Title: Assessment of percutaneous intramedullary screw fixation in lateral malleolar ankle fractures

Authors: Ahmed Ramadan Darwish, Mohamed Ibrahim Abulsoud, Adnan Sebaie

 DOI: https://dx.doi.org/10.18535/jmscr/v7i9.117

Abstract

  

Purpose: To evaluate the outcome of using percutanous intramedullary screw and its efficacy on fixation of lateral malleolar ankle fractures.

Methods and Materials: Twenty-five patients with Weber A and Weber B displaced lateral malleolus fractures were retrospectively reviewed after they had done closed reduction and percutaneous internal fixation with an intramedullary fully threaded screw with a washer. A 3.5-mm, fully threaded, self- tapping bone screw. The length of the screw varies between 90 mm and 110 mm, depending on the fracture location and pattern.

Results: All fractures united within an average time to union of 5.86 ± 1.74 weeks. There were no deep wound infections or complaints of painful hardware. At latest follow-up, functional results were excellent in 16 patients (64%) good in 8 patients (32 %), fair in one patient (4%).

Conclusion: Percutaneous intramedullary screw fixation is a good easy technique in management of   lateral malleolar fracture that provides good clinical and radiological results as it is rapid, minimally invasive and  without prominent  hardware.

Keywords: Ankle Fracture; Lateral Malleolus; Intramedullary Screw

References

  1. Koval KJ. Bimalleolar ankle fractures: open reduction and internal fixation. In: Atlas of orthopaedic surgery. Koval KJ, Zuckerman JD. 1st Philadelphia. Lippincott Williams & Wilkin 2004;1(23):353-71.
  2. White TO, Bugler KE. Ankle fractures. In: Rockwood and Green’s Fractures in Adult. Court-Brown CM, Heckman JD, McQueen MM, Ricci W, Tornetta III P, McKee M. 8th Wolters Kluwer Health. 2015;2 (59):2541-92.
  3. Makwana NK, Bhowal B, Harper WM, Hui AW. Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. J Bone Joint Surg (Br) 2001;83(4):525-9.
  4. Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger Fractures of the ankle joint, investigation and treatment options. Dtsch Arztebl Int 2014;111 (21):377-88.
  5. Rammelt Management of ankle fractures in the elderly. EFORT Open Rev 2016;1(5): 239-46.
  6. Bugler KE, Watson CD, Hardie AR, Appleton P, Mcqueen MM, Court-Brown CM, et al. The treatment of unstable fractures of the ankle using the acumed fibular nail. J Bone Joint Surg (Br) 2012; 94(8):1107-12.
  7. Mehta SS, Rees K, Cutler L, Mangwani J. Understanding risks and complications in the management of ankle fractures. Indian J Orthop 2014;48(5):445-52.
  8. Soo Hoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS. Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg (Am) 2009; 91(5):1042-9.
  9. White TO, Bugler KE, Appleton P, Will E, McQueen MM, Court-Brown CM. A prospective randomised controlled trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients. J Bone Joint Surg (Br) 2016;98(9):1248-52.
  10. Evans JM, Gardner MJ, Brennan ML, Phillips CJ, Henley MB, Dunbar RP. Intramedullary fixation of fibular fractures associated with pilon fractures. J Orthop Trauma 2010;24(8):491-4.
  11. Olerud C, Molander H, Olsson T, Hagstedt B. Ankle fractures treated with non- rigid internal fixation. Injury 1986;17(1):23-7.
  12. Pritchett JW. Rush rods versus plate osteosyntheses for unstable ankle fractures in the elderly. Orthop Rev 1993;22(6):691-6.
  13. Latif G, Al-Saadi H, Zekry M, Hassan M, Mulla J. The effect of percutaneous screw fixation of lateral malleolus on ankle fracture healing and function. Surgical Science 2013; 4(8):365-70.
  14. Covino BM, Barsanti CM, Wolfe J, Wang GJ. Internal fixation of lateral malleolus fractures: a clinical and biomechanical comparison of two techniques. Orthop Trans 1990; 5:90.
  15. Bankston AB, Anderson LD, Nimityongskul P. Intramedullary screw fixation of lateral malleolus fractures. Foot Ankle Int 1994; 15(11):599-607.
  16. D. Ray, P. Nimityongskul and L. D. Anderson, “Per-cutaneous Intramedullary Fixation of Lateral Malleolus Fractures: Technique and Report of Early Results,” Journal of Trauma, Vol. 36, No. 5, 1994, pp. 669-675.
  17. Yablon IG, Heller FG, Shouse The key role of lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg (Am) 1977;59(2):169-73.
  18. Ray TD, Nimityongskul P, Anderson LD. Percutaneous intramedullary fixation of lateral malleolus fractures: Technique and report of early results. J Trauma 1994;36(5):669-75
  19. Kim HJ, Oh JK, Hwang JH, Park YH. The use of T-LCP (locking compression plate) for the treatment of the lateral malleolar fractures. Eur J Orthop Surg Traumatol 2013;23(2):233-7.
  20. Lamontagne J, Blachut PA, Broekhuyse HM, O'Brien PJ, Meek RN. Surgical treatment of a displaced lateral malleolus fracture: the antiglide technique versus lateral plate fixation. J Orthop Trauma 2002;16(7):498-502.
  21. Sharma JP, Salhotra R. Tourniquets in orthopedic surgery. Indian J Orthop 2012;46(4):377-83.
  22. Brown OL, Dirschl DR, Obremskey WT. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma 2001;15(4):271-4.
  23. Jacobsen S, Honnens de Lichtenberg M, Jensen CM, Torholm C. Removal of internal fixation--the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures. Foot Ankle Int 1994;15(4):170-1.
  24. Tornetta P III, Creevy W. Lag screw only fixation of the lateral malleolus. J Orthop Trauma 2001;15(2):119-21.
  25. Ostrum RF. Posterior plating of displaced Weber B fibula fractures. J Orthop Trauma 1996;10(3):199-203.
  26. Weber M, Krause F. Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures: the effect of plate and screw position. Foot Ankle Int 2005;26(4):281-5.

Corresponding Author

Ahmed Ramadan Darwish

Orthopaedic and Traumatology Department, Al Azhar University, Egypt