Twenty-two displaced medial malleolar ankle fractures that were treated surgically using the modified tension band method of Cleak and Dawson were retrospectively reviewed at an average follow-up of 25 months. The technique involves the use of a screw to anchor a figure-of-eight wire. There were no malreductions and all fractures healed. Problems with the technique included technical errors with hardware placement, medial ankle pain, and asymptomatic wire migration. Despite this, modified tension band wiring remains an acceptable method for fixation of selected displaced medial malleolar fractures. It is especially suited for small fracture fragments and osteoporotic bone.
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References
1.
. AliM.S.McLarenC.A.N.RouholaminE.O'ConnorB.T.: Ankle fractures in the elderly: non-operative or operative treatment. J. Orthop. Trauma, 1:275–280, 1987.
2.
. BeauchampC.G.ClayN.P.ThextonP.W.: Displaced ankle fractures in patients over 50 years of age. J. Bone Joint Surg., 65B:329–332, 1983.
3.
. BostmanO.VainionpaaS.HirvensaloE.MakelaA.VihtonenK.TormalaP.RokkanenP.: Biodegradable internal fixation for malleolar fractures. J. Bone Joint Surg., 69B:615–619, 1987.
4.
. BurwellH.N.CharnleyA.D.: The treatment of displaced fractures of the ankle by rigid internal fixation and early joint motion. J. Bone Joint Surg., 47B:634–660, 1965.
5.
. CleakD.K.DawsonM.H.O.: Tension band wiring of avulsion fractures of the medial malleolus: a modified technique minimizing soft tissue injury. Injury, 13:519–520, 1982.
6.
. DeSouzaL.J.GustiloR.B.MeyerT.J.: Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J. Bone Joint Surg., 67A:1066–1074, 1985.
7.
. HughesJ.: The medial malleolus in ankle fractures. Orthop. Clin. North Am., 11:649–660, 1980.
8.
. JohnsenE.E.DavlinL.B.: Open ankle fractures. The indications for immediate open reduction and internal fixation. Clin. Orthop., 292:118–127, 1993.
9.
. KanakisT.E.PapadakisE.OrfanosA.AndreadakisA.XylourisE.: Figure of eight tension band in the treatment of fractures and pseudarthroses of the medial malleolus. Injury, 21:393–397, 1990.
10.
. LundKristensenJ.GrieffJ.RiegelsNielsonP.: Malleolar fractures treated with rigid internal fixation and immediate mobilization. Injury, 13:191–195, 1981.
11.
. MastJ.W.TeipnerW.A.: A reproducible approach to the internal fixation of adult ankle fracture: rationale, technique, and early results. Orthop. Clin. North Am., 11:661–679, 1980.
12.
. MullerM.E.AllgowerM.SchneiderR.WilleneggerH.: Manual of Internal Fixation, 3rd Ed., New York, Springer-Verlag, 1991.
13.
. MullerM.E.NazarianS.KochP.SchatzkerJ.: The Comprehensive Classification of Fractures of the Long Bones. New York, Springer-Verlag, 1990.
14.
. OstrumR.F.LitskyA.S.: Tension band fixation of medial malleolus fractures. J. Orthop. Trauma, 6:464–468, 1992.
15.
. PettroneF.A.GailM.PeeD.FitzpatrickT.Van HerpeL.B.: Quantitative criteria for prediction of the results after displaced fracture of the ankle. J. Bone Joint Surg., 65A: 667–677, 1983.
16.
. PhillipsW.A.SchwartzH.S.KellerC.S.WoodwardH.R.RuddW.S.SpiegelP.G.LarosG.S.: A prospective randomized study of the management of severe ankle fractures. J. Bone Joint Surg., 67A:67–78, 1985.
. SegalD.: Internal fixation of ankle fractures. In AAOS Instructional Course Lectures, Vol. 28. St. Louis, C. V. Mosby, 1979, pp. 107–117.
19.
. TileM.: Fractures of the ankle. In The Rational of Operative Fracture Care. SchatzkerJ.TileM. (eds.), New York, Springer-Verlag, 1987, p. 399.
20.
. TunturiT.KemppainenK.PatialaH.SuokasM.TamminenO.RokkanenP.: Importance of anatomical reduction for subjective recovery after ankle fracture. Acta Orthop. Scand. 54:641–647, 1983.
21.
. Vander GriendR.A.SavoieF.H.HughesJ.L.: Fractures of the ankle. In Rockwood and Green's Fractures in Adults, 3rd Ed., Vol. 2. RockwoodC.A.GreenD.P.BucholzR.W. (eds.), Philadelphia, J. B. Lippincott, 1991, p. 2017.
22.
. WissingJ.C.Van der WerkenC.: Tension band osteosynthesis with resorbable suture material. Unfallchirurg, 94:45–46, 1991.
23.
. YablonI.G.SegalD.: Ankle fractures. In Surgery of the Musculoskeletal System, 2nd Ed., Vol. 4. EvartsC.M. (ed.), New York, Churchill Livingstone, 1990, pp. 3827–3828.
