Less is more: lag screw only fixation of lateral malleolar fractures

Abstract

Displaced fractures of the lateral malleolus are typically treated with plate osteosynthesis with or without the use of lag screws, and immobilisation in a plaster cast for up to 6 weeks. Fixation through a smaller incision with less metal, such as lag screw only fixation, would theoretically lead to decreased infection rates and less irritation caused by hardware. The purpose of this study was to evaluate the benefits and success of lag screw only fixation of the lateral malleolus in non-comminuted oblique fractures of the lateral malleolus. A total of 25 patients who had non-comminuted unstable oblique fractures of their lateral malleolus that had been surgically fixed with lag screws only were retrospectively evaluated. All patients were younger than 60 years of age. Evaluation of the success of fixation, complications, resultant mobility and patient satisfaction was based on information gathered from chart reviews, X-ray findings and a standardised questionnaire based on the AOFAS Foot and Ankle Outcomes Questionnaire. These results were compared to an age-matched group of 25 consecutive patients treated with plate osteosynthesis. Of the 25 patients fixed with lag screws, nine had an unstable fracture of the lateral malleolus only, ten were bimalleolar fractures and six were trimalleolar. Eighteen patients were treated with two lag screws, and seven were treated with three lag screws. The bi- and trimalleolar fractures were treated with standard partially threaded cancellous screws. None of the lag screw-only group lost reduction. There were no documented wound infections in the lag screw group as compared to three deep infections in the plate group. Lag screw-only patients reported no palpable hardware as compared to 50% of the plate group. AOFAS scores at a mean of 12 months post-operative were similar in both groups. Lag screw only fixation of the lateral malleolus is a safe and effective method that has a number of advantages over plate osteosynthesis, in particular less soft tissue dissection, less prominent, symptomatic and palpable hardware and a reduced requirement for secondary surgical removal.

Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures

“…This means that the choice of screw type, screw size, number of fixed cortices, and indications for screw removal still remain under debate [1]. In all cases though, the goal of surgery in unstable ankle fractures is to restore the joint congruence [3]. The latter means that it is important to repair the ankle mortise correcting both the rotation and the original length of the fibula, as well as reducing the lateral talar shift [3].…”

“…In all cases though, the goal of surgery in unstable ankle fractures is to restore the joint congruence [3]. The latter means that it is important to repair the ankle mortise correcting both the rotation and the original length of the fibula, as well as reducing the lateral talar shift [3]. The postoperative complications include (1) unsatisfactory outcome in 17-24% of the patients due to hardware misplacement and/or peroneal tendonitis and (2) development of osteoarthritis (OA) [4][5][6].…”

Supination-External Rotation Ankle Fractures: Stability a Key Issue

“…Five studies [3,13,26,34,40] on operative treatment recorded 37 complications in 355 ankles (10.4%), including thromboembolic events, hardware failure, nonunions, and infections. One patient died of fatal pulmonary embolism.…”

“…Completion of the sequence of traumatic events on the medial side characterizes an unstable fracture pattern ( Fig. 2) [1,24,26]. Based on the stability concept, nonoperative treatment seems appropriate for stable injuries, whereas maintenance of reduction of unstable fractures without operative fixation is difficult to achieve [1,41].…”

Lateral fixation of AO type-B2 ankle fractures: the Acutrak plus compression screw technique

“…Extramedullary fixation of lateral malleolus fractures was commonly used in previous studies [2,[5][6][7]13]. One or two lag screws were recommended by Kim et al [5].…”