Bi- and Trimalleolar Ankle Fractures Operated with Nonrigid Internal Fixation

Abstract

The results of bi-and trimalleolar fractures treated with nonrigid internal fixation were analyzed in 134 patients. The fractures were of both pronation and supination type. The operative success was evaluated in terms of congruency as seen on the postoperative radiographs. The congruency was classified as either congruent, small, or grave displacement respectively. At follow-up evaluation, four variables were recorded: a linear analogue scale, an ankle score, range of motion, and presence of osteoarthritis. Fifty percent had congruent joints, 20% had small, and 30% had grave displacements. At follow-up examination those with congruent joints had significantly better function than those with displacements in all four variables. There were only minor differences between the two displacement groups. The nonrigid technique seems inadequate in retaining congruency of the unstable bi-and trimalleolar fractures. Congruency is the key to good prognosis. Even minor displacement significantly increases the risk of impending disability.tation of its effect on other than supinationeversion injuries. The functional outcome after ankle fractures is largely dependent on the congruency of the j~i n t .~'~-'~The authors have reported that the "adaptive" internal fixation according to Cedel16 is insufficient to retain an anatomic position of the fracture components of multicomponent injuries of both the supination and pronation type. Because many ankles operated on with the Cedell technique show subtle displacements, it is very interesting to see how this affects the prognosis.One aim of this study was to analyze the functional outcome after multicomponent ankle-joint injuries of both supination and pronation types were operated on according to Cedell. Another aim was to compare the results of the group with subtle displacement with the groups without and with grave displacements respectively. Today displaced fractures of the ankle joint are most often treated operatively. The results have improved compared with when conservative treatment was dominant.2 In Sweden, different methods of internal fixation are used. Maybe the most widespread technique is the MATERIALS The material consisted of 134 patients with multicomponent ankle fractures. The fractures correcounty hospital'in Sweden during a four-year period. The distributions of different fracture classes (range, 15-86). The age and sex distribution is seen in Figure 2. A posterior fragment was present in 86 fractures (68%), Of which 49 were <y. of the joint surface, 32 were between 76 and '13, and 5 were >'I3 of the joint surface. At follow-up examination 18-54 months after injury, 127 patients were examined

The Effect of Percutaneous Screw Fixation of Lateral Malleolus on Ankle Fracture Healing and Function

“…Cancellous screws alone have also been used for fixation of Weber A fibula fractures [11,12], but, as with smooth pins, these fixation devices may allow rotation of the distal fragment. Several authors have described fixation of fibular fractures with an axial screw [14,15].…”

Early mobilization of operated on ankle fractures: Prospective, controlled study of 40 bimalleolar cases

“…With conventional radiography it is difficult to detect small redisplacements that might be of clinical importance (Willenegger I96 I, Ramsey andHamilton 1976, Olerud andMolander 1986). RSA makes it possible to detect such small movements between fracture fragments.…”

“…It has been suggested that even small fracture displacements might jeopardize the clinical outcome and eventually cause early arthrosis (Ramsey andHamilton 1976, Olerud andMolander 1986). This is not in agreement with our study, which revealed similar or even better clinical results in the orthosis group, where small fracture movements were observed.…”

Early weight bearing of displaced ankle fractures

“…In our study a minimum of osteosynthesis devices, such as wires, small staples, and pins, have been used. To our knowledge, when using this technique, only late weight bearing has been advocated when dealing with bimalleolar fractures (Cedell 1967, Olerud & Molander 1986). …”