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Mehraban N, Lew AR, Foran IM, Lee S, Bohl DD, Hamid KS. Lateral Locking Plate Fixation of Simple Weber B Fibula Fractures Without a Lag Screw Yields Excellent Radiographic Results. Foot Ankle Spec 2024; 17:131-136. [PMID: 34747245 DOI: 10.1177/19386400211055280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The most common first-line fixation technique for simple Weber B fibula fractures is a lag screw with lateral neutralization plate. The most common surgical technique for unstable Weber B fibula fracture is one-third semi-tubular plate and cortical screws, implemented with lag screw when appropriate. However, the lag technique can be technically challenging in osteoporotic bone or within fibulas of smaller diameter, and in some cases can result in fragmentation at the fracture site, malreduction, or peroneal irritation. The purpose of this study is to examine an alternative first-line method for routine treatment of simple Weber B fibula fractures. METHODS Fifty-two consecutive patients undergoing open reduction internal fixation (ORIF) of a Weber B fibula fracture by a single surgeon were included in this retrospective study. After reduction, a lateral locking plate was applied with cortical screws proximally and locking screws distally. No screw crossed the fracture in any case. Per published precedent, nonunion was defined as either a gap of >3 mm between fracture surfaces >6 months postoperatively or a fracture line >2 to 3 mm wide and sclerosing of the fracture surfaces. Similarly, malunion was defined as one or more of the following: talar tilt >2º, talar subluxation >2 mm, or tibiofibular clear space ≥5 mm. RESULTS The mean (± standard deviation) age of the 52 included patients was 44.2 ± 16.2 years, the mean body mass index was 27.7 ± 6.6 kg/m2, and 63.5% of patients identified themselves as female sex. The mean follow-up was 6.2 (range: 1.5-15) months. In addition to undergoing fixation of the lateral malleolus, 21 patients also underwent fixation of the posterior malleolus, 27 underwent fixation of the medial malleolus, 29 underwent fixation across the syndesmosis, and 7 underwent repair of the deltoid. In all patients, bony anatomic union of the fibula and congruence of the mortise were achieved with no cases of malunion or nonunion. CONCLUSIONS The Arbeitsgemeinschaft für Osteosynthesefragen (AO) fixation technique for simple Weber B fractures with a lag screw and lateral neutralization plating has provided good outcomes for decades. We present an alternative technique for ORIF of these fractures with a lateral locking plate and no lag screw. In our series, we evaluated radiographic union and alignment as our primary outcome measures and found no cases of nonunion or malunion. Prospective cohort testing of lateral locking plates versus traditional fixation in the context of patient-centered value is warranted.Level of Evidence: Level III.
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Affiliation(s)
- Nasima Mehraban
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (NM, ARL, IMF, SL, DDB, KSH)
| | - Alexandra R Lew
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (NM, ARL, IMF, SL, DDB, KSH)
| | - Ian M Foran
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (NM, ARL, IMF, SL, DDB, KSH)
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (NM, ARL, IMF, SL, DDB, KSH)
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (NM, ARL, IMF, SL, DDB, KSH)
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (NM, ARL, IMF, SL, DDB, KSH)
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Comparison between headless compression screws and tension band wires for the fixation of medial malleolar fractures: a prospective randomized trial. Arch Orthop Trauma Surg 2022; 142:2627-2633. [PMID: 34160673 DOI: 10.1007/s00402-021-04003-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION To date, there has been no prospective randomized trial supporting the rationale of the use of headless compression screw (HCS) compared to conventional fixation methods for medial malleolar fractures. This study aimed to prospectively compare the outcomes of the HCS and tension band wire (TBW) for the fixation of medial malleolar fractures. MATERIAL AND METHODS Sixty patients were randomized to receive either an HCS or a TBW for the fixation of a medial malleolar fracture. Clinical outcomes were assessed using the Olerud-Molander ankle score (OMAS), EuroQoL five-dimensional instrument (EQ-5D) score, visual analog scale (VAS) score, patient satisfaction with implant-related symptoms, operative time, and incision length. Radiographic outcomes were assessed using the presence of nonunion, delayed union, and articular incongruity. Clinical and radiographic assessments were performed at 2 and 6 weeks and 3, 6, and 12 months postoperatively. RESULTS The OMAS, EQ-5D score, VAS score, and operative time did not differ between the HCS and TBW groups; however, the HCS group had greater satisfaction with implant-related symptoms and smaller incision than the TBW group. There was no difference in the presence of nonunion, delayed union, and articular incongruity. CONCLUSION HCS fixation for medial malleolar fractures is not inferior to TBW fixation, while reducing implant-related symptoms. These findings suggest that HCS is a viable alternative for the fixation of medial malleolar fractures.
