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Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures.

ABSTRACT: The optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis.Patients with a PMF involving over 25% of the articular surface were recruited and assigned to the direct reduction (DR) group or the indirect reduction (IR) group. Following reduction and fixation of the fracture, the quality of fracture reduction was evaluated in post-operative CT images. Clinical and radiological follow-ups were performed at 6 weeks, 3 months, 6 months, 12 months, and then at 6 month-intervals postoperatively. Functional outcome (AOFAS score), ankle range of motion, and Visual Analog Scale (VAS) were evaluated at the last follow-up. Statistical differences were compared between the DR and IR groups considering the patient demographics, quality of fracture reduction, AOFAS score, and VAS.Totally 116 patients were included, wherein 64 cases were assigned to the DR group and 52 cases were assigned to the IR group. The quality of fracture reduction was significant higher in the DR group (P?=?0.038). In the patients who completed a minimum of 12 months' follow-up, a median AOFAS score of 87 was recorded in the DR group, which was significantly higher than that recorded in the IR group (a median score of 80). The ankle range of motion was slightly better in the DR group, with the mean dorsiflexion restriction recorded to be 5.2° and 6.1° in the DR and IR group respectively (P?=?0.331). Similar VAS score was observed in the two groups (P?=?0.419).The direct reduction technique through a posterolateral approach provide better quality of fracture reduction and functional outcome in the management of PMF over 25% of articular surface, as compared with the indirect reduction technique using ligamentotaxis.NCT02801474 (retrospectively registered, June 2016, ClinicalTrails.gov).

SUBMITTER: Shi HF

PROVIDER: S-EPMC5351253 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures.

Shi Hong-Fei HF Xiong Jin J Chen Yi-Xin YX Wang Jun-Fei JF Qiu Xu-Sheng XS Huang Jie J Gui Xue-Yang XY Wen Si-Yuan SY Wang Yin-He YH

BMC musculoskeletal disorders 20170314 1

<h4>Background</h4>The optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis.<h4>Methods</h4>Patients with a PMF involving over 25% of the ...[more]

PMID: 28292290

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Project description:BACKGROUND:It is still unknown whether bioabsorbable magnesium (Mg) screws provide an advantage over titanium screws in the treatment of medial malleolar (MM) fractures. The purpose of this retrospective study is to compare the clinical and radiological outcomes of MM fractures fixed with either bioabsorbable Mg screws or conventional titanium screws. MATERIALS AND METHODS:A cohort of 48 patients with MM fractures who underwent compression screw fixation was retrospectively reviewed. Twenty-three patients (16 male, 7 female; mean age: 37.9?±?17.7 years) were treated with bioabsorbable Mg screws, and 25 patients (14 male, 11 female; mean age: 45.0?±?15.7 years) were treated with conventional titanium screw fixation. All patients were followed up for at least 1 year, with a mean time of 24.6?±?10.5 months (12-53 months). The American Orthopedic Foot and Ankle Society (AOFAS) scale was used to evaluate the clinical results. The Kellgren-Lawrence (KL) osteoarthritis grading was used to evaluate posttraumatic osteoarthritis on final ankle radiographs. Fracture union, rate of implant removal, and complications were recorded. Comparative analysis of two independent groups was performed using the chi-squared test and the Mann-Whitney U-test. RESULTS:The two groups were comparable concerning demographic and clinical characteristics. Age (p?=?0.146), sex (p?=?0.252), side (p?=?0.190), MM fracture type (p?=?0.500), associated fractures (p?=?0.470), and follow-up period (p?=?0.903) were similar between the groups. At final follow-up examination, AOFAS score (p?=?0.191) was similar between groups. Fracture union was achieved in all cases. Grade of posttraumatic osteoarthritis, according to KL, was equally distributed in both groups (p?=?0.074). No deep infection or osteomyelitis was seen. Five patients in the titanium screw group underwent implant removal, due to pain in three of them and difficulty in wearing shoes in the other two (p?=?0.031). Implant removal was performed after a mean of 14.2?±?3.1 months (12-19 months). CONCLUSIONS:Bioabsorbable Mg and titanium screws had similar therapeutic efficacy in MM fracture fixation regarding functional and radiological outcomes. However, the rate of implant removal was higher with titanium screws. Bioabsorbable Mg screws may be a favorable fixation option since secondary implant removal procedures can be prevented. LEVEL OF EVIDENCE:Level IV, Retrospective case series.

Dataset Information

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures.

Publications

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures.

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