A clinical evaluation of alternative fixation techniques for medial malleolus fractures

Barnes, Hayley; Cannada, Lisa K.; Watson, John T.

doi:10.1016/j.injury.2014.05.031

Cited by 39 publications

(34 citation statements)

References 3 publications

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“…We did not observe nonunion or delayed union in our study, which was similar to the study of Barnes et al, [14] who fixed medial malleolus fractures with headless compression screws. Öçgüder et al, [8] reported only one delayed union out of 20 patients who were operated with malleolar screws and 100% union in the patients operated with tension band wiring.…”

Section: Discussionsupporting

confidence: 92%

“…[11][12][13] The treatment of malleolar fractures with accurate open reduction and stable internal fixation using the AO method and principles produced a higher percentage of excellent and good results. [14] The current study supports these statements. Different methods and implants have been described in the literature.…”

Section: Discussionsupporting

confidence: 82%

“…Sang-Hanko and Young-Junpark, [21] achieved excellent and good results in 78% of cases treated with malleolar screws and 89% of cases treated with tension-band wiring. Barnes et al, [14] reported a satisfactory functional outcome with high rates of union with headless compression screws. Li et al, [22] who performed a minimally invasive surgery for medial malleolus fracture, also reported good and excellent results in 91.6% of patients.…”

Section: Discussionmentioning

confidence: 98%

“…These include cancellous screws (unicortical or bicortical), solid cortical screws, headless compression screws, staples, and tension band wiring. [14][15][16][17][18] There is no adequate evidence to state one method is superior over any other, and implant-related pain is a significant factor requiring hardware removal in approximately 13 to 17% of patients. [19][20][21] In the current study, we aimed to compare the three most popular surgical techniques for medial malleolus fractures.…”

Section: Discussionmentioning

confidence: 99%

“…By comparison, Ostrum and Litsky [15] reported a 15% rate of implant-related complications, and Georgiadis and White [25] reported rate of 13.6% for implant-related complications. Barnes et al [14] reported that none of the patients with headless compression screws required hardware removal from the screw prominence. Tekin et al [24] also reported no implant-related complications with headless compression screws.…”

Section: Discussionmentioning

confidence: 99%

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A comparative study of three commonly used fixation techniques for isolated medial malleolus fracture

Kochai

Türker²,

Çiçekli³

et al. 2018

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada medial malleol kırıklarında en çok kullanılan üç farklı tespit yöntemi olan gergi bandı tekniği, kısmi yivli kanüllü kompresyon vida ve tam yivli başsız kanüllü kompresyon vida yöntemleri karşılaştırıldı. Hastalar ve yöntemler:Çalışmaya medial malleol kırığı olan 90 hasta dahil edildi. Hastalar üç gruba ayrıldı. Grup A gergi bandı ile ameliyat edilen hastalar (n=26), grup B kısmen yivli kanüllü kompresyon vidalar (n=32) ve grup C başsız kanüllü kompresyon vidalar ile ameliyat edilen hastalar (n=32) olarak ayrıldı. Kırığın tipi, iyileşme oranları, implanta bağlı komplikasyonlar, enfeksiyon oranı, implant tahliyesi, yükten kısıtlamaları, yaralanmadan cerrahiye kadar olan süre ve hastaların vücut kütle indeksleri (VKİ) araştırıldı. Hastaların standart ön-arka, yan ve Mortis grafileri incelendi. AOFAS (American Orthopedic Foot and Ankle Society) skorlama sistemi klinik değerlendirme için kullanıldı. Bulgular: Üç grup arasında yaş, cinsiyet, VKİ, izleme periyodu ve kırık tipi açısından anlamlı bir fark gözlenmedi. Kaynama süresi grup C'de grup A ve B'ye oranla anlamlı olarak daha kısa idi. Grup C hastalarında implant başarısızlığı veya irritasyonu görülmedi ve bu durum grup A ve B ile kıyaslayınca istatistiksel olarak anlamlı idi (p= 0.037). Ancak bu konuda, grup A ve grup B arasında anlamlı bir fark yoktu (p= 0.41). AOFAS skorlamasına göre üç grup arasında anlamlı bir fark görülmedi. A ve B grubunda VKİ'si düşük olan hastalarda yüksek oranda implanta bağlı komplikasyon görüldü. Düşük VKİ ile implanta bağlı komplikasyon oranı arasında anlamlı ilişki bulundu (p<0.001).Sonuç: Kaynama süresinin tam yivli başsız kanüllü kompresyon vidası ile ameliyat edilen grupta diğer gruplara oranla anlamlı olarak daha kısa olduğu görüldü. Bu çalışma, gergi bandı yöntemi ve kısmi yivli kanüllü kompresyon vida ile medial malleol fiksasyonu yumuşak doku irritasyonuna ve implant bölgesinde ağrıya neden olabileceğini göstermiştir. Düşük VKİ'si olan hastalar implanta bağlı komplikasyonlara daha açıktır.Anahtar sözcükler: Ayak bileği kırığı; vücut kütle indeksi; başsız kanüllü kompresyon vidası; medial malleol kırığı; kısmı yivli kanüllü kompresyon vidası; gergi bandı. ABSTRACT Objectives:This study aims to compare the three most commonly used fixation techniques: tension-band wire fixation, partially threaded cannulated screws, and fully threaded cannulated headless compression screws. Patients and methods:Ninety patients with medial malleolus fractures were included in the study. Patients were divided into three groups. Group A included patients who underwent tension-band wire fixation (n=26), Group B partially threaded cannulated compression screws (n=32), and Group C fully threaded cannulated headless compression screws (n=32). The type of medial malleolus fracture, healing rates, implant-related complications, rate of infection, hardware removal, weight-bearing restrictions, mean interval time from the injury to the surgery, and Body Mass Indexes (BMIs) were investigated. The patients' radiographs (standard anterop...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A comparative study of three commonly used fixation techniques for isolated medial malleolus fracture

