Necessity of Interfragmentary Lag Screws in Precontoured Lateral Locking Plate Fixation for Supination-External Rotation Lateral Malleolar Fractures

Park, Young Hwan; Cho, Hyun Woo; Choi, Gi Won

doi:10.1177/1071100720917645

Cited by 5 publications

(7 citation statements)

References 33 publications

(37 reference statements)

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“…In our study, we did not use interfragmentary lag screws. A recent prospective randomized study demonstrated that interfragmentary lag screws are not essential for precontoured lateral LP fixation in non‐comminuted supination‐external rotation lateral malleolar fractures, provided that intraoperative compression with a reduction clamp is performed 40 . The lag screw head and purchase impede proper plate placement.…”

Section: Discussionmentioning

confidence: 99%

One‐Third Tubular Plate Remains a Clinically Good Option in Danis‐Weber Type B Distal Fibular Fracture Fixation

Ahn

Cho

Jeong

et al. 2021

Orthopaedic Surgery

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Objective: To compare the clinical outcomes of locking plate (LP) and non-locking one-third tubular plate (TP) fixation, and to provide guidance on plate selection for Danis-Weber type B distal fibular fracture treatment.Methods: In total, 83 patients who underwent plate fixation for Danis-Weber type B distal fibular fractures between March 2013 and July 2018 were retrospectively reviewed: 41 (49.0%) received LPs and 42 (51.0%) received TPs. Patients' demographic data, follow-up durations, the proportion of comminuted fractures, and ankle range of motion were investigated. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Karlsson scale, Foot and Ankle Ability Measure (FAAM), and Lower Extremity Functional Scale (LEFS) scores were assessed. The radiographic union progression and implant removal time were evaluated, along with postoperative complications. Data from the LP and TP groups were compared statistically. Results:The mean patient ages were 53.3 AE 17.5 years (range, 16-80 years) and 47.6 AE 17.0 years (range, 14-68 years) in the LP and TP groups, respectively (P > 0.05). The gender distribution did not differ significantly between groups (P > 0.05). Other demographic data also did not differ significantly between groups (P > 0.05). The mean follow-up durations were 16.8 AE 7.7 months (range, 13.0-19.0 months) in the LP group and 16.1 AE 6.2 months (range, 12.0-20.0 months) in the TP group (P > 0.05). Comminuted fractures were observed in 18 of 41 (43.9%) patients with LP and 10 of 42 (23.8%) patients with TP (P > 0.05). Forward bending ankle dorsiflexion was possible at the final follow-up in 82.9% and 85.7% of LP and TP patients, respectively (P > 0.05). The AOFAS ankle-hindfoot scale, Karlsson scale, FAAM, and LEFS scores did not differ significantly between groups at the final follow-up (P > 0.05). The pre-fracture and final postoperative scores on these four instruments did not differ significantly in the LP or TP group (P > 0.05). The mean times to radiographic union progression were 13.5 AE 7.1 weeks and 15.1 AE 10.2 weeks in the LP and TP groups, respectively (P > 0.05). The mean times to implant removal surgery reaffirming solid union were 15.6 AE 5.5 months and 14.8 AE 4.9 months in the LP and TP groups, respectively (P > 0.05). Hardware irritation was detected in five patients in the LP group (12.2%) and three in the TP group (7.1%) (P > 0.05). One patient in the LP group and two in the TP group developed superficial wound infections, which resolved without further surgical intervention. Conclusion:Conventional TP remains a good option for the fixation of Danis-Weber type B distal fibular fractures, regardless of the biomechanical properties.

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Section: Discussionmentioning

confidence: 99%

One‐Third Tubular Plate Remains a Clinically Good Option in Danis‐Weber Type B Distal Fibular Fracture Fixation

Ahn

Cho

Jeong

et al. 2021

Orthopaedic Surgery

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“…In other words, the proximal portion of the two-dimensionally pre-contoured plate may not contact properly with the fibular body if it is adjusted to the lateral malleolus, which interrupts the proper placement of the proximal screws. In addition, a twodimensionally pre-contoured plate may result in impingement between the plate and the bulky head of the lag screw inserted in advance [7].…”

Section: Discussionmentioning

confidence: 99%

“…In terms of surgical fixation devices for an isolated Weber B type fracture, lag screws in combination with locking plates are preferred currently [6]. With the development of a pre-contoured locking plate, however, studies showed that plate itself can provide sufficient fixation power beyond its role of neutralizing the fixation accomplished by lag screws [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Three-Dimensional Anatomically Pre-Contoured Locking Plate for Isolated Weber B Type Fracture

