TY - JOUR T1 - THE EFFECT OF SCREW FIXATION AND BUTTRESS PLATE FIXATION ON CLINICAL AND RADIOLOGICAL RESULTS IN THE SURGICAL TREATMENT OF POSTERIOR MALLEOLAR FRACTURES TT - POSTERİOR MALLEOL KIRIKLARININ CERRAHİ TEDAVİSİNDE VİDA SABİTLEME VE DESTEK PLAKASI SABİTLEMESİNİN KLİNİK VE RADYOLOJİK SONUÇLAR ÜZERİNDEKİ ETKİSİ AU - Encu, Kadri AU - Sungur, İbrahim AU - Aydın, Mahmud AU - Sürücü, Serkan AU - Çapkın, Sercan PY - 2023 DA - October DO - 10.26650/JARHS2023-1320786 JF - Journal of Advanced Research in Health Sciences JO - SABİAD PB - Istanbul University WT - DergiPark SN - 2651-4060 SP - 234 EP - 238 VL - 6 IS - 3 LA - en AB - Objective: Posterior malleolar fractures (PMF) are common among ankle fractures and their proper management is crucial to maintaining ankle stability. The purpose of this study was to compare the clinical and radiological effects of screw versus support plate fixation in the surgical treatment of PMF.Material and Methods: Between December 2016 and February 2018, 82 patients who underwent surgical treatment for PMF were analyzed retrospectively. Patients were divided into two groups based on the type of fixation material used: screws and buttress plates. Using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, range of motion measurements, and radiographic evaluations, clinical evaluations were conducted.Results: A total of 60 patients were included in the study, 33 of whom were treated with plate osteosynthesis and 27 with screw osteosynthesis. The demographic and clinical characteristics were similar between the groups. The AOFAS scores, range of motion measurements, and complication rates were comparable between the screw and plate fixation groups. The radiological evaluation showed no significant difference in posttraumatic arthritis levels between the two groups.Conclusion: The screw fixation alone provides similar clinical andmradiological results compared to buttress plate fixation in the surgicaln treatment of PMF. These results are in advance of the growing evidence supporting screw-only osteosynthesis for Haraguchi type 1 and 2 posterior malleolus fractures. KW - Ankle fracture KW - bone screw KW - posterior malleolar fracture KW - surgical procedures N2 - Amaç: Posterior malleol kırıkları (PMF) ayak bileği kırıkları arasında yaygındır ve uygun tedavileri ayak bileği stabilitesini korumak için çok önemlidir. Bu çalışmanın amacı, PMF’nin cerrahi tedavisinde vida ile destek plağı tespitinin klinik ve radyolojik etkilerini karşılaştırmaktır.Gereç ve Yöntemler: Aralık 2016 ile Şubat 2018 tarihleri arasında PMF nedeniyle cerrahi tedavi uygulanan 82 hasta retrospektif olarak analiz edildi. Hastalar kullanılan fiksasyon materyalinin türüne göre iki gruba ayrıldı: vidalar ve destek plakları. Amerikan Ortopedik Ayak ve Ayak Bileği Derneği (AOFAS) ayak bileği-arka ayak skoru, hareket açıklığı ölçümleri ve radyografik değerlendirmeler kullanılarak klinik değerlendirmeler yapıldı.Bulgular: Çalışmaya 33’ü plak osteosentezi ve 27’si vida osteosentezi ile tedavi edilen toplam 60 hasta dâhil edildi. Demografik ve klinik özellikler gruplar arasında benzerdi. AOFAS skorları, hareket açıklığı ölçümleri ve komplikasyon oranları vida ve plak fiksasyon grupları arasında karşılaştırılabilirdi. Radyolojik değerlendirmede iki grup arasında posttravmatik artrit düzeyleri açısından anlamlı bir fark saptanmadı.Sonuç: PMF’nin cerrahi tedavisinde tek başına vida tespiti, butress plak tespiti ile