Kochai

Türker²,

Çiçekli³

et al. 2018

Eklem Hastalik Cerrahisi

View full text Add to dashboard Cite

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Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures

Carter,

Oliver,

Bell

et al. 2024

JAMA Netw Open

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ImportanceUnstable ankle fractures are routinely managed operatively. However, because of soft tissue and implant-related complications, recent literature has reported on the nonoperative management of well-reduced medial malleolus fractures after fibular stabilization, but with limited evidence supporting the routine application.ObjectiveTo assess the superiority of internal fixation of well-reduced (displacement ≤2 mm) medial malleolus fractures compared with nonfixation after fibular stabilization.Design, Setting, and ParticipantsThis superiority, pragmatic, parallel, prospective randomized clinical trial was conducted from October 1, 2017, to August 31, 2021. A total of 154 adult participants (≥16 years) with a closed, unstable bimalleolar or trimalleolar ankle fracture requiring surgery at an academic major trauma center in the UK were assessed. Exclusion criteria included injuries with no medial-sided fracture, open fractures, neurovascular injury, and the inability to comply with follow-up. Data analysis was performed in July 2022 and confirmed in September 2023.InterventionsOnce the lateral (and where appropriate, posterior) malleolus had been fixed and satisfactory intraoperative reduction of the medial malleolus fracture was confirmed by the operating surgeon, participants were randomly allocated to fixation (n = 78) or nonfixation (n = 76) of the medial malleolus.Main Outcome and MeasureOlerud-Molander Ankle Score (OMAS) 1 year after randomization (range, 0-100 points, with 0 indicating worst possible outcome and 100 indicating best possible outcome).ResultsAmong 154 randomized participants (mean [SD] age, 56.5 [16.7] years; 119 [77%] female), 144 (94%) completed the trial. At 1 year, the median OMAS was 80.0 (IQR, 60.0-90.0) in the fixation group compared with 72.5 (IQR, 55.0-90.0) in the nonfixation group (P = .17). Complication rates were comparable. Significantly more patients in the nonfixation group developed a radiographic nonunion (20% vs 0%; P &lt; .001), with 8 of 13 clinically asymptomatic; 1 patient required surgical reintervention for this. Fracture type and reduction quality appeared to influence fracture union and patient outcome.Conclusions and RelevanceIn this randomized clinical trial comparing internal fixation of well-reduced medial malleolus fractures with nonfixation, after fibular stabilization, fixation was not superior according to the primary outcome. However, 1 in 5 patients developed a radiographic nonunion after nonfixation, and although the reintervention rate to manage this was low, the future implications are unknown. These results support selective nonfixation of anatomically reduced medial malleolar fractures after fibular stabilization.Trial RegistrationClinicalTrials.gov Identifier: NCT03362229

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In Silico Analysis of Bone Tension During Fixation of the Medial Malleolus Fracture After Ankle Joint Endoprosthesis

Lorkowski

Wilk

Pokorski

2020

Advances in Experimental Medicine and Biology

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A clinical evaluation of alternative fixation techniques for medial malleolus fractures

Cited by 39 publications

References 3 publications

A comparative study of three commonly used fixation techniques for isolated medial malleolus fracture

A comparative study of three commonly used fixation techniques for isolated medial malleolus fracture

Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures

In Silico Analysis of Bone Tension During Fixation of the Medial Malleolus Fracture After Ankle Joint Endoprosthesis

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