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Abstract

A biomechanical evaluation of intramedullary versus buttress plate and lag screw fixation of lateral malleolus fractures is combined with a clinical evaluation of 44 patients with lateral malleolus fractures who underwent intramedullary screw fixation.

The biomechanical study was performed in experimentally produced, Weber B, supination-eversion ankle fractures. The fractures were fixed with one of the two above fixation methods and then placed under a torsional load to failure. Sixteen cadaver ankles were tested as compared with native bone. The intramedullary screw provided 66.5% the resistance of torsion, and the buttress plate and lag screw provided 61.5% the resistance to torsion. There was no statistical difference between these two groups.

The 44 fractures treated with an intramedullary screw were reviewed retrospectively. There was one failure of fixation, and one prominent hardware problem. Time to full weightbearing averaged 7.2 weeks.

These results suggest that intramedullary screw fixation of noncomminuted lateral malleolus fractures provides stable fixation with good clinical results. This technique has the advantages of providing dynamic intramedullary fixation with limited surgical dissection and no subcutaneous hardware.

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References

1. Bauer

Bergstrom

Hemborg

Sandegard

: Malleolar fractures: non-operative vs. operative treatment. Clin. Orthop., 199:1702, 1985.

2. Bolin

: The fibula and its relationship to the tibia and talus in injuries of the ankle due to forced external rotation. Acta Roentgenol. Scand., 56:439, 1961.

3. Burwell

H.N.

Charnly

: The treatment of displaced fractures of the ankle by rigid internal fixation and early joint movement. J. Bone Joint Surg., 47B(4):634–659, 1965.

4. Covino

B.M.

Barsanti

C.M.

Wolfe

Wang

G.J.

: Internal fixation of lateral malleolus fractures: a clinical and biomechanical comparison of two techniques. Orthop. Trans., 5:90, 1990.

5. Desouza

L.J.

Gustilo

R.B.

Meyer

T.J.

: Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J. Bone Joint Surg., 67A(7):1066–1074, 1985.

6. Harper

: An anatomic study of the short oblique fracture of the distal fibula and ankle stability. Foot Ankle, 4:23–29, 1983.

7. Hughes

J.L.

Weber

Willenegger

Kunder

B.H.

: Evaluation of ankle fractures. Non-operative and operative treatment. Clin. Orthop., 138:111–119, 1979.

8. Jergensen

: Open reduction of fractures and dislocation of the ankle. Am. J. Surg., 98:136, 1959.

9. Kirstinsen

K.D.

Hansen

: Closed treatment of ankle fractures. Acta Orthop. Scand., 56:107–109, 1985.

10.

10. Lauge-Hansen

: Fractures of the ankle II. Arch. Surg., 60:957–985, 1950.

11.

11. Lindsjo

: Classification of ankle fractures: the Lauge-Hansen or AO system. Clin. Orthop., 199:12–16, 1985.

12.

12. Mifsod

R.P.

Batten

R.L.

: External rotation and abduction fractures around the ankle joint treated by internal fixing using AO instrumentation. Injury, 11:33–38, 1979.

13.

13. Mitchell

C.L.

Fleming

J.L.

: Fractures and dislocations of the ankle. Postgrad. Med., 26:773, 1959.

14.

14. Muller

M.E.

Allgower

Schneider

Willenger

: Manual of Internal Fixation, 2nd Ed., New York, Springer, 1979, pp. 282–295.

15.

15. Pankovich

A.M.

: Fractures of the fibula at the distal tibiofibular syndesmosis. Clin. Orthop., 143:138–147, 1979.

16.

16. Ramsey

P.L.

Hamilton

: Changes in the tibiotalar area of contact caused by lateral talar shift. J. Bone Joint Surg., 58A:356–357, 1976.

17.

17. Sammarco

G.J.

Burnstein

A.H.

Frankel

V.H.

: Biomechanics of the Ankle: a kinematic study. Orthop. Clin. North Am., 104:299, 1973.

18.

18. Schaffer

J.J.

Manoli

: The antiglide plate for distal fibula fixation. J. Bone Joint Surg., 69A:596–604, 1987.

19.

19. Vasli

: Operative treatment of ankle fractures. Acta Chir. Scand. [Suppl.], 226, 1957.

20.

20. Wilson

F.C.

: Fractures and dislocations of the ankle. In Fractures in Adults, Vol. 2. Rockwood

C.A.

Jr. Green

D.P.

(eds.), Philadelphia, J. B. Lippincott, 1984, pp. 1665–1707.

21.

21. Yablon

I.G.

Heller

F.G.

Shorse

: The key role of the lateral malleolus in displaced fractures of the ankle. J. Bone Joint Surg., 59A(2):169–173, 1977.

Intramedullary Screw Fixation of Lateral Malleolus Fractures

Abstract

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