Kim

Chun

Won

et al. 2021

JCM

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We aimed to evaluate the functional and radiographic outcomes of a three-dimensionally (3D) pre-contoured lateral locking plate fixation for isolated Weber B type fractures and to evaluate the necessity of an interfragmentary lag screw in the use of the plate. Patients who underwent surgery for isolated Weber B type fracture were divided into two groups: 41 patients treated with the 3D plate and lag screw (Group A) and 31 patients treated with the 3D plate only (Group B). The included patients were evaluated regarding the functional and radiographic outcomes. According to the McLennan and Ungersma criteria, the majority of patients showed good or fair outcomes in both groups. Comparing the two groups, Group B showed better functional outcomes (p < 0.0046), while no difference between the two groups was found in terms of the radiographic outcomes (p = 0.143). The operation time was significantly shorter in Group B (p < 0.001) and the time to bony union was within 14 months in all patients with no significant difference between the two groups (p = 0.0821). No postoperative complication was observed in both groups. In conclusion, the use of a 3D pre-contoured lateral locking plate fixation for isolated Weber B type fractures demonstrated satisfactory functional and radiographic outcomes, regardless of lag screw insertion.

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“…As a measure of radiographic outcome, the Kellgren and Lawrence (K&L) grading scale was used to assess arthritic changes after ankle fractures. 11,23 In addition, the quality of fracture reduction was evaluated using previously defined criteria: acceptable reduction was defined as <2 mm of displacement of any fracture line near the joint or 2 mm of translation of the talus relative to its normal articulation with the tibial plafond. 17,33 The K&L grade and quality of fracture reduction were determined independently by 2 orthopedic surgeons (Y.H.P., H.W.C.)…”

Section: Methodsmentioning

confidence: 99%

Investigation of the Effect of Bone Mineral Density on the Postoperative Outcome of Ankle Fractures in Elderly Patients

et al. 2021

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Background: The association between ankle fractures in elderly patients and low bone mineral density (BMD) has recently been recognized, but the effect of BMD on the postoperative outcome of these fractures is unknown. The aim of this study was to investigate the effect of BMD on the postoperative outcome of ankle fractures in elderly patients to evaluate the need for BMD screening. Methods: We retrospectively reviewed 48 patients aged 65 years or older who had ankle fractures and underwent dual-energy x-ray absorptiometry to assess BMD after surgical treatment of the fracture. Postoperative outcomes were assessed using the Olerud-Molander Ankle Score (OMAS), visual analog scale (VAS) score for pain, Kellgren and Lawrence (K&L) grading scale score, and quality of fracture reduction. The correlation between the BMD and the outcome measures at 12 months after surgery was analyzed using the Pearson correlation coefficient. Results: The mean absolute value of BMD was 0.6 ± 0.1 g/cm2 (T-score, –1.5 ± 1.2) at the femoral neck and 0.8 ± 0.2 g/cm2 (T-score, –1.2 ± 1.5) at the lumbar spine. Osteoporosis was present in 33% of female patients and in 11% of male patients. At 12 months after surgery, the OMAS was 70 ± 17 and the VAS score for pain was 18 ± 17. Of the patients, 20, 21, 5, 1, and 1 had K&L grades of 0, 1, 2, 3, and 4, respectively. None of the clinical and radiographic outcome measures were correlated with the BMD values of the patients. Conclusion: The postoperative outcome of the ankle fractures in elderly patients at 12 months after surgery showed no correlation with femoral neck or lumbar spine BMD at the time of fracture. Level of Evidence: Level III, retrospective comparative study.

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Necessity of Interfragmentary Lag Screws in Precontoured Lateral Locking Plate Fixation for Supination-External Rotation Lateral Malleolar Fractures

Cited by 5 publications

References 33 publications

One‐Third Tubular Plate Remains a Clinically Good Option in Danis‐Weber Type B Distal Fibular Fracture Fixation

One‐Third Tubular Plate Remains a Clinically Good Option in Danis‐Weber Type B Distal Fibular Fracture Fixation

Three-Dimensional Anatomically Pre-Contoured Locking Plate for Isolated Weber B Type Fracture

Investigation of the Effect of Bone Mineral Density on the Postoperative Outcome of Ankle Fractures in Elderly Patients

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