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Ahn JH, Cho SH, Jeong M, Kim YC. One-Third Tubular Plate Remains a Clinically Good Option in Danis-Weber Type B Distal Fibular Fracture Fixation. Orthop Surg 2021; 13:2301-2309. [PMID: 34708569 PMCID: PMC8654649 DOI: 10.1111/os.13160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To compare the clinical outcomes of locking plate (LP) and non-locking one-third tubular plate (TP) fixation, and to provide guidance on plate selection for Danis-Weber type B distal fibular fracture treatment. METHODS In total, 83 patients who underwent plate fixation for Danis-Weber type B distal fibular fractures between March 2013 and July 2018 were retrospectively reviewed: 41 (49.0%) received LPs and 42 (51.0%) received TPs. Patients' demographic data, follow-up durations, the proportion of comminuted fractures, and ankle range of motion were investigated. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Karlsson scale, Foot and Ankle Ability Measure (FAAM), and Lower Extremity Functional Scale (LEFS) scores were assessed. The radiographic union progression and implant removal time were evaluated, along with postoperative complications. Data from the LP and TP groups were compared statistically. RESULTS The mean patient ages were 53.3 ± 17.5 years (range, 16-80 years) and 47.6 ± 17.0 years (range, 14-68 years) in the LP and TP groups, respectively (P > 0.05). The gender distribution did not differ significantly between groups (P > 0.05). Other demographic data also did not differ significantly between groups (P > 0.05). The mean follow-up durations were 16.8 ± 7.7 months (range, 13.0-19.0 months) in the LP group and 16.1 ± 6.2 months (range, 12.0-20.0 months) in the TP group (P > 0.05). Comminuted fractures were observed in 18 of 41 (43.9%) patients with LP and 10 of 42 (23.8%) patients with TP (P > 0.05). Forward bending ankle dorsiflexion was possible at the final follow-up in 82.9% and 85.7% of LP and TP patients, respectively (P > 0.05). The AOFAS ankle-hindfoot scale, Karlsson scale, FAAM, and LEFS scores did not differ significantly between groups at the final follow-up (P > 0.05). The pre-fracture and final postoperative scores on these four instruments did not differ significantly in the LP or TP group (P > 0.05). The mean times to radiographic union progression were 13.5 ± 7.1 weeks and 15.1 ± 10.2 weeks in the LP and TP groups, respectively (P > 0.05). The mean times to implant removal surgery reaffirming solid union were 15.6 ± 5.5 months and 14.8 ± 4.9 months in the LP and TP groups, respectively (P > 0.05). Hardware irritation was detected in five patients in the LP group (12.2%) and three in the TP group (7.1%) (P > 0.05). One patient in the LP group and two in the TP group developed superficial wound infections, which resolved without further surgical intervention. CONCLUSION Conventional TP remains a good option for the fixation of Danis-Weber type B distal fibular fractures, regardless of the biomechanical properties.
