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

Abstract

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.

Percutaneous intramedullary screw fixation in lateral malleolar ankle fractures

“…the results were excellent in 25 patients (54.3%), good in 20 patients (43.5%) and fair in one patient (2.2%). (13) In the present study, the average time for union was 5.86 ± 1.74 weeks, ranging from 4 to 8 weeks with a rate of union 100%. While in the study of Ray TD et al (18) , the average time of fracture union was 8.2 weeks with one case developed nonunion, with a union rate of 95.5%.…”

“…The age and sex of the patients were not statistically significant, which was proven in this study and other studies that were done by other authors. (13,18) Of the twenty-five patients in the present study, three patients had associated medial malleolus fractures. While in the study of Ray TD et al (18) , five patients had an associated medial malleolar fracture and one patient had a trimalleolar fracture.…”

“…Two of the patients with associated medial malleolus fractures had an unsatisfactory result, one patient with fair score had a malunited medial malleolus and one patient with poor score had an ununited medial malleolus. But in the study of Latif G et al (13) , fifteen patients had an associated fracture of the medial malleolus and ten patients had a trimalleolar fracture as well as in the study of Kim HJ et al (19) , eleven patients had associated medial malleolar fractures. But both studies didn't report the correlation between associated fractures and the final score.…”

“…Because the fracture hematoma is not violated. (13) The long intramedullary screw allows getting a purchase within the fibular canal, therefore eliminating hardware migration. The intramedullary position allows for dynamic compression at the fracture site with weight-bearing, thus enhances fracture healing.…”

“…In the study of Ray TD et al (18) and Latif G et al (13) , using this percutaneous technique, the use of a tourniquet is optional, and they didn't report the use of tourniquet in isolated lateral malleolus fractures. But in the study of Kim HJ et al, who used a 3.5 mm T-shaped locking compression plate, the conventional lateral approach was utilized to expose the lateral malleolus under tourniquet, and they didn't report any postoperative tourniquet complications.…”