ankle fractures. Acta Orthopaedica Scandinavian, 58: 539-44.
- Bauer M, Benger U, Johnell O.(1987) Supination–eversion fractures of ankle joint: Changes in incidence over 30 years. J Foot Ankle ; 8: 26-8.
- Carragee EJ, Csongradi JJ, Bleck EE. (1991) Early complications in the operative treatment of ankle fractures. J Bone Joint Surg 73B : 79-82.
- Whittle AP, Wood II GW. (1998) Fractures of lower extremity. In: Campbell's operative orthopaedics, Chapter- 51, 10th edn. Vol.3, edt. Canale ST, Daugherty K, Jones L, Burns B. Philadelphia; Mosby, yearbook, 2728- 2872pp.
- Marsh JL and Saltzman CL. (2001) Ankle fractures. In: Rockwood and Green's fractures in adults, Chapter-47, 5th Edn., Vol.2, Edt. Bucholz RW, Heckman JD. Philadelphia: Lippincott Williams and Wilkins, 2001- 2090pp.
- Tornetta, Paul III, Creevy, Villiam. (2001) Lag screw only fixation of the lateral malleolus. J Orthop Trauma; 15(2): 119-121.
- Lamontagne Jean, Blachut, Piotr A, Broekhuyse, Henry M, O'Brien Peter J, Meek Robert N.(2002) Surgical treatment of a displaced lateral malleolus fracture: The antiglide technique Versus lateral plate fixation. J Orthop Trauma, 2002 Aug; 16(7): 498-502.
- Lee Yih- Shiunn, Huang, Chun-Chen NSP, Chen, Cheng- Nan, Lin Chien- Chung.(2005) Operative treatment of displaced lateral malleolar fractures : The Knowles pin technique. J Orthop Trauma, 19(3): 192-197.
- Konrad Gerhard, Markmiller Max, Lenich Adreas, Mayer Edgar, Ruter Axel.(2005) Tourniquets may increase postoperative swelling and pain after internal fixation of ankle fractures. Clin.Orthop & Related Research; 433: 189-194.
- Andrew Williams. Foot and ankle. In: Grays anatomy. Chapter-115, 39th Edn.,Edt. Susan Standring, Edinburgh: Elsevier, Churchill.
- Nirmal C. Tejwani MD.(2007) Outcome of bimalleolar outcome poorer than those of lateral malleolar fracture with medial ligamentous injury? JBJS: 89 (A) :1438-41.
- Dolfi Herscovici Tr.(2008) Avoiding complication in the treatment of pronation – external rotation of ankle fracture, Syndesmotic injuries, and talar neck fracture. JBJS, 90 (A) : 898-908.
- Nelson F., Soohoo MD.(2009) Compli-cation rates following open reduction and internal fixation of ankle fracture, JBJS, 91 (A) : 1042-1049.
- Hong CC, Nashi N, Prosad Roy S, Tan KJ. (2013) Foot Ankle Surg. 2014 Mar;20 (1):48-51.doi:10.1016/j.fas.2013.10.001. Epub 2013 Oct 24
- Ebraheim NA, Ludwig T, Weston JT, Carroll T, Liu J.(2014) Foot Ankle Int. 2014 May;35 (5):471-7. doi:10.1177/1071100714524553.Epub 2014 Feb 13.
Corresponding Author
Dr Arvind Kumar
Associate Professor & Unit Head, Department of Orthopaedic, Sumandeep Vidyapith University
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.88
