The Role of Far Cortical Endosteal Fixation for the Treatment of Medial Malleolus Fractures: A Biomechanical Study

Comparison of two versus three-screw fixation for biplanar chevron medial malleolar osteotomy

PURPOSE

This study was designed to compare the clinical outcomes and complications of using two versus three screws to fix the biplanar chevron medial malleolar osteotomy (MMO).

PATIENTS AND METHODS

A retrospective review was conducted on 43 patients (46 ankles) who underwent biplanar chevron MMO to treat talus osteochondral lesions. Of these, MMO was fixed with two parallel screws placed perpendicular to the osteotomy plane in 16 ankles, while in the remaining 30 ankles, MMO was secured with two parallel screws plus an additional third screw inserted parallel to the tibial plafond. Patients were divided into two groups based on the fixation method and clinical outcomes, union and malunion rates, and complications were compared.

RESULTS

Demographic and clinical characteristics such as age (p: 0.411), gender distribution (p: 0.119), affected side (p: 0.126), lesion grades (p: 0.056), and lesion sizes (p: 0.310), immobilization (p: 0.119) and weight-bearing periods (p: 0.252) were statistically similar across both groups. Initial malreduction were observed in five cases within the three-screw group and one case in the two-screw group (p: 0.307). However, neither group exhibited any progressive step-off or gap in the follow-up radiographs, and osteotomy union was achieved in all patients. Delayed union was observed in one patient from the three-screw group. Significant improvements in American Orthopedic Foot and Ankle Society scores were observed in both groups, with no functional discrepancies evident at the final follow-up (p: 0.488).

CONCLUSIONS

The study found no significant differences in union rates, complications, or clinical outcomes between two and three-screw fixation methods for medial malleolar osteotomies (MMO). Both methods allowed for effective MMO fixation without loss or displacement post-surgery, suggesting their safety and efficacy.

LEVEL OF EVIDENCE

Level III, retrospective comparison.

Effect of buttress plate in Herscovici type D vertical medial malleolar fractures and peripheral fractures: a retrospective comparative cohort study

BACKGROUND

The purpose of current retrospective study was to review the surgical methods and to evaluate the clinical efficacy of supporting plate for the treatment of vertical medial malleolus fractures on the basis of stable fixation of ipsilateral fibula.

METHODS

This retrospective study included a total of 191 patients with vertical medial malleolus fractures. Patients enrolled were divided into simple vertical medial malleolus fractures and complex types of fractures. General demographic information and surgical information, including age, sex, surgical procedure and postoperative complications, were collected. The functional prognosis of patients was evaluated by American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) and Visual Analog Scale (VAS).

RESULT

Among patients with simple vertical fractures, the respective incidence of internal fixation failure in screw group, buttress plate group, and screw combined buttress plate fixation group (combined fixation group) was 10/61 (16.4%),1/54 (7.4%) and 1 (1.9%), and the difference was statistically significant (P = 0.024). The incidence of abnormal fracture growth and healing in screw group, buttress plate group and combined fixation group was, respectively, 13/61 (21.3%), 6/54 (12.5%) and 2 (3.85%), with statistically significant difference (P = 0.019). In the patients with complex types of fractures, after 2 years of postoperative follow-up, the AOFAS score and VAS score of the following subgroups had good results: 91.18 ± 6.05 and 2.18 ± 1.08 in patients with joint surface collapse, and 92.50 ± 4.80 and 2.50 ± 1.29 in patients with tibial fractures, with 100% excellent and good rate.

CONCLUSION

For simple and complex vertical medial malleolus fractures, buttress plate showed excellent fixation. Despite poor wound healing and extensive soft tissue dissection with this approach, buttress plate may provide a novel insight into medial malleolar fractures, especially for extremely unstable medial malleolar fractures.