Percutaneous Reduction Technique Using a Kirschner Wire for Displaced Posterior Malleolar Fractures

Lee, Han-Jun; Kang, Ki-Ser; Kang, Sang Wook; Lee, Jae-Sung

doi:10.3113/fai-2009-0157

Cited by 12 publications

(8 citation statements)

References 4 publications

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“…The posterior malleolus was then reduced through ligamentotaxis with the ankle in dorsiflexion. If necessary, percutaneously applied pointed reduction forceps, bone hook, K-wire, or periosteal elevator was used to reduce the posterior malleolar fragment anatomically [13, 14]. Intraoperative lateral view radiographs were taken using C-arm to verify the reduction.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis.MethodsPatients with a PMF involving over 25% of the articular surface were recruited and assigned to the direct reduction (DR) group or the indirect reduction (IR) group. Following reduction and fixation of the fracture, the quality of fracture reduction was evaluated in post-operative CT images. Clinical and radiological follow-ups were performed at 6 weeks, 3 months, 6 months, 12 months, and then at 6 month-intervals postoperatively. Functional outcome (AOFAS score), ankle range of motion, and Visual Analog Scale (VAS) were evaluated at the last follow-up. Statistical differences were compared between the DR and IR groups considering the patient demographics, quality of fracture reduction, AOFAS score, and VAS.ResultsTotally 116 patients were included, wherein 64 cases were assigned to the DR group and 52 cases were assigned to the IR group. The quality of fracture reduction was significant higher in the DR group (P = 0.038). In the patients who completed a minimum of 12 months’ follow-up, a median AOFAS score of 87 was recorded in the DR group, which was significantly higher than that recorded in the IR group (a median score of 80). The ankle range of motion was slightly better in the DR group, with the mean dorsiflexion restriction recorded to be 5.2° and 6.1° in the DR and IR group respectively (P = 0.331). Similar VAS score was observed in the two groups (P = 0.419).ConclusionsThe direct reduction technique through a posterolateral approach provide better quality of fracture reduction and functional outcome in the management of PMF over 25% of articular surface, as compared with the indirect reduction technique using ligamentotaxis.Trial registration NCT02801474 (retrospectively registered, June 2016, ClinicalTrails.gov).

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Section: Methodsmentioning

confidence: 99%

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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“…Simple, undisplaced PMFs can be fixed percutaneously with minimally invasive techniques (8) . However, this technique has some limitations, such as indirect anatomical reduction.…”

Section: Introductionmentioning

confidence: 99%

Incidence of early complications in the posterolateral approach to posterior malleolus fractures

et al. 2020

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Introduction: To ascertain the incidence of early complications in the posterolateral approach to open reduction and internal fixation of posterior malleolar fractures and identify possible risk factors related to occurrence of these complications. Methods: Retrospective study carried out in three tertiary hospitals. Patients who underwent open reduction and internal fixation of posterior malleolus fractures via the posterolateral route were divided into two groups: with versus without delayed postoperative healing. To assess risk and protective factors for the outcome of delayed healing, we evaluated the time between trauma and surgery, whether the patient had a fracture-dislocation of the ankle, and whether external fixation was performed before surgery. We also evaluated whether improvement in operative technique led to a reduction in complication rates. Results: A total of 43 individuals who underwent surgical correction of posterior malleolus fractures via the posterolateral route between 2013 and 2018 were included. Of these, 19 (44.2%) had skin complications that led to delayed healing. Skin complications occurred more frequently at the beginning of the learning curve of the surgeons involved; the incidence up to the year 2016 was 56.3%, decreasing significantly to 37% from 2017 onward. Conclusion: Patients who undergo open reduction and internal fixation of posterior malleolus fractures via the posterolateral route at the beginning of the learning curve are a greater risk of developing skin complications, demonstrating the importance of this approach being restricted to more experienced surgeons. Level of Evidence III; Prognostic Studies; Retrospective Study.

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“…Simple posterior malleolar fractures can be reduced in minimally invasive ways, such as percutaneous reduction with anteroposterior screw fixation. However, these methods have some limitations.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Posteromedial Versus Posterolateral Approach for Posterior Malleolus Fixation in Trimalleolar Ankle Fractures

Zhong

Shen

Zhao

et al. 2017

Orthopaedic Surgery

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Objective: To compare clinical and radiographic outcomes of posterior malleolar fractures (PMF) treated with lag screws from anterior to posterior versus posterior to anterior approach. Methods:We retrospectively analyzed 48 patients with trimalleolar fractures who underwent open reduction and internal fixation (ORIF) with either posteromedial (PM) or posterolateral (PL) approaches between January 2012 and December 2014. Fixation of the posterior malleolus was made with anteroposterior screws in 20 patients using the PM approach and posteroanterior screws in 28 patients using the PL approach. The American Orthopedic Foot and Ankle Society (AOFAS) scores and range of motion (ROM) of the ankle were used as the main outcome measurements, and results were evaluated at the 6-month, 12-month and final follow-up. Postoperative radiographs and computed tomography scans were used to evaluate the residual gap/step-off. The degree of arthritis was evaluated on final follow-up using Bargon criteria. Other complications were also recorded to compare the clinical outcomes of the two approaches.Result: The mean duration of follow-up regardless of the approaches was 21.1 months (range, 15-54 months). None of the patients developed delayed union or nonunion. Functional bone healing was obtained in all patients at 10.7 weeks (range, 8-16 weeks). The mean AOFAS scores of the PM group at the postoperative 6-mouth, 12-month, and final follow-up were 91.4 (range, 82-100), 92.5 (range, 84-100), and 92.9 (range, 86-100), respectively. In the PL group, the mean AOFAS scores were 89.9 (range, 72-100), 91.4 (range, 77-100), and 91.9 (range, 77-100), respectively. At the final follow-up, the median loss of range of motion (ROM) for dorsiflexion and plantaflexion were 0 (0 , 5 ) and 0 (0 , 0 ), respectively, in both groups. There were no significant differences between the two approaches in AOFAS scores and ROM of the ankle in each period postoperatively (P > 0.05). Two patients in the PL group and 1 in the PM group developed Bargon grade 2 or 3 arthritis. We detected a 2-mm and 3-mm step-off in 1 patient in the PM and PL groups, respectively. Conclusion:Satisfactory results were obtained by using the two approaches for fixation of posterior malleolus, and the approaches have similar clinical and radiographic outcomes. Surgeons should choose the appropriate approach based on their experience.

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Percutaneous Reduction Technique Using a Kirschner Wire for Displaced Posterior Malleolar Fractures

Cited by 12 publications

References 4 publications

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Incidence of early complications in the posterolateral approach to posterior malleolus fractures

Comparison of Posteromedial Versus Posterolateral Approach for Posterior Malleolus Fixation in Trimalleolar Ankle Fractures

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