Lateral malleolar fractures Weber Type A and B: does percutaneous intramedullary screw confer a solid alternative to the traditional neutralization plate?

Abstract

Purpose To compare the clinical results, complication rates, and radiographic outcome between both methods of fixation of lateral malleolar fractures: lateral neutralization plates and intramedullary fully threaded screws. Patients and methods This prospective case series study involved 73 patients with fractured lateral malleolus of type A, B according to Weber classification, to whom internal fixation was performed by either lateral plate and screws construct (Group A) or intramedullary screw (Group B). All patients were followed up for 12 months at least, with an average follow-up time of 12.7 months. Results There was no significant difference in the functional outcome score between both groups. The intramedullary screw group had a significantly shorter operative time and time to full union (P<0.001 and =0.006 respectively). There was a relatively higher accuracy of reduction with the plate fixation group, but it was statistically insignificant. There was a relatively fewer complication rate with the use of intramedullary screw fixation compared to plate fixation. Conclusion The use of intramedullary fixation is a good alternative for plate fixation in low fibular fractures (Weber A and B). Although plate fixation provides an optimal anatomic reconstruction of the fractures, intramedullary fixation may have a lower risk of complications.

Use of Fibula Nails With Proximal and Distal Fixation

“… 2 Another study comparing plate fixation and intramedullary nail fixation performed by the same surgeon had 31.6% of implant complications with plate fixation, 12.5% of these patients underwent a second surgery for removal, compared to 0% implant complications or removal seen in patients who received intramedullary nails. 18 In our results, only 1 case (0.5%) required implant removal for a proud nail, which is in line with the current literature findings. 18 …”

“… 18 In our results, only 1 case (0.5%) required implant removal for a proud nail, which is in line with the current literature findings. 18 …”

“…However, interestingly, fibula nailing still had equivocal results to plating techniques, many even showing improved results when nailing over plating. 3 , 7 , 8 , 18 Rush rods, Ender nails, and Knowles pins are earlier intramedullary devices that were effective at aligning the fibula, but did not provide good rotational or axial stability. 4 We believe that a nail that provides both distal and proximal fixation is essential for rotational stability and length control.…”

“…Although we acknowledge that rates of infection and nonunion with plate-and-screw fixation are relatively low, rates of implant irritation and removal are relatively higher. 2 , 6 , 18 In a review of 404 surgically plated fibula fractures, 13.4% of patients had implant complications resulting in removal. 2 Another study comparing plate fixation and intramedullary nail fixation performed by the same surgeon had 31.6% of implant complications with plate fixation, 12.5% of these patients underwent a second surgery for removal, compared to 0% implant complications or removal seen in patients who received intramedullary nails.…”

Percutaneous intramedullary screw or rush pin fixation of unstable ankle fractures in patients with fragile soft tissue – retrospective study of 80 cases

“…A recent prospective study by Zawam et al [ 18 ] comparing an percutaneous intramedullary screw to the traditional neutralizations plate reported no significant difference in functional outcome between the two groups.…”