Technique Tip: Percutaneus Screw Fixation of Posterior Malleolar Fractures

Idusuyi, Osaretin B

doi:10.1177/107110070602700818

Cited by 21 publications

(28 citation statements)

References 2 publications

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“…The posterior malleolus was then reduced through ligamentotaxis with the ankle in dorsiflexion. If necessary, percutaneously applied pointed reduction forceps, bone hook, K-wire, or periosteal elevator was used to reduce the posterior malleolar fragment anatomically [13, 14]. Intraoperative lateral view radiographs were taken using C-arm to verify the reduction.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis.MethodsPatients with a PMF involving over 25% of the articular surface were recruited and assigned to the direct reduction (DR) group or the indirect reduction (IR) group. Following reduction and fixation of the fracture, the quality of fracture reduction was evaluated in post-operative CT images. Clinical and radiological follow-ups were performed at 6 weeks, 3 months, 6 months, 12 months, and then at 6 month-intervals postoperatively. Functional outcome (AOFAS score), ankle range of motion, and Visual Analog Scale (VAS) were evaluated at the last follow-up. Statistical differences were compared between the DR and IR groups considering the patient demographics, quality of fracture reduction, AOFAS score, and VAS.ResultsTotally 116 patients were included, wherein 64 cases were assigned to the DR group and 52 cases were assigned to the IR group. The quality of fracture reduction was significant higher in the DR group (P = 0.038). In the patients who completed a minimum of 12 months’ follow-up, a median AOFAS score of 87 was recorded in the DR group, which was significantly higher than that recorded in the IR group (a median score of 80). The ankle range of motion was slightly better in the DR group, with the mean dorsiflexion restriction recorded to be 5.2° and 6.1° in the DR and IR group respectively (P = 0.331). Similar VAS score was observed in the two groups (P = 0.419).ConclusionsThe direct reduction technique through a posterolateral approach provide better quality of fracture reduction and functional outcome in the management of PMF over 25% of articular surface, as compared with the indirect reduction technique using ligamentotaxis.Trial registration NCT02801474 (retrospectively registered, June 2016, ClinicalTrails.gov).

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Section: Methodsmentioning

confidence: 99%

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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“…In previous studies, PMFs with small displacement were often reduced indirectly and fixed with screws using the anterior to posterior approach [18,19,20], which can avoid delayed wound healing, soft tissue adhesion and iatrogenic sural nerve damage caused by soft tissue dissection. However, due to the interposition of soft tissue or loose osseous fragments in the PMF gaps, it is difficult for indirect reduction to achieve anatomical reduction, and it is technically difficult to fix small or comminuted fragments [21,22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Efficacy of Posterior-Anterior Screws, Anterior-Posterior Screws and a Posterior-Anterior Plate in the Fixation of Posterior Malleolar Fractures with a Fragment Size of ≥15% and <15%

Wang

Sun

Yan

et al. 2020

Preprint

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Background To investigate the efficacy of posterior-anterior (PA), anterior-posterior (AP) screws and a PA plate in the fixation of posterior malleolar fractures (PMFs) with a fragment size of ≥ 15% and < 15%.MethodsThis is a retrospective study of the clinical data of 243 patients with unilateral ankle fractures involving the posterior malleolus. All patients were divided into two groups based on their fragment size, ≥ 15% (n = 136) and < 15% (n = 107). PA screws, AP screws and a posterior plate were used for fixation of PMF in the two groups. All patients were followed up at 1, 3, 6, and 12 months after surgery and thereafter at 6-month intervals. The primary outcomes were AOFAS and ROM, which were recorded at the final follow-up.Results The average follow-up time for all patients was 18.9 months and all fractures healed. There was no significant difference between the PA plate fixation, PA screw, and AP screw fixations in terms of AOFAS scores or ankle ROM in the fragment size of ≥ 15% group (P > 0.05). In the fragment size of < 15% group, there were statistically significant differences in the AOFAS scores and ankle ROM between the PA plate fixation and PA, AP screw fixation (P < 0.05); while no significant difference was observed between PA and AP screw fixation.Conclusion For PMFs with fragment size ≥ 15%, there was no significant difference in the outcomes between the three fixation methods. For PMF with fragmentation < 15%, the PA and AP screws both provided good fixation.

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“…For posterolateral fragments created either by a posterior fracture dislocation or following a rotational mechanism, 1 or 2 screws are used either through a separate posterolateral approach or using a percutaneous lag screw technique. 15 Alternatively, a second plate may be used for larger fracture fragments. Articular reduction can be fluoroscopically assessed before application of the medial malleolar buttress plate.…”

Section: Surgical Techniquementioning

confidence: 99%

Posterior Fracture Dislocation of the Ankle: Technique and Clinical Experience Using a Posteromedial Surgical Approach

Bois

Dust

2008

Journal of Orthopaedic Trauma

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Technique Tip: Percutaneus Screw Fixation of Posterior Malleolar Fractures

Cited by 21 publications

References 2 publications

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Comparison of the Efficacy of Posterior-Anterior Screws, Anterior-Posterior Screws and a Posterior-Anterior Plate in the Fixation of Posterior Malleolar Fractures with a Fragment Size of ≥15% and <15%

Posterior Fracture Dislocation of the Ankle: Technique and Clinical Experience Using a Posteromedial Surgical Approach

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Technique Tip: Percutaneus Screw Fixation of Posterior Malleolar Fractures

Cited by 21 publications

References 2 publications

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Comparison of the Efficacy of Posterior-Anterior Screws, Anterior-Posterior Screws and a Posterior-Anterior Plate in the Fixation of Posterior Malleolar Fractures with a Fragment Size of ≥15% and &lt;15%

Posterior Fracture Dislocation of the Ankle: Technique and Clinical Experience Using a Posteromedial Surgical Approach

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Comparison of the Efficacy of Posterior-Anterior Screws, Anterior-Posterior Screws and a Posterior-Anterior Plate in the Fixation of Posterior Malleolar Fractures with a Fragment Size of ≥15% and <15%