Comparative study on screw or buttress plate for fixation of supination-adduction type-II medial malleolar fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Hongmou , ZHANG Yan , HU Dong ,  LIANG Xiaojun , LI Yi , LU Jun , WANG Junhu

Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding?author：

LIANG Xiaojun, Email: liangxj33369@163.com

Keywords：

Ankle fracture; supination-adduction; medial malleolar fracture; internal fixation

DOI：

10.7507/1002-1892.201612046

Video：

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Objective To investigate the functional outcomes of buttress plate fixation and simple screws fixation for the treatment of supination-adduction type-II medial malleolar fractures so as to provide reference for selection of internal fixation. Methods Between March 2009 and December 2012, 53 patients with supination-adduction type-II medial malleolar fractures were treated with open reduction and internal fixation. Of them, buttress plate fixation was used in 30 cases (buttress plate fixation group), and screws fixation was used in 23 cases (screw fixation group). There was no significant difference in age, gender, injury cause, injury side, disease duration, and combined injuries between 2 groups (P>0.05). Complications and full weight-bearing time were recorded; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. Post-operative anteroposterior and lateral X-ray films were taken to evaluate fracture reduction and union condition. And the treatment failures were recorded. Results There was no significant difference in incision related complication rate and infection rate between 2 groups (P>0.05). The patients were followed up 46-91 months (mean, 64.5 months) in buttress plate fixation group and 44-86 months (mean, 59.5 months) in screw fixation group. The full weight-bearing time of the buttress plate fixation group was significantly shorter than that of screw fixation group (t=2.05,P=0.04). During follow-up time, malunion and nonunion occurred in 2 cases and 1 case of screw fixation group; anatomic reduction and bony union were observed in the other patients of 2 groups. The union time showed no significant difference between 2 groups (t=1.06,P=0.30). No significant difference was found in AOFAS score and good and excellent rate, VAS score, operation failure rate, and traumatic osteoarthritis rate between groups (P>0.05). Conclusion For patients with supination-adduction type-II medial malleolar fracture, the angle between fracture line and tibial axial line is too small to be fixed firmly with simple screws fixation, with a relatively higher failure rate. And buttress plate fixation can reach rigid fixation, and has better functional outcomes.

Citation： ZHAO Hongmou, ZHANG Yan, HU Dong, LIANG Xiaojun, LI Yi, LU Jun, WANG Junhu. Comparative study on screw or buttress plate for fixation of supination-adduction type-II medial malleolar fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(5): 553-558. doi: 10.7507/1002-1892.201612046 Copy

1.	?Warner SJ, Garner MR, Hinds RM, et al. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma, 2015, 29(12): 574-578.
2.	McConnell T, Tornetta P 3rd. Marginal plafond impaction in association with supination-adduction ankle fractures: a report of eight cases. J Orthop Trauma, 2001, 15(6): 447-449.
3.	Ebraheim NA, Ludwig T, Weston JT, et al. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry. Foot Ankle Int, 2014, 35(5): 471-477.
4.	Toolan BC, Koval KJ, Kummer FJ, et al. Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques. Foot Ankle Int, 1994, 15(9): 483-489.
5.	陳宇, 張暉, 黃富國, 等. 外踝鉤鋼板在Ⅱ度旋后-內收型內踝骨折中的應用. 中國修復重建外科雜志, 2014, 28(9): 1077-1081.
6.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
7.	俞光榮, 樊健, 周家鈐, 等. 旋后內收型Ⅱ度踝關節骨折的治療策略. 中華創傷雜志, 2011, 27(4): 336-340.
8.	Schoenleber SJ, Hutson JJ Jr. Treatment of hypertrophic distal tibia nonunion and early malunion with callus distraction. Foot Ankle Int, 2015, 36(4): 400-407.
9.	Krause F, Barandun A, Klammer G, et al. Ankle joint pressure changes in high tibial and distal femoral osteotomies: a cadaver study. Bone Joint J, 2017, 99-B(1): 59-65.
10.	Aurégan JC, Finidori G, Cadilhac C, et al. Children ankle valgus deformity treatment using a transphyseal medial malleolar screw. Orthop Traumatol Surg Res, 2011, 97(4): 406-409.
11.	趙宏謀, 梁曉軍, 李毅, 等. 脛骨遠端內外翻畸形對脛距關節接觸的影響. 中國修復重建外科雜志, 2016, 30(7): 826-829.
12.	趙宏謀, 梁曉軍, 李毅, 等. 后踝骨折復位程度對脛距關節接觸情況的影響. 中華創傷雜志, 2014, 30(10): 1035-1039.
13.	趙宏謀, 梁曉軍, 俞光榮, 等. 三種內固定方法治療后側 Pilon 骨折的臨床與生物力學分析. 中國修復重建外科雜志, 2013, 27(10): 1190-1195.
14.	Wegner AM, Wolinsky PR, Robbins MA, et al. Antiglide plating of vertical medial malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation. Clin Biomech (Bristol, Avon), 2016, 31: 29-32.
15.	俞光榮, 陳大偉, 趙宏謀, 等. 支撐鋼板固定后側 pilon 骨折的療效分析. 中華創傷雜志, 2013, 29(3): 243-248.
16.	Jones DA, Cannada LK, Bledsoe JG. Are hook plates advantageous compared to antiglide plates for vertical shear malleolar fractures? Am J Orthop (Belle Mead NJ), 2016, 45(3): E98-102.
17.	Tan EW, Sirisreetreerux N, Paez AG, et al. Early weightbearing after operatively treated ankle fractures: a biomechanical analysis. Foot Ankle Int, 2016, 37(6): 652-658.
18.	Wang Y, Wang J, Luo CF. Modified posteromedial approach for treatment of posterior pilon variant fracture. BMC Musculoskelet Disord, 2016, 17: 328.
19.	Lübbeke A, Salvo D, Stern R, et al. Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study. Int Orthop, 2012, 36(7): 1403-1410.

