Ankle fractures. Comparison between open surgery and a minimally invasive method.
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Published:
Feb 19, 2016
Keywords:
Ankle fracture, RAFI - MIPO, Comparison fractures
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Abstract
Introduction. Ankle fractures are common traumatic injuries. Treatment is usually surgical. Surgery may be open or percutaneous. The aim of this study is to compare the minimally invasive method, and conventional open reduction internal fixation (RAFI) surgery in the treatment of ankle fractures AO B.Material and methods. This study prospective included 75 pacients with ankle fracture AO classification type B operated with MIPO technique and 58 pacients operated by RAFI. They were grouped according to the AO classification. Intraoperative characteristics and hospitalization, functional outcomes according to AOFAS and Weber score and radiological results were evaluated. The follow-up was 20.4 months for both groups.Results. Comparative results of surgical time, hospital stay, fluoroscopy time, weight load. AOFAS at 3 months: Group A: 96.5 points, and group B: 99 points. Anatomical reduction: 97.4% using MIPO technique and 98.3% using RAFI technique. Return to work activity: Group A, 3.6 average months Group B: average 2.5 months. Return to sport: in Group A: mean 4.8 months; Group B: mean 3.7 monthsConclusions. It is clear from this study that the MIPO technique for the treatment of fractures syndesmotic is a good choice, presenting evolution and faster recovery than open surgery, and low complication rate.
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How to Cite
Yañez Arauz, J. M., Arzac Ulla, I. R., Fiorentini, G., & Yañez Arauz, J. M. (2016). Ankle fractures. Comparison between open surgery and a minimally invasive method. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(1), 27-34. https://doi.org/10.15417/506
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Clinical Research
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References
1. Milner B, Mercer D. Bicortical screw fixation of distal fibula fractures with a lateral plate: An anatomic and biomechanical study of a new technique. J Foot Ankle Surg 2007; 46(5):341-7.
2. Garrigues G, Glisson R. Can locking screws allow smaller, low-profile plates to achieve comparable stability to larger, standard plates? J Orthop Trauma 2011;25(6):347-54.
3. Hughes JL, Weber H, Willenegger H, Kuner EH. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Rel Res 1979;138:111-9.
4. Minihane K, Lee C, Ahn C. Comparison of lateral locking plate and antiglade plate for fixation of distal fibular fractures in osteoporotic bone. A biomechanical study. J Orthop Trauma 2006;20(8):562-6.
5. Stufkens S,Van den Bekerom M, Kerkhoffs G. Long term outcome after 1822 operatively treated ankle fractures: A systematic review of the literature. Injury-Int J Care Injured 2011;42:119-27.
6. Yablon IG, Heller FG, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg Am 1977;59:169-73.
7. Hess F, Sommer C. Minimally invasive plate osteosynthesis of the distal fibula with the locking compression plate: First experience of 20 cases. J Orthop Trauma 2011;25:110-5.
8. Bloomstein L, Schenk R, Grob P. Percutaneous plating of periarticular tibial fractures: a reliable, reproducible technique for controlling plate passage and positioning. J Orthop Trauma 2008;22(8):566-71.
9. Collinge C, Sanders R, DiPasquale, T. Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res 2000;375:69-77.
10. Ozkaya U, Parmaksizoglu A, Gul M. Minimally invasive treatment of distal tibial fractures with locking and non locking plates. Foot Ankle Int 2009;30(12):1161-7.
11. Ruedi TP, Buckley RE, Morgan CG. AO Principles of fracture management. Pathophysiology, evaluation, and classification of fractures; AO Foundation Publishing; 2007.
12. Tornkvist H, Hearn TC, Schatzker J. The strength of plate fixation in relation to number and spacing of bone screws. J Orthop Trauma 1996;10(3):204-8.
13. Yañez Arauz JM. Osteosíntesis mínimamente invasiva en fracturas del peroné distal. Rev Asoc Argent Ortop Traumatol 2005;70(2):136-45.
14. Bauer M, Bengner U, Johnell O, Redlund Johnell I. Supination-eversion fractures of the ankle joint: changes in incidence over 30 years. Foot Ankle 1987;8(1):26-8.
15. Hahn DM, Colton CL. Malleoli. En: Ruedi TP, Buckley RE (eds). AO Principles of fracture management, 2nd ed. New York: AO Publishing, Thieme; 2007:870-97.
16. Chapman MW. Fracture and fracture dislocation of the ankle. En: Mann RA, Coughlin MJ. Surgery of the foot and ankle, 6th ed. St Louis: Mosby; 1993:1464-93.
17. Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br 1965;47:634-60.
18. Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 1997;28(Suppl 1):A7-A12.
19. Rhinelander FW. The normal microcirculation of diaphyseal cortex and its response to fracture. J Bone Joint Surg Am 1968;50784-800.
20. Robinson CM, McLaughlan GJ, McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing. J Bone Joint Surg 1995;77(5):781-7.
21. Yañez Arauz JM. Osteosíntesis mínimamente invasiva del maléolo peróneo. Flamecipp 2012;2(1):37-46.
22. Fink B, Mizel MS. What’s news in foot and ankle surgery? J Bone Joint Surg Am 2002;84(3):504-9.
23. Shah NH, Sundaram RO, Velusamy A, Braithwaite IJ. Five year functional outcome analysis of ankle fracture fixation. Injury 2007;38:1308-12.
