Osteosynthesis of ankle fracture. Evolutionary analysis with early loading. Preliminary study.
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Published:
May 11, 2016
Keywords:
Ankle fracture, RAFI - MIPO, Comparison fractures
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Abstract
IntroductionAnkle 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.MethodsThis 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.ResultsComparative 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 monthsConclusionsIt 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 complications rate.
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Yañez Arauz, J. M., Arzac Ulla, I. R., Fiorentini, G., & Yañez Arauz, J. M. (2016). Osteosynthesis of ankle fracture. Evolutionary analysis with early loading. Preliminary study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(2), 93-98. https://doi.org/10.15417/507
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Clinical Research
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References
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10 - Takabe K, Nakagawa A, Minami H, et al. Role of the fibula in weigh-bearing. Clin Orthop 1984; 184:289-292.
11 - Hughes J, Weber H, Willenegger H, et al. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Rel Res 1979; 138:111–119.
12 - 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 Sep-Oct; 46(5):341-7.
13 - 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): 562-566.
14 - Stufkens S,Van den Bekerom M, Kerkhoffs G. Long term outcome after 1822 operatively trated ankle fractures: A systematic review of the literature. Injury Int. J. Care Injured 2011; 42: 119-127.
15 - Yablon IG, Heller FG, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg 1977; 59A:169–173.
16 - Schatzer, J, Tile, M. The role of Operative Fracture Care. Springer Verlag, New York, 1987.
17 - Van Laarhoven C, Meeuwis J, Van der Werken C. Postoperative treatment of internally fixed ankle fractures: a prospective randomised study. J Bone Joint Surg Br. 1996; 78(3):395–9.
18 - Yañez Arauz JM. Osteosintesis mínimamente invasiva en fracturas del peroné distal. Rev. Asoc Argentina Ortop Traumatol. 2005; 70(2):136-145.
19 - Yañez Arauz JM. Osteosíntesis mínimamente invasiva del maléolo peroneo. Flamecipp. 2012; (2):N1 37-46.
20 - Bloomstein, L; Schenk, R; Grob, P: Percutaneous Plating of Periarticular Tibial Fractures: A Reliable, Reproducible Technique for Controlling Plate Passage and Positioning J Orthopaedic Trauma. 2008; 22(8):566–571.
21 - Collinge, C; Sanders, R; DiPasquale, T: Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res. 2000; 375:69 – 77.
22 - 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) 1161-1167.
23 - Ruedi, TP; Buckley, RE; Morgan, CG: AO Principles of Fracture Management Pathophysiology, evaluation, and classification of fractures AO Foundation Publishing 2007.
24 - 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. 614.
25 - Bauer M, Bengner U, Johnell O, et al. Supination – eversion fractures of the ankle joint: Changes in incidence over 30 years. Foot ankle 1987; 8(1):26-28.
26 - Chapman MW. Fracture and fracture dislocation of the ankle. In: Mann RA, Coughlin MJ. Surgery of the foot and ankle 6a ed. St Louis: Mosby; 1993.pp 1493-1464.
27 - Muller, M; Allgower, M; Scneider, et al. H: Manual of Internal Fixation, Techniques Recommended by the AO Group, 3rd ed. Springer Verlag, New York, 1991.
28 - Muller, M; Allgower, M; Scneider, et al. Manual der osteosyntheses, AO-technique. Springer Verlag, Berlin, 1969.
29 - Ramsey PL, Hamilton W: Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am) 1976; 58(3):356-357.
30 - Stuart P, Brumby C, Smith S. Comparative study of functional bracing and plaster cast treatment of stable lateral malleolar fracture. Injury 1989; 20:323-326.
31 - Jarvinen M, Kannus P. Current concepts review. Injury of an extremity as a risk factor for the developing of osteoporosis. J. Bone Joint Surg 1997; 79-A:263–276.
32 - Kalish S. Pelcovitz N, Zawada S, et al. The Aircast Walking Brace versus conventional casting methods. A comparison study. J. Am. Podiatr. Med. Assoc. 1987; 77:589–595.
33 - Mohtadi N. Commentary: Injured limbs recover better with early mobilisation and functional bracing than with cast immobilisation. J. Bone Joint. Surg. 2005; 87-A:1167.
34 - Nash C, Mickan S, Del Mar C, et al. Resting injured limbs delays recover: A systematic review. J. Fam. Pract. 2004; 53:706–712.
35 - Sondenaa K, Hoigaard U, Smith D, et al. Immobilization of operated ankle fractures. Acta Orthop Scand 1986; 57:59-61.
36 - Ahl T, Dalen N, Holmberg S, et al. Early weight bearing of displaced ankle fractures. Acta Orthop Scand 1987; 58:535-8.
37 - Ahl T, Dalen N, Holmberg S, el al. Early weight bearing of malleolar fractures. Acta Orthop Scand 1986; 57:526-9.
38 - Lehtonen B, Jarvinen T, Honkonen S, et al. Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study. J. Bone Joint Surg. 2003; 85-A:205 – 211.
39 - Shah NH, Sundaram RO, Velusamy A, Braithwaite IJ. Five year functional outcome analysis of ankle fracture fixation. Injury. 2007; 38:1308-1312.
40 - DiStasio A, Jaggears F, DePasquale L, et al. Protected early motion versus cast immobilization in postoperative management of ankle fractures. Contemp Orthop. 1994; 29(4):73–7.
2 - Scranton P, Mc Master J, Kelly E. Dynamic fibular function. A new concept. Clinic Orthop Relat Res 1976; 118:76.
