The Current Aproaches to the Osteosynthesis of the Posterior Rim of the Distal Tibia in Cases of Unstable Ankle Fractures

Belenkiy, I.G.; Mayorov, B.A.; Tulchinskiy, A.E.; Grigoryan, F.S.; Nikolaev, I.K.

doi:10.17513/spno.30751

СПНО (MPSE)

2021

DOI: 10.17513/spno.30751

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The Current Aproaches to the Osteosynthesis of the Posterior Rim of the Distal Tibia in Cases of Unstable Ankle Fractures

I.G. Belenkiy¹,

B.A. Mayorov²,

A.E. Tulchinskiy³

et al.

Abstract: Переломы лодыжек сочетаются с переломами заднего края большеберцовой кости в 7-40% случаев. При этом чёткие показания к остеосинтезу переломов заднего края большеберцовой кости до сих пор не определены. Цель работы: на основании анализа профильных научных публикаций осветить современное состояние проблемы хирургической фиксации заднего края ББК при сочетаниях его повреждений с переломами лодыжек и наметить перспективные пути дальнейших научных исследований в этой области. Изучены современные классификации пере… Show more

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Posteromedial Approach in Fracture Fixation of Malleoli and Posterior Edge of Tibia

Belenkiy

Майоров

Sergeev

et al. 2022

Traumatology and Orthopedics of Russia

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Background. Surgical treatment of malleoli injuries is performed according to the principles of articular fractures management. It is particularly true for ankle injuries involving fractures of posterior edge of the tibia. The posteromedial approach enables to improve the results of surgical treatment of patients due to the direct reduction of tibia fragments. Aim of the study to evaluate the efficacy and advisability of the modified posteromedial approach in patients with unstable fractures of malleoli and posterior edge of the tibia. Methods. Twenty two patients with unstable fractures of malleoli and posterior edge of the tibia underwent surgical treatment via the posteromedial approach. The X-ray control was performed the next day after the surgery as well as 6, 12, 24 and 48 weeks from the osteosynthesis. The functional results were evaluated in 12, 24 and 48 weeks after the surgery with the use of AOFAS and Neer scales. Results. The average duration of postoperative period (9.33.8 days) was mainly determined by the state of the soft tissues. 91% of patients had anatomical reduction of posterior edge fragment of the tibia, 17 (77%) from 22 patients demonstrated fracture consolidation in X-rays 12 weeks after the surgery and all 22 patients (100%) 24 weeks after surgery. There were no cases of postoperative complications in patients 24 weeks after the surgery. While managing patients the range of motion in the ankle joint increased from 41.16.9 12 weeks after the surgery to 57.34.6 48 weeks after the surgery, that was statistically significant (p0.01). The functional results improved as well according to both AOFAS and Neer scales and this improvement was also statistically significant (p0.01). Conclusion. The is rather effective in Patients with unstable fractures of malleoli and posterior edge of the tibia had a statistically significant improvement in function after posteromedial approach.

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Posteromedial Approach in Fracture Fixation of Malleoli and Posterior Edge of Tibia

Belenkiy

Майоров

Sergeev

et al. 2022

Traumatology and Orthopedics of Russia

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Unstable Fractures Osteosynthesis of Malleoli and Posterior Edge of the Tibia Using Posterolateral Surgical Approach

Беленький

Григорьевич²,

Майоров

et al. 2021

Traumatology and Orthopedics of Russia

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The malleoli fractures in combination with the fractures of posterior edge of the tibia are considered unstable injuries and present particular difficulties in surgical treatment. The aim of the study was to evaluate short-term and mid-term results of osteosynthesis on account of unstable fractures of malleoli and posterior edge of the tibia using posterolateral surgical approach. Materials and Methods. The analysis of short-term and mid-term results of the treatment of 29 patients with malleoli fractures types 44-B3 and 44-C1.3, C2.3 and C3.3 (according to the AO classification) with the involvement of the Volkman`s posterior tibia fragment was performed in traumatology departments of three hospitals during the period from January 2019 to September 2020. In all 29 cases the fracture of the posterior edge of the tibia was classified as type 1 according to the classification of N. Haraguchi et al. All patients underwent osteosynthesis of the posterior edge of the tibia and the lateral malleolus via posterolateral surgical approach. Combined fracture of the medial malleolus was fixed via classical medial approach. 5 patients (17.2%) with continued instability of the distal tibiofibular syndesmosis underwent fixation with positional screw. Functional results, as well as the range of motions in the ankle joint were evaluated with the use of AOFAS and Neer scales 3, 6 and 12 months after surgery. Results. Statistically significant improvement in functional outcomes over time was noted when evaluated on the AOFAS scale (p0.05) and on the Neer scale (p0.01). 12 months after the surgery these points were 83.213.4 and 87.816.8 respectively. Complications were noted in 5 patients (17.24%). Deep periimplant infection was registered just in one case, another patient had marginal necrosis of the operative wound. Three patients had clinically significant post-traumatic deforming arthritis of the ankle joint. Conclusion. Posterolateral surgical approach has advantages when performing osteosynthesis in patients of the studied profile and enables anatomical reduction and stable fixation of fragments of the Volkman`s posterior edge of the tibia, which provides the possibility of early mobilization of the ankle joint and has positive effect on the results of treatment.

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The Current Aproaches to the Osteosynthesis of the Posterior Rim of the Distal Tibia in Cases of Unstable Ankle Fractures

Cited by 2 publications

References 2 publications

Posteromedial Approach in Fracture Fixation of Malleoli and Posterior Edge of Tibia

Posteromedial Approach in Fracture Fixation of Malleoli and Posterior Edge of Tibia

Unstable Fractures Osteosynthesis of Malleoli and Posterior Edge of the Tibia Using Posterolateral Surgical Approach

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