karşılaştırıldığında benzer klinik ve radyolojik sonuçlar sağlamaktadır. Bu sonuçlar, Haraguchi tip 1 ve 2 posterior malleol kırıkları için sadece vida osteosentezini destekleyen artan kanıtların ilerisindedir. CR - Irvin TA, Lien J, Kadakia AR. Posterior malleolus fracture. J Am Acad Orthop Surg 2013;21(1):32-40. google scholar CR - Hong CC, Nashi N, Roy SP, Tan KJ. Impact of trimalleolar ankle fractures: How do patients fare post-operatively? Foot Ankle Surg 2014;20(1):48-51. google scholar CR - Lui TH, Ip K, Chow HT. Comparison of radiologic and arthroscopic diagnoses of distal tibiofibular syndesmosis disruption in acute ankle fracture. Arthroscopy 2005;21(11):1370-74. google scholar CR - Jaskulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. J Trauma 1989;29(11):1565-70. google scholar CR - Koval KJ, Lurie J, Zhou W, Sparks MB, Cantu RV, Sporer SM, Weinstein J. Ankle fractures in the elderly: what you get depends on where you live and who you see. J Orthop Trauma 2005;19(9):635-9. google scholar CR - Bartoníček J, Rammelt S, Kostlivý K, Vaněček V, Klika D, Trešl I.Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg 2015;135(4):505-16. google scholar CR - Alexandropoulos C, Tsourvakas S, Papachristos J, Tselios A, Soukouli P. Ankle fracture classification: An evaluation of three classification systems: Lauge-Hansen, AO, Broos-Bisschop. Acta Orthop Belg 2010;76(4):521-5. google scholar CR - Haraguchi N, Haruyama H, Toga H, Kato F. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg Am 2006;88(5):1085-92. google scholar CR - Behery OA, Narayanan R, Konda SR, Tejwani NC, Kenneth AE. Posterior malleolar fixation reduces the incidence of transsyndesmotic fixation in rotational ankle fracture repair. Iowa Orthop J 2021;41(1):121-5. google scholar CR - Pogliocomi F, De Filippo M, Casalini D, Longhi A, Tacci F, Perotta R, et al. Acute syndesmotic injuries in ankle fractures: from diagnosis to treatment and current concepts. World J Orthop 2021;12(5):270-91. google scholar CR - Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S. Management of Posterior Malleolar Fractures: a systematic review. J Foot Ankle Surg. 2016;55(1):140-5. google scholar CR - Barbosa P, Bonnaire F, Kojima K. AO foundation. Available from URL :http://www2.aofoundation.org. 2013. google scholar CR - Hartford JM, Gorczyca JT, McNamara JL, Mayor MB. Tibiotalar contact area. Contribution of posterior malleolus and deltoid ligament. Clin Orthop Relat Res 1995;(320):182-7. google scholar CR - Langenhuijsen JF, Heetveld MJ, Ultee JM, Steller EP, Butzelaar RM. Results of ankle fractures with involvement of the posterior tibial margin. J Trauma 2002;53(1):55-60. google scholar CR - Broos PL, Bisschop AP. Operative treatment of ankle fractures in adults: correlation between types of fracture and final results. Injury 1991;22(5):403-6. google scholar CR - Bargon G. Röntgenmorphologische Gradeinteilung der posttraumatischen Arthrose im oberen Sprunggelenk. HefteUnfallheilkd 1978;133:28-34. google scholar CR - Miller AN, Carroll EA, Parker RJ. Posterior malleolar stabilization of syndesmoticinjuries is equivalent to screw fixation. Clin Orthop Relat Res 2010;468(4):1129-35. google scholar CR - Fu S, Zou ZY, Mei G. Advances and disputes of posterior malleolus fracture. Chin Med J (Engl) 2013;126(20):3972-77. google scholar UR - https://doi.org/10.26650/JARHS2023-1320786 L1 - https://dergipark.org.tr/en/download/article-file/3236224 ER -