Modified minimally invasive anteromedial approach with cannulated screw fixation for medial malleolus fracture: A novel technique

Abstract

Background: In the treatment of medial malleolus fracture with traditional anteromeal ankle incision, the skin incision is larger and the incision-related complications are more. This study aims to explore the efficacy of this minimally invasive approach in the treatment of medial malleolus fracture.Methods: A retrospective analysis the patients with ankle fracture who were treated with modified minimally invasive anteromedial approach (MMITAA group) in our hospital between January 2019 and April 2020, and patients with ankle fracture treated with traditional anteromedial approach (TAA group) between January 2018 and December 2019. After regular follow-up, perioperative period, follow-up and imaging data of the two groups were compared to evaluate whether the therapeutic effect of the modified approach was better than that of the traditional approach.Results: The preoperative VAS score was 6.89 ± 1.74 in the MMIAA group and 7.17 ± 1.06 in the TAA group (P > 0.05). The VAS score in the MMIAA group was 4.97 ± 1.10 at 3 days after the surgery, which was significantly lower than the 6.20 ± 0.92 in the TAA group. The VAS score at 1 month after the surgery was still lower in the MMIAA group than in the TAA group.According to the results of postoperative ankle CT, the maximum postoperative step-off of the articular surface was 0.14 ± 0.12 mm in the MMIAA group and 0.18 ± 0.18 mm in the TAA group, but the difference was not statistically significant. The postoperative AOFAS score was 95.95 ± 6.81 points in the MMIAA group and 93.99 ± 8.74 points in the TAA group, which was slightly higher in the MMIAA group than in the TAA group, with no significant difference. Of the four subjective scores included in the AOFAS, the pain score of 38.15 ± 3.90 in the MMIAA group was significantly lower than the 36.51 ± 5.03 in the TAA group.All patients achieved fractrue healing.Conclusions: The modified minimally invasive anteromedial approach greatly shortened the lenth of incision, thereby reducing the incidence of incision-related complications, by smaller trauma achieve the same clinical effect.