Fixation of Distal Fibula Fractures

Mitchell, Justin J.; Bailey, James R.; Bozzio, Anthony E.; Fader, Ryan R.; Mauffrey, Cyril

doi:10.1177/1071100714555712

Cited by 16 publications

(11 citation statements)

References 39 publications

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“…A 1-mm displaced talus is associated with more than 40% of tibiotalar contact area decreases and changes [5]. The lateral malleolus is important for ankle mortise stability, especially in AO (Arbeitsgemeinschaft für Osteosynthesefragen )/OTA (Orthopaedic Trauma Association )-44B transsyndesmotic fibula fractures accompanied by mortise changes and talus tilt [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Treating AO/OTA 44B lateral malleolar fracture in patients over 50 years of age: periarticular locking plate versus non-locking plate

et al. 2020

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Background: The role of locking plate in lateral malleolar fracture fixation for the elderly remains unclear. The aim of our study is to compare radiological and functional outcomes in older patients (> 50 years) with AO/OTA 44B lateral malleolar fractures after locking plate (PLP) or one-third non-locking tubular plate (TP) lateral fixation. Methods: We retrospectively reviewed the medical records of 72 patients (PLP group, 34 patients; TP group, 38 patients; mean age, 61.9 ± 7.6 years; range, 51-80 years; follow-up, 1 year). Patients with open fractures, syndesmosis injuries, and a previous ankle trauma or surgery were excluded. Demographic data, union rate, complications, radiographic outcomes, visual analog scale (VAS) scores, and foot and ankle outcome scores (FAOSs) between the groups were recorded and compared. We also investigated the association of clinical features with pain and function. Statistically, the Fisher's exact test was used for categorical variables and the Mann-Whitney U test for the continuous variables. The final model for the multiple regression analysis was used to predict factors related to functional outcomes. Results: There were no significant between-group differences in demographic data, complication rates, immediately postoperative distal fibula lengths, ankle osteoarthritis (OA) grades, talar tilt angles (TTAs) ≥ 2°, or reduction accuracy. All fractures achieved union. The PLP group had significantly lower rates of distal screw loosening, fibula shortening > 2 mm, OA grade progression, and TTAs ≥ 2°, and better FAOSs and VAS scores than was the case for the TP group after 1 year of follow-up (all p < 0.05). The severity of OA, TTA ≥ 2°, and distal screw loosening were positively associated with VAS scores, and negatively associated with FAOSs. Conclusions: When treating AO/OTA 44B fractures in patients over 50 years of age, PLPs provided better VAS scores, FAOSs, and radiological outcomes, including less fibula shortening > 2 mm, less osteoarthritic (OA) ankle progression, less implant removal rate, and fewer TTAs ≥ 2°than was the case for TPs after a 1-year follow-up. Level of evidence: Therapeutic level III

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Section: Introductionmentioning

confidence: 99%

Treating AO/OTA 44B lateral malleolar fracture in patients over 50 years of age: periarticular locking plate versus non-locking plate

et al. 2020

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“…Overall, both groups demonstrated a relatively low complication rate (10%), with hardware-related issues being the most prevalent. The rate of hardware removal is similar to other procedures, [6][7][8][9][10][11] such as anterior cruciate ligament (ACL) reconstructions, where screws or staple prongs are commonly proud or unicortical due to the nature of this type of hardware. [12][13][14] Hardware function (such as in ACL graft tunnel mismatch) must be considered, because repositioning of the hardware placed around an already well-secured surgical site or ACL graft could lead to significant graft damage.…”

Section: See Related Article On Page 2141mentioning

confidence: 85%

Editorial Commentary: Limited Data Shows How Little We Know

Mitchell¹,

Chahla²,

LaPrade³

2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Lateral compartment osteoarthritis of the knee can be a challenging problem to address in the younger, active population. The challenge is compounded by limited treatment options and high patient expectations, with patients often desiring a return to impact high intensity activity. Distal femoral osteotomy has been reported to be one potential treatment option; however, a highly heterogeneous literature exists for both opening and closing wedge distal femoral osteotomies for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment. The literature does not provide significant direction for surgeons on the appropriate surgical approach; however, opening wedge osteotomies allow for fine adjustment and maintain leg length and joint alignment, and are our preferred approach.

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“…11 This rate is significantly higher in certain high-risk patients such as patients over 65 years of age with poor soft tissue, diabetics, and smokers. 13 Several studies reviewing intramedullary fixation of fibular fractures have reported significantly lower rates of wound breakdown and hardware irritation than seen traditionally with standard AO techniques. 2,5,8,10,12,14,15 The majority of complications seen in early descriptions of the procedure were minimized as the technique evolved.…”

Section: Discussionmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

“…17 Regardless of fracture pattern, these devices are most commonly used in elderly patients with osteoporotic bone, and patients who are at high risk for hardware failure or skin and soft tissue complications, including diabetic patients and smokers. 13 comminuted fractures, and extremely distal fibular fractures. We recommend operative management within 7 to 10 days of injury if a completely percutaneous approach is to be utilized as fracture callus increases the difficulty of fragment manipulation.…”

Section: Indicationsmentioning

confidence: 99%

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