24. Colvin AC, Walsh M, Koval KJ, Mc Laurin T, Tejwani N, Egol K. Return to sports following operatively treated ankle fractures. Foot Ankle Int 2009;30(4):292-6.
25. Kennedy JG, Johnson SM, Collins SL, Dallo Vedova P, Mc Manus WF, Hynes DM, et al. An evaluation of the Weber classification of ankle fractures. Injury 1998;29:557-80.
26. Tejwani NC, Mc Laurin TM, Walsh M, Bhadsavle, Koval K, Egol K. Are outcomes of bimalleolar fractures poorer than those of lateral maleolar fractures with medial ligament injury? J Bone Joint Surg Am 2007;89:1438-41.
27. Khurana S, Raj Karia, Kenneth A. Operative treatment of no union following distal fibula and medial maleolar ankle fractures. Foot Ankle Int 2013;34(3):365
2. Garrigues G, Glisson R. Can locking screws allow smaller, low-profile plates to achieve comparable stability to larger, standard plates? J Orthop Trauma 2011;25(6):347-54.
3. Hughes JL, Weber H, Willenegger H, Kuner EH. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Rel Res 1979;138:111-9.
4. Minihane K, Lee C, Ahn C. Comparison of lateral locking plate and antiglade plate for fixation of distal fibular fractures in osteoporotic bone. A biomechanical study. J Orthop Trauma 2006;20(8):562-6.
5. Stufkens S,Van den Bekerom M, Kerkhoffs G. Long term outcome after 1822 operatively treated ankle fractures: A systematic review of the literature. Injury-Int J Care Injured 2011;42:119-27.
6. Yablon IG, Heller FG, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg Am 1977;59:169-73.
7. Hess F, Sommer C. Minimally invasive plate osteosynthesis of the distal fibula with the locking compression plate: First experience of 20 cases. J Orthop Trauma 2011;25:110-5.
8. Bloomstein L, Schenk R, Grob P. Percutaneous plating of periarticular tibial fractures: a reliable, reproducible technique for controlling plate passage and positioning. J Orthop Trauma 2008;22(8):566-71.
9. Collinge C, Sanders R, DiPasquale, T. Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res 2000;375:69-77.
10. Ozkaya U, Parmaksizoglu A, Gul M. Minimally invasive treatment of distal tibial fractures with locking and non locking plates. Foot Ankle Int 2009;30(12):1161-7.
11. Ruedi TP, Buckley RE, Morgan CG. AO Principles of fracture management. Pathophysiology, evaluation, and classification of fractures; AO Foundation Publishing; 2007.
12. Tornkvist H, Hearn TC, Schatzker J. The strength of plate fixation in relation to number and spacing of bone screws. J Orthop Trauma 1996;10(3):204-8.
13. Yañez Arauz JM. Osteosíntesis mínimamente invasiva en fracturas del peroné distal. Rev Asoc Argent Ortop Traumatol 2005;70(2):136-45.
14. Bauer M, Bengner U, Johnell O, Redlund Johnell I. Supination-eversion fractures of the ankle joint: changes in incidence over 30 years. Foot Ankle 1987;8(1):26-8.
15. Hahn DM, Colton CL. Malleoli. En: Ruedi TP, Buckley RE (eds). AO Principles of fracture management, 2nd ed. New York: AO Publishing, Thieme; 2007:870-97.
16. Chapman MW. Fracture and fracture dislocation of the ankle. En: Mann RA, Coughlin MJ. Surgery of the foot and ankle, 6th ed. St Louis: Mosby; 1993:1464-93.
17. Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br 1965;47:634-60.
18. Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 1997;28(Suppl 1):A7-A12.
19. Rhinelander FW. The normal microcirculation of diaphyseal cortex and its response to fracture. J Bone Joint Surg Am 1968;50784-800.
20. Robinson CM, McLaughlan GJ, McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing. J Bone Joint Surg 1995;77(5):781-7.
21. Yañez Arauz JM. Osteosíntesis mínimamente invasiva del maléolo peróneo. Flamecipp 2012;2(1):37-46.
22. Fink B, Mizel MS. What’s news in foot and ankle surgery? J Bone Joint Surg Am 2002;84(3):504-9.
23. Shah NH, Sundaram RO, Velusamy A, Braithwaite IJ. Five year functional outcome analysis of ankle fracture fixation. Injury 2007;38:1308-12.
24. Colvin AC, Walsh M, Koval KJ, Mc Laurin T, Tejwani N, Egol K. Return to sports following operatively treated ankle fractures. Foot Ankle Int 2009;30(4):292-6.
25. Kennedy JG, Johnson SM, Collins SL, Dallo Vedova P, Mc Manus WF, Hynes DM, et al. An evaluation of the Weber classification of ankle fractures. Injury 1998;29:557-80.
26. Tejwani NC, Mc Laurin TM, Walsh M, Bhadsavle, Koval K, Egol K. Are outcomes of bimalleolar fractures poorer than those of lateral maleolar fractures with medial ligament injury? J Bone Joint Surg Am 2007;89:1438-41.
27. Khurana S, Raj Karia, Kenneth A. Operative treatment of no union following distal fibula and medial maleolar ankle fractures. Foot Ankle Int 2013;34(3):365