Principles of operative treatment of malleolar fractures today

Sutter, Paul Martin; Peltzer, Jill

doi:10.1007/s00068-010-0059-0

Cited by 15 publications

(11 citation statements)

References 23 publications

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“…In 18 cases, a separate medial incision was used for ORIF wherein a medial malleolar fracture was involved. All procedures including the management of the medial malleolar and posterior malleolar fractures were done according to AO rules 1. The distal cancellous bone screws need to be short of the medial side of the fibula to avoid damage to the lateral talar articular surface [Figure 2].…”

Section: Methodsmentioning

confidence: 99%

“…The goal of managing the comminuted fracture of lateral malleolus is to restore length, rotation and alignment which might be more challenging with extensive comminution around the area of the distal tip 123. Different techniques are commonly used to address this comminuted fracture, such as K-wires, tension band wires, one-third tubular plate, screws and intramedullary nails 145678910…”

Section: Introductionmentioning

confidence: 99%

“…Different techniques are commonly used to address this comminuted fracture, such as K-wires, tension band wires, one-third tubular plate, screws and intramedullary nails 145678910…”

Section: Introductionmentioning

confidence: 99%

“…There are no operative indications for the majority of Weber A and partial Weber B fracture due to good stability 111. However, when there is distal fibular fracture with shortening, comminution and rotation, involving the talus instability; open reduction and internal fixation (ORIF) is recommended 1.…”

Section: Introductionmentioning

confidence: 99%

“…However, when there is distal fibular fracture with shortening, comminution and rotation, involving the talus instability; open reduction and internal fixation (ORIF) is recommended 1. The lateral malleolar fracture, which exhibits an oblique or spiral pattern is generally stabilized with an infragmentary screw and is supplemented by a neutralizing tubular plate 12.…”

Section: Introductionmentioning

confidence: 99%

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Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study

Fang¹,

Waizy

Xie³

et al. 2013

IJOO

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Background:The goal of managing the comminuted fracture of lateral malleolus is to restore length, rotation and alignment which might be more challenging with extensive comminution around the area of the distal tip. The common osteosynthesis techniques such as the one-third tubular plate, tension band wiring, K-wires, screws, or intramedullary nail may be insufficient in cases with a comminuted lateral malleolus. The anatomical hook plate is an alternative implant in such cases. We present our results of the comminuted lateral malleolar fractures (Weber A, B), managed by open reduction and internal fixation (ORIF) with an anatomical hook plate of lateral malleolus (Königsee Implant Company, Germany).Materials and Methods:We retrospectively reviewed 20 patients of comminuted fracture of distal lateral malleolus between 2008 and 2010. There were 12 males and 8 females, right side was involved in 18 patients and left in 2. The mean age was 51.9 years (range 18-75 years). The fractures were categorized by Denis-Weber classification type A (n=1), B1 (n=1), B2 (n=13) and B3 (n=5). Nineteen cases were of closed injury and one of open injury (Gustilo Anderson type II). These patients underwent ORIF with a lateral malleolus anatomical hook plate. Followup including radiographs and clinical examinations were performed. The American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were documented at followups.Results:The mean followup was 21.4 months (range 16-27 months). The average AOFAS score was 94.3 (range 78-100) points. A stable anatomic reduction and bony union were obtained in all the cases. The average time was 3.1 months (range 2.5-4 months). Four cases had complications like posttraumatic osteoarthritis, hardware impingement and superficial wound infection.Conclusion:A reasonably good stability can be obtained in distal most comminuted fractures of lateral malleolus with a lateral malleolus anatomical hook plate. We believe this method to be a reasonable treatment option for a distal lateral comminuted malleolar fracture when other common fixations are insufficient to fix the fragments.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Different techniques are commonly used to address this comminuted fracture, such as K-wires, tension band wires, one-third tubular plate, screws and intramedullary nails 145678910…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study

Fang¹,

Waizy

Xie³

et al. 2013

IJOO

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Problems and controversies in the treatment of ankle fractures

Rammelt

Heim²,

Hofbauer³

et al. 2011

Unfallchirurg

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Ankle fractures are the most frequent injuries of a load-bearing joint. Their treatment belongs to the daily routine in trauma surgery. However, despite an increased understanding of the mechanism of injury and relatively straightforward fixation techniques, the medium- to long-term results are often less than satisfactory. The following article therefore explicitly focusses on unsolved problems and controversies in the treatment of ankle fractures in the light of the current literature. These include the therapeutic and prognostic relevance of frequently used classification systems, criteria for the indication for surgery, frequent hazards in internal fixation, the question of whether and how to fix the posterior malleolus, and the detection and treatment of syndesmotic instability. Furthermore, trauma surgeons face the increasing incidence of ankle fractures in the elderly. The presence of osteoporosis, diabetes mellitus and neuropathic osteoarthropathy represents a special challenge.

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Der posteriore Malleolus bzw. das Volkmann-Dreieck

Heim¹

2013

Unfallchirurg

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Having observed Nelsons and Jensen's rule for the fixation of the posterior malleolus in ankle fractures for over 70 years recent studies have shown that this dogma might have its limitations. Today no one can determine with absolute conviction what to do with this controversial fragment. To fix it operatively means to follow some strict surgical procedures (e.g. anatomy, approach and placement of implants). These guidelines are presented, the indications for fixation are discussed and the prognosis for these difficult fractures is outlined.

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Principles of operative treatment of malleolar fractures today

Cited by 15 publications

References 23 publications

Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study

Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study

Problems and controversies in the treatment of ankle fractures

Der posteriore Malleolus bzw. das Volkmann-Dreieck

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