3 - Wang Q, Whittle M, Cunningham J. et al. Fibula and its ligaments in load transmission and ankle joint stability. Clinic Orthop Relat Res 1996; 330:261-270
4 - Weiner C, Mc Master J, Ferguson R. Dynamic function of the human fibula. Am J Anat 1969; 138:145-150.
5 - Karrholm J, Hansson L, Selvik G. Mobility of the lateral malleolus: A roentgen stereophontogrammetric study. Acta Orthop Scand 1985; 56:479-483.
6 - Lofvenberg R, Karrholm J, Selvik G. Fibular mobility in chronic lateral instability of the ankle. Foot Ankle 1990; 11:22-29.
7 - Segal D, Wiss D, Whitelaw G. Functional bracing and rehabilitation of ankle fractures. Clinic Orthop. 1985; 199:39-45.
8 - Lambert K. The weight-Bearing function of the fibula. A strain gauge study. J Bone Joint Surg. 1971; 53:(3)507-513.
9 - Skraba J, Greenwald A. The role of the interosseous membrane on tibiofibular weightbearing. Foot Ankle 1984; 4:301-304.
10 - Takabe K, Nakagawa A, Minami H, et al. Role of the fibula in weigh-bearing. Clin Orthop 1984; 184:289-292.
11 - Hughes J, Weber H, Willenegger H, et al. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Rel Res 1979; 138:111–119.
12 - 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 Sep-Oct; 46(5):341-7.
13 - 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): 562-566.
14 - Stufkens S,Van den Bekerom M, Kerkhoffs G. Long term outcome after 1822 operatively trated ankle fractures: A systematic review of the literature. Injury Int. J. Care Injured 2011; 42: 119-127.
15 - Yablon IG, Heller FG, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg 1977; 59A:169–173.
16 - Schatzer, J, Tile, M. The role of Operative Fracture Care. Springer Verlag, New York, 1987.
17 - Van Laarhoven C, Meeuwis J, Van der Werken C. Postoperative treatment of internally fixed ankle fractures: a prospective randomised study. J Bone Joint Surg Br. 1996; 78(3):395–9.
18 - Yañez Arauz JM. Osteosintesis mínimamente invasiva en fracturas del peroné distal. Rev. Asoc Argentina Ortop Traumatol. 2005; 70(2):136-145.
19 - Yañez Arauz JM. Osteosíntesis mínimamente invasiva del maléolo peroneo. Flamecipp. 2012; (2):N1 37-46.
20 - Bloomstein, L; Schenk, R; Grob, P: Percutaneous Plating of Periarticular Tibial Fractures: A Reliable, Reproducible Technique for Controlling Plate Passage and Positioning J Orthopaedic Trauma. 2008; 22(8):566–571.
21 - Collinge, C; Sanders, R; DiPasquale, T: Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res. 2000; 375:69 – 77.
22 - 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) 1161-1167.
23 - Ruedi, TP; Buckley, RE; Morgan, CG: AO Principles of Fracture Management Pathophysiology, evaluation, and classification of fractures AO Foundation Publishing 2007.
24 - 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. 614.
25 - Bauer M, Bengner U, Johnell O, et al. Supination – eversion fractures of the ankle joint: Changes in incidence over 30 years. Foot ankle 1987; 8(1):26-28.
26 - Chapman MW. Fracture and fracture dislocation of the ankle. In: Mann RA, Coughlin MJ. Surgery of the foot and ankle 6a ed. St Louis: Mosby; 1993.pp 1493-1464.
27 - Muller, M; Allgower, M; Scneider, et al. H: Manual of Internal Fixation, Techniques Recommended by the AO Group, 3rd ed. Springer Verlag, New York, 1991.
28 - Muller, M; Allgower, M; Scneider, et al. Manual der osteosyntheses, AO-technique. Springer Verlag, Berlin, 1969.
29 - Ramsey PL, Hamilton W: Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am) 1976; 58(3):356-357.
30 - Stuart P, Brumby C, Smith S. Comparative study of functional bracing and plaster cast treatment of stable lateral malleolar fracture. Injury 1989; 20:323-326.
31 - Jarvinen M, Kannus P. Current concepts review. Injury of an extremity as a risk factor for the developing of osteoporosis. J. Bone Joint Surg 1997; 79-A:263–276.
32 - Kalish S. Pelcovitz N, Zawada S, et al. The Aircast Walking Brace versus conventional casting methods. A comparison study. J. Am. Podiatr. Med. Assoc. 1987; 77:589–595.
33 - Mohtadi N. Commentary: Injured limbs recover better with early mobilisation and functional bracing than with cast immobilisation. J. Bone Joint. Surg. 2005; 87-A:1167.
34 - Nash C, Mickan S, Del Mar C, et al. Resting injured limbs delays recover: A systematic review. J. Fam. Pract. 2004; 53:706–712.
35 - Sondenaa K, Hoigaard U, Smith D, et al. Immobilization of operated ankle fractures. Acta Orthop Scand 1986; 57:59-61.
36 - Ahl T, Dalen N, Holmberg S, et al. Early weight bearing of displaced ankle fractures. Acta Orthop Scand 1987; 58:535-8.
37 - Ahl T, Dalen N, Holmberg S, el al. Early weight bearing of malleolar fractures. Acta Orthop Scand 1986; 57:526-9.
38 - Lehtonen B, Jarvinen T, Honkonen S, et al. Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study. J. Bone Joint Surg. 2003; 85-A:205 – 211.
39 - Shah NH, Sundaram RO, Velusamy A, Braithwaite IJ. Five year functional outcome analysis of ankle fracture fixation. Injury. 2007; 38:1308-1312.
40 - DiStasio A, Jaggears F, DePasquale L, et al. Protected early motion versus cast immobilization in postoperative management of ankle fractures. Contemp Orthop. 1994; 29(4):73–7.