The Effect of Percutaneous Screw Fixation of Lateral Malleolus on Ankle Fracture Healing and Function

Girgis Latif, Hayder Al-Saadi, Medhat Zekry, Malallah Ali Hassan, Jamal Al Mulla

Heart of England NHS Foundation Trust, Bimingham, UK.
Rashid Hospital and Trauma Center, Dubai, UAE.

DOI: 10.4236/ss.2013.48072                

Abstract

Purpose: To measure the effectiveness of using percutaneous intramedullary screw fixation of the lateral malleolus fracture on the healing and functional outcome of ankle fracture. Materials and methods: Forty-six patients with Weber A and low Weber B displaced lateral malleolus fractures who underwent closed reduction and percutaneous internal fixation with an intramedullary, fully threaded, screw were retrospectively reviewed. A 3.5-mm, fully threaded, selftapping bone screw (stainless steel from Pelvic Set Synthes). The length of the screw varies between 100 mm and 120 mm, depending on the fracture location and pattern. Results: All fractures united within an average time to union of 8.2 weeks. In all patients the average time to full weight bearing was 6.8 weeks, whereas that in patients with isolated lateral malleolus fractures was 4.5 weeks. There were no deep wound infections or complaints of painful hardware. At latest follow-up, functional results were excellent in, 25 patients (54.3%) good in 20 (43.5%), fair in (2.2%). Conclusion: If reduction of the lateral malleolus fracture can be obtained in a closed fashion (with the aid of an image x-ray intensifier), we believe that fixation may be performed with an axial screw percutaneously. This technique is quick, safe and easy to do with less complication.

Keywords

Ankle Fracture; Lateral Malleolus; Intramedullary Screw

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	H. Bolin, “The Fibula and Its Relationship the Tibia and Talus in Injuries of the Ankle Due to Forced External Rotation,” Acta Radiologica, Vol. 56, No. 6, 1961, pp. 439-448. doi:10.3109/00016926109172839
[2]	M. C. Harper, “An Anatomic Study of the Short Oblique Fracture of the Distal Fibula and Ankle Stability,” Foot Ankle, Vol. 4, No. 1, 1983, pp. 23-29. doi:10.1177/107110078300400106
[3]	M. Bauer, et al., “Malleolar Fractures: Nonoperative versus Operative Treatment. A Controlled Study,” Clinical Orthopaedics and Related Research, Vol. 199, 1985, pp. 17-27.
[4]	K. E. Bugler, C. D. Watson, A. R. Hardie, P. Appleton, M. M. Mcqueen, C. M. Court-Brown and T. O. White, “The Treatment of Unstable Fractures of the Ankle Using the Acumed Fibular Nail,” The Journal of Bone & Joint Surgery, Vol. 94-B, No. 8, 2012, pp. 1107-1112. doi:10.1302/0301-620x.94b8.28620
[5]	H. N. Burwell and A. D. Charnley, “The Treatment of Displaced Fractures at the Ankle by Rigid Internal Fixation and Early Joint Movement,” The Bone & Joint Journal, Vol. 47, No. 4, 1965, pp. 634-660.
[6]	L. J. de Souza, R. B. Gustilo and T. J. Meyer, “Results of Operative Treatment of Displaced External RotationAbduction Fractures of the Ankle,” The Journal of Bone & Joint Surgery, Vol. 67, No. 7, 1985, pp. 1066-1074.
[7]	W. C. McDade, “Treatment of Ankle Fractures,” AAOS Instructional Course Lectures, Vol. 24, 1975, pp. 251-294.
[8]	N. F. SooHoo, L. Krenek, M. J. Eagan, B. Gurbani, C. Y. Ko and D. S. Zingmond, “Complication Rates Following Open Reduction and Internal Fixation of Ankle Fractures,” The Journal of Bone & Joint Surgery, Vol. 91, 2009, pp. 1042-1049.
[9]	F. C. Wilson and L. A. Skilbred, “Long-Term Results in the Treatment of Displaced Bimalleolar Fractures,” The Journal of Bone & Joint Surgery, Vol. 48, No. 6, 1966, pp. 1065-1078.
[10]	J. J. Schaffer and A. Manoli, “The Antiglide Plate for Distal Fibular Fixation. A Biomechanical Comparison with Fixation with a Lateral Plate,” The Journal of Bone & Joint Surgery, Vol. 69, No. 4, 1987, pp. 596-604.
[11]	K. A. Solonen and L. Lauttamus, “Operative Treatment of Ankle Fractures,” Acta Orthopaedica Scandinavica, Vol. 39, No. 2, 1968, pp. 223-237.
[12]	C. Olerud and H. Molander, “Biand Trimalleolar Ankle Fractures Operated with Nonrigid Internal Fixation,” Clinical Orthopaedics and Related Research, Vol. 206, 1986, pp. 253-260.
[13]	J. L. Hughes, et al., “Evaluation of Ankle Fractures: Non-Operative and Operative Treatment,” Clinical Orthopaedics and Related Research, Vol. 138, 1979, pp. 111-119.
[14]	F. Jergesen, “Open Reduction of Fractures and Dislocations of the Ankle,” The American Journal of Surgery, Vol. 98, No. 2, 1959, pp. 136-151. doi:10.1016/0002-9610(59)90057-1
[15]	C. L. Mitchell and J. L. Fleming, “Fractures and Fracture-Dislocations of the Ankle,” Postgraduate Medicine, Vol. 26, 1959, pp. 773-782.
[16]	A. B. Bankston, L. D. Anderson and P. Nimityongskul, “Intramedullary Screw Fixation of Lateral Malleolus Fractures,” Foot & Ankle International, Vol. 15, No. 11, 1994, pp. 599-607. doi:10.1177/107110079401501105
[17]	T. D. Ray, P. Nimityongskul and L. D. Anderson, “Percutaneous Intramedullary Fixation of Lateral Malleolus Fractures: Technique and Report of Early Results,” Journal of Trauma, Vol. 36, No. 5, 1994, pp. 669-675. doi:10.1097/00005373-199405000-00012
[18]	B. M. Covino, C. M. Barsanti, J. Wolfe and G. J. Wang, “Internal Fixation of Lateral Malleolus Fractures: A Clinical and Biomechanical Comparison of Two Techniques,” Orthopaedics Transaction Journal, Vol. 5, 1990, p. 90.