1. ?Warner SJ, Garner MR, Hinds RM, et al. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma, 2015, 29(12): 574-578.
2. McConnell T, Tornetta P 3rd. Marginal plafond impaction in association with supination-adduction ankle fractures: a report of eight cases. J Orthop Trauma, 2001, 15(6): 447-449.
3. Ebraheim NA, Ludwig T, Weston JT, et al. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry. Foot Ankle Int, 2014, 35(5): 471-477.
4. Toolan BC, Koval KJ, Kummer FJ, et al. Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques. Foot Ankle Int, 1994, 15(9): 483-489.
5. 陳宇, 張暉, 黃富國, 等. 外踝鉤鋼板在Ⅱ度旋后-內收型內踝骨折中的應用. 中國修復重建外科雜志, 2014, 28(9): 1077-1081.
6. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
7. 俞光榮, 樊健, 周家鈐, 等. 旋后內收型Ⅱ度踝關節骨折的治療策略. 中華創傷雜志, 2011, 27(4): 336-340.
8. Schoenleber SJ, Hutson JJ Jr. Treatment of hypertrophic distal tibia nonunion and early malunion with callus distraction. Foot Ankle Int, 2015, 36(4): 400-407.
9. Krause F, Barandun A, Klammer G, et al. Ankle joint pressure changes in high tibial and distal femoral osteotomies: a cadaver study. Bone Joint J, 2017, 99-B(1): 59-65.
10. Aurégan JC, Finidori G, Cadilhac C, et al. Children ankle valgus deformity treatment using a transphyseal medial malleolar screw. Orthop Traumatol Surg Res, 2011, 97(4): 406-409.
11. 趙宏謀, 梁曉軍, 李毅, 等. 脛骨遠端內外翻畸形對脛距關節接觸的影響. 中國修復重建外科雜志, 2016, 30(7): 826-829.
12. 趙宏謀, 梁曉軍, 李毅, 等. 后踝骨折復位程度對脛距關節接觸情況的影響. 中華創傷雜志, 2014, 30(10): 1035-1039.
13. 趙宏謀, 梁曉軍, 俞光榮, 等. 三種內固定方法治療后側 Pilon 骨折的臨床與生物力學分析. 中國修復重建外科雜志, 2013, 27(10): 1190-1195.
14. Wegner AM, Wolinsky PR, Robbins MA, et al. Antiglide plating of vertical medial malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation. Clin Biomech (Bristol, Avon), 2016, 31: 29-32.
15. 俞光榮, 陳大偉, 趙宏謀, 等. 支撐鋼板固定后側 pilon 骨折的療效分析. 中華創傷雜志, 2013, 29(3): 243-248.
16. Jones DA, Cannada LK, Bledsoe JG. Are hook plates advantageous compared to antiglide plates for vertical shear malleolar fractures? Am J Orthop (Belle Mead NJ), 2016, 45(3): E98-102.
17. Tan EW, Sirisreetreerux N, Paez AG, et al. Early weightbearing after operatively treated ankle fractures: a biomechanical analysis. Foot Ankle Int, 2016, 37(6): 652-658.
18. Wang Y, Wang J, Luo CF. Modified posteromedial approach for treatment of posterior pilon variant fracture. BMC Musculoskelet Disord, 2016, 17: 328.
19. Lübbeke A, Salvo D, Stern R, et al. Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study. Int Orthop, 2012, 36(7): 1403-1410.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study on screw or buttress plate for fixation of supination-adduction type-II medial malleolar fracture

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