A prospective study of osteosynthesis of malleolar fractures of ankle in adults

Abstract

Background: Open fractures of tibial shaft are important for the reason that they are most commonly fractured long bone in the body & subcutaneous location of the anteromedial surface of the tibia makes their management controversial. The precarious blood supply and lack of soft tissue cover of the shaft of the tibia make these fractures vulnerable to delayed union, nonunion, malunion and infection. The treatment of tibial fractures has developed from a strictly non-operative to a variety of operative techniques. While reamed Intramedullary nailing offer improved stability of the fracture, their use carries a theoretical risk of infection and nonunion as a consequence of disturbing endosteal blood supply. Recent reports suggest that the reaming is safe for grade I, II and IIIA open fractures of tibia. Material & Method: A total of 25 patients presented to Father Muller Hospital, Mangalore from Jan'06 to July'07 with type I and II open tibial shaft fractures were included in the study and all cases underwent debridement within 6 hours of admission and treated with reamed intramedullary interlocking nailing. They were reviewed at every 2 weeks for 6 weeks and then monthly post operatively and x-rays were repeated at 6,12,24 weeks to check for fracture healing. The average duration of follow-up was 32 weeks. Functional results were graded according to criteria by klemm & borner. Result:The average time to union was 19.68 weeks. Type I united in 18.86 weeks as compared to 20.5 weeks for Type II fractures. The average range of motion in the knee joint was 135.6 degrees. Full ankle motion was observed in 19 patients. One patient showed a loss >25° of motion at ankle compared to normal side while 5 patients showed < 25 0 loss of joint motion. 92% patients achieved good or excellent results, fair results were obtained in one patient & in one patient functional results were poor. Conclusion: Anatomical & functional outcome of open tibial fractures type I and type II treated with reamed intramedullary interlocking nailing is excellent to good and it is safe and effective technique for the management of Gustilo type I and type II.

Comparative result between adult men and women with ankle fractures surgically treated

“…Our study suggests that the lateral malleolus is the key to the anatomical reduction of bimalleolar fractures. In this sense, Mahesh and Venkataramana (13) found that the accurate anatomical reduction of AF is not enough; it is also necessary to maintain this reduction until a complete fracture union is reached. This is supported by Mitchell et al (22) study, which affirmed that the anatomical reduction of the displaced malleolar fracture, especially restoring the fibula length and maintaining the reduction, is almost impossible using the closed conservative method.…”

“…In adult age, the most frequent cause of AFs has been roadtraffic accidents (11,12) and sports activities (13,14) . However, in the last two decades, the prevalence of such fractures has increased among young, active patients, particularly younger men (2,15) .…”

“…The key to success in this surgical treatment is the anatomical reduction of displaced malleolar fractures, especially restoring the fibula length and maintaining reduction until the complete union of the fracture, which is almost impossible with non-surgical treatment (13,22) . In addition, there is a concern that a non-surgical approach may fail to produce an anatomical reduction of the mortise, leading to ankle instability, nonunion, and post-traumatic osteoarthritis of the ankle (22) .…”