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Affiliation(s)
- Jae Hoon Ahn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hyun Cho
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mingi Jeong
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Chung Kim
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim J, Chun DI, Won SH, Min TH, Yi Y, Park S, Cho MS, Cho J. Three-Dimensional Anatomically Pre-Contoured Locking Plate for Isolated Weber B Type Fracture. J Clin Med 2021; 10:jcm10132976. [PMID: 34279460 PMCID: PMC8268111 DOI: 10.3390/jcm10132976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
We aimed to evaluate the functional and radiographic outcomes of a three-dimensionally (3D) pre-contoured lateral locking plate fixation for isolated Weber B type fractures and to evaluate the necessity of an interfragmentary lag screw in the use of the plate. Patients who underwent surgery for isolated Weber B type fracture were divided into two groups: 41 patients treated with the 3D plate and lag screw (Group A) and 31 patients treated with the 3D plate only (Group B). The included patients were evaluated regarding the functional and radiographic outcomes. According to the McLennan and Ungersma criteria, the majority of patients showed good or fair outcomes in both groups. Comparing the two groups, Group B showed better functional outcomes (p < 0.0046), while no difference between the two groups was found in terms of the radiographic outcomes (p = 0.143). The operation time was significantly shorter in Group B (p < 0.001) and the time to bony union was within 14 months in all patients with no significant difference between the two groups (p = 0.0821). No postoperative complication was observed in both groups. In conclusion, the use of a 3D pre-contoured lateral locking plate fixation for isolated Weber B type fractures demonstrated satisfactory functional and radiographic outcomes, regardless of lag screw insertion.
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Affiliation(s)
- Jahyung Kim
- Department of Orthopaedic Surgery, Armed Force Gangneung Hospital, Gangneung 25422, Korea;
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea; (D.-I.C.); (S.-H.W.); (T.-H.M.)
| | - Sung-Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea; (D.-I.C.); (S.-H.W.); (T.-H.M.)
| | - Tae-Hong Min
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea; (D.-I.C.); (S.-H.W.); (T.-H.M.)
| | - Young Yi
- Department of Orthopaedic Surgery, Inje University Seoul Paik Hospital, Seoul 04551, Korea;
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Min-Soo Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon 24253, Korea;
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon 24253, Korea;
- Correspondence: ; Tel.: +82-33-240-5198
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Park YH, Cho HW, Choi JW, Kim HJ. Investigation of the Effect of Bone Mineral Density on the Postoperative Outcome of Ankle Fractures in Elderly Patients. Foot Ankle Int 2021; 42:929-934. [PMID: 33719642 DOI: 10.1177/1071100721996262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The association between ankle fractures in elderly patients and low bone mineral density (BMD) has recently been recognized, but the effect of BMD on the postoperative outcome of these fractures is unknown. The aim of this study was to investigate the effect of BMD on the postoperative outcome of ankle fractures in elderly patients to evaluate the need for BMD screening. METHODS We retrospectively reviewed 48 patients aged 65 years or older who had ankle fractures and underwent dual-energy x-ray absorptiometry to assess BMD after surgical treatment of the fracture. Postoperative outcomes were assessed using the Olerud-Molander Ankle Score (OMAS), visual analog scale (VAS) score for pain, Kellgren and Lawrence (K&L) grading scale score, and quality of fracture reduction. The correlation between the BMD and the outcome measures at 12 months after surgery was analyzed using the Pearson correlation coefficient. RESULTS The mean absolute value of BMD was 0.6 ± 0.1 g/cm2 (T-score, -1.5 ± 1.2) at the femoral neck and 0.8 ± 0.2 g/cm2 (T-score, -1.2 ± 1.5) at the lumbar spine. Osteoporosis was present in 33% of female patients and in 11% of male patients. At 12 months after surgery, the OMAS was 70 ± 17 and the VAS score for pain was 18 ± 17. Of the patients, 20, 21, 5, 1, and 1 had K&L grades of 0, 1, 2, 3, and 4, respectively. None of the clinical and radiographic outcome measures were correlated with the BMD values of the patients. CONCLUSION The postoperative outcome of the ankle fractures in elderly patients at 12 months after surgery showed no correlation with femoral neck or lumbar spine BMD at the time of fracture. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Korea
| | - Hyun Woo Cho
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Korea
| | - Jung Woo Choi
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Korea
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