Efficacy of antiglide plate in vertical shear fractures of medial malleolus due to supination adduction injury around ankle: a prospective clinical study
DOI:
https://doi.org/10.18203/2349-2902.isj20214756Keywords:
Ankle fractures, Open reduction and internal fixation, OMASAbstract
Background: Ankle fractures represent 10% of all fractures with an incidence of around 137/100000 population per year, making these the second most common lower limb fractures after hip fractures. Increasing age, obesity and alcohol abuse are the major causal factors for the fractures around the ankle joint. These are typically low energy injuries with the majority occurring due to simple falls or sport. The aim was to open reduction and internal fixation of these with an antiglide plate.
Methods: The present prospective study was carried out at government medical college Amritsar, Punjab in 25 patients of same demographic profile, March 2018 to December 2020 after having the clearance of ethical committee. All the patients after careful assessment of the injury both clinically (pain, swelling, deformity, any blisters) and radiologically (type of fracture, that is, vertical shear fracture of medial malleolus) were internally fixed under spinal anesthesia, with an antiglide plate after reduction of the fracture fragments.
Results: The results were assessed accordance with Olerud-Molander ankle score (OMAS). We achieved excellent to good results with an average OMAS score of 80/100 in the present study.
Conclusions: The open reduction and internal fixation of vertical shear fractures of medial malleolus with an antiglide plate is an effective way of management of these fractures. It ensures maximum stability and more so safeguards against loss of reduction or the implant failure under axial loading and at the same time ensures the timely union of such fractures without any significant complications.
References
Bengnér U, Johnell O, Redlund-Johnell I. Epidemiology of ankle fracture 1950 and 1980. Increasing incidence in elderly women. Acta Orthop Scand. 1986;57(1):35-7.
Court-Brown CM, McBirnie J. Adult Ankle fractures-an increasing problem. Acta Orthop. 1998;69(1):43-7.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: are view. Injury. 2006;37(8):691-7.
Owens BD, Davey S, Zacchilli MA, Belmont PJ. Th eepidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010; 92(13):2279-84.
Daly PJ, Fitzgerald RH, Melton LJ, Ilstrup DM. Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand. 1987;58(5):539-44.
Bugler KE, Clement ND, Duckworth AD, Timothy O, White TO, McQueen MM, et al. Open ankle fractures: who gets them and why? Arch Orthop Trauma Surg. 2015;135(3):297-303.
Hasselman CT, Vogt MT, Stone KL, Cauley JA, Conti SF. Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Joint Surg Am. 2003;85(5):820-4.
Stein EM, Liu XS, Nickolas TL, Cohen A, Thomas V, McMahon DJ, et al. Abnormal microarchitecture and stiffness in postmenopausal women with ankle fractures. J Clin Endocrinol Metab. 2011;96(7):2041-8.
Jensen SL, Andresen BK, Mencke S, Nielsen PT. Epidemiology of ankle fractures: a prospective population-based study of 212 cases in Aalborg, Denmark. Acta Orthop Scand. 1998;69(1):48-50.
Spaine LA, Bollen SR. The bigger they come: the relationship between body mass index and severity of ankle fractures. Injury.1996;27(10):687-9.
Danis R. The malleolar fractures theory and practice of osteosynthesis. Theory and Practice of Osteosynthesis. Paris: Mason; 1949.
Weber BG. Die injuries to the upper ankle joint. Bern: Hans Huber; 1966.
Surgery reference. Fact sheet: AO Foundation. Available at: https://www2.aofoundation.org/ wps/portal/surgery. Accessed on 1 October 2021.
Wang X, Chang SM, Yu GR, Rao ZT. Clinical value of the Ottawa ankle rules for diagnosis of fractures in acute ankle injuries. Plos One. 2013;8(4):63228.
Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental- roentgenologic investigations. Arch Surg. 1950;60(5):957-85.
Zhao H, Zhang Y, Hu D, Liang X, Li Y, Lu J, et al. Comparative study on screw or buttress plate for fixation of supination-adduction type-II medial malleolar fracture. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017;31(5):553-8.
Zhang J, Zhang Y, Liang J, Liu P, Zhao H. Pathoanatomy and clinical outcomes following operativetreatmentofsupinationadductiontypeIImedialmalleolusfractures-acohortstudy.Ann Palliat Med. 2021;10(7):7802-12.
Wegner AM, Wolinsky PR, Robbins MA, Garcia TC, Maitra S, Amanatullah DF. Bristol, Avon. 2016;31:29-32.
Dumigan RM, Bronson DG, Early JS. J Orthop Trauma. 2006 Nov-Dec; 20(10):687-9
Jones DA, Cannada LK, Bledsoe JG. Am J Orthop. 2016 Mar-Apr;45(3):E98- 102.
Ricci WM, Tornetta P, Borrelli J. Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws. J Orthop Trauma. 2012;26(2012):602-6.
King CM, MCobb DR, Collman PM, Lagaay JD. Bicortical fixation of medial malleolar fractures: are view of 23 cases at risk for complicated bone healing. J Foot Ankle Surg. 2012;51:39-44.
Fowler TT, Pugh KJ, Litsky AS, Taylor BC, French BG. Medial malleolar fractures: a biomechanical study of fixation techniques. Orthopedics. 2011;34:349-55.
