Intramedullary Screw Fixation of Lateral Malleolus Fractures

Bankston, A. Brent; Anderson, Lewis D.; Nimityongskul, Prasit

doi:10.1177/107110079401501105

Cited by 41 publications

(33 citation statements)

References 14 publications

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“…While limited fixation is biomechanically weaker than lateral or postero-lateral plate osteosynthesis [3,25], the absence of any loss of fracture reduction in the present series suggests that while not absolutely rigid, fracture fixation is clearly stable. We have found no evidence to suggest that this less rigid fixation compromises fracture healing or clinical outcome.…”

Section: Discussioncontrasting

confidence: 46%

“…In tandem with the move towards less invasive surgical approaches in other areas of orthopaedic surgery, there have been a number of studies in the literature examining the results of operatively treated fibular fractures using alternative techniques, such as cerclage wiring supplemented with lag screws, intra-medullary and bio-absorbable fixation [2,3,7]. The rationale for adopting these more conservative approaches has been to respect the integrity of an often already compromised soft tissue envelope and hence to minimise the "second hit" of surgery.…”

Section: Introductionmentioning

confidence: 99%

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Less is more: lag screw only fixation of lateral malleolar fractures

McKenna

O’Shea

Burke

2006

International Orthopaedics (SICO

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Displaced fractures of the lateral malleolus are typically treated with plate osteosynthesis with or without the use of lag screws, and immobilisation in a plaster cast for up to 6 weeks. Fixation through a smaller incision with less metal, such as lag screw only fixation, would theoretically lead to decreased infection rates and less irritation caused by hardware. The purpose of this study was to evaluate the benefits and success of lag screw only fixation of the lateral malleolus in non-comminuted oblique fractures of the lateral malleolus. A total of 25 patients who had non-comminuted unstable oblique fractures of their lateral malleolus that had been surgically fixed with lag screws only were retrospectively evaluated. All patients were younger than 60 years of age. Evaluation of the success of fixation, complications, resultant mobility and patient satisfaction was based on information gathered from chart reviews, X-ray findings and a standardised questionnaire based on the AOFAS Foot and Ankle Outcomes Questionnaire. These results were compared to an age-matched group of 25 consecutive patients treated with plate osteosynthesis. Of the 25 patients fixed with lag screws, nine had an unstable fracture of the lateral malleolus only, ten were bimalleolar fractures and six were trimalleolar. Eighteen patients were treated with two lag screws, and seven were treated with three lag screws. The bi- and trimalleolar fractures were treated with standard partially threaded cancellous screws. None of the lag screw-only group lost reduction. There were no documented wound infections in the lag screw group as compared to three deep infections in the plate group. Lag screw-only patients reported no palpable hardware as compared to 50% of the plate group. AOFAS scores at a mean of 12 months post-operative were similar in both groups. Lag screw only fixation of the lateral malleolus is a safe and effective method that has a number of advantages over plate osteosynthesis, in particular less soft tissue dissection, less prominent, symptomatic and palpable hardware and a reduced requirement for secondary surgical removal.

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Section: Discussioncontrasting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Less is more: lag screw only fixation of lateral malleolar fractures

McKenna

O’Shea

Burke

2006

International Orthopaedics (SICO

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“…Bankston, et al [16] they found the Intramedullary screw provided 66.5% of the strength of native bone compared to the lateral buttress plate provided 61.5%. This was not statistically significant, but it did prove that an Intramedullary screw provides stable fixation, thereby assuring that rehabilitation can be instituted early without the risk of loss of reduction.…”

Section: Discussionmentioning

confidence: 99%

“…The long intramedullary screw also allows better purchase within the fibular canal than a smooth pin (while accommodating the distal fibular lateral bow), therefore eliminating hardware migration [5]. Furthermore, Bankston et al demonstrated biomechanically that this particular fixation device was superior in strength, although not statistically followed up compared to other fixations with plate and screws [16]. They reported their clinical results using open reduction and internal fixation of lateral malleolus fractures with an intramedullary screw, which demonstrated stable fracture fixation (allowing early weight bearing) and a 100% rate of union in their series.…”

Section: Introductionmentioning

confidence: 99%

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

Latif¹,

Al-Saadi²,

Zekry³

et al. 2013

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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.

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“…O ut of the various modalities of treatment option for fracture of lateral malleolus, [1][2][3][4][5][6][7][8] open reduction and internal fixation (ORIF) is the most preferred option for restoration of the anatomic ankle mortise with reduction of talar shift and correction of fibular length and rotation. Direct lateral approach has been most commonly used for the ORIF of lateral malleolar fractures.…”

mentioning

confidence: 99%