Comparison Of Two Different Plating Technique For Lateral Malleolar Fractures

Abstract

Aim: In this study we aimed to compare functional and clinical results of two different plate application technique by evaluating the results of patients whom were treated with either posterolateral anti-glide plating or lateral neutralization plating for Type B lateral malleolar fractures.

Material and Method: Thirty-seven patients with Type B lateral malleolar fracture which were caused by supination-external rotation injury that were treated with plate and screw fixation between November 2016 to June 2017 in our clinic were included in the study. Two different plating technique were compared for functional and clinical results and complications.

Results: Twenty-one (56.8%) patients were treated with lateral anatomical locking neutralization plate, remaining 16 (43.2%) were treated with posterolateral tubular anti-glide plate. All fractures were healed without any extra intervention. Twelfth month AOFAS scores of (Group 2) patients in who were treated with anti-glide plate were higher than others’ (P<0.01). There was no difference between groups in respect to range of motion at 6^th month, preoperative and 12^th month LEFS scores, AOFAS score at 3^rd and 6^th month and complications (P>0.05). LEFS scores preoperatively and at 12^th month were not different in groups (P=0.49, 0.56).

Conclusion: Both plating techniques provide healing of lateral malleolar fractures that necessitates healing in anatomical position with good clinical results. Posterolateral anti-glide plating, with its unique advantages compared to the commonly used lateral anatomical locking plating, is recommended as the primary method in the surgery of Weber Type B lateral malleolar fractures with better functional outcomes and low complication rates.

Keywords

• anti-glide plate,lateral malleolar fracture,anatomical plate,neutralization plate

Lateral Malleol Kırıkları Tespitinde İki Farklı Plak Uygulama Yönteminin Karşılaştırılması

Abstract

Amaç: Bu çalışmada lateral malleol Tip B kırığı posterolateralden anti-glide plaklama tekniği veya lateralden nötralizasyon plağı tekniği ile tedavi edilen hastalar değerlendirilerek iki yöntemin fonksiyonel ve klinik sonuçlarının karşılaştırılması amaçlanmıştır.

Gereç ve Yöntemler: Kasım 2016 – Haziran 2017 tarihleri arasında supinasyon-eksternal rotasyon yaralanması ile oluşan Weber Tip B lateral malleol kırıkları plak ve vida tespiti ile tedavi edilen 37 hasta değerlendirildi. İki farklı plak uygulama tekniği fonksiyonel skorlar, klinik sonuçlar ve komplikasyonlar açısından kıyaslandı.

Bulgular: Ortalama yaş 43,7 (19-69) idi. Hastaların 21 (%56,8)’inin cerrahisinde lateralden anatomik kilitli plak kullanılırken; 16 (%43,2)’sının cerrahisinde posterolateralden tübüler plak tercih edildi. Tüm hastaların kırıkları ek müdahale gerekmeksizin kaynadı. Anti-glide plak tercih edilen Grup 2’deki hastaların 12. aydaki AOFAS sonuçları istatistiksel olarak daha yüksekti (P<0,01). Gruplar arasında 6. ayda iki ayak bileği eklem hareket açıklıkları farkı, ameliyat öncesi ve 12. aydaki LEFS skoru, 3 ve 6. ay AOFAS skoru ve komplikasyonlar yönünden istatistiksel olarak anlamlı fark yoktu (P>0,05). Grupların kendi içinde ameliyat öncesi LEFS skoru ile 12. aydaki LEFS skoru arasında istatistiksel olarak anlamlı fark yoktu (P=0,49, 0,56). Grup 1’deki lateralden anatomik plak kullanılan hastalarda daha fazla vida kullanıldığı görüldü (P<0,001).

Sonuç: Anatomik pozisyonda kaynamanın gerektiği lateral malleol kırıklarının tedavisi için iki plak vida tespit yöntemi de iyi klinik sonuçlarla iyileşme sağlamaktadır. Sıklıkla kullanılan lateralden anatomik kilitli plakla tespit yöntemine göre kendine özgü avantajları olan posterolateralden anti-glide plak tekniği düşük komplikasyon oranı ve daha iyi fonksiyonel sonuçlar ile Weber Tip B lateral malleol kırıkları cerrahisinde öncelikli tercih edilebilecek yöntem olduğunu düşünmekteyiz.

Keywords

• Lateral malleol kırığı,anti-glide plak,anatomik plak,nötralizasyon plağı

References

1. Kannus P, Niemi S, Parkkari J, Palvanen M. Epidemiology of adulthood injuries: a quickly changing injury profile in Finland. J Clin Epidemiol. 2001;54(6):597-602.
2. Michelsen JD, Ahn UM, Helgemo SL. Motion of the ankle in a simulated supination-external rotation fracture model. J Bone Joint Surg Am. 1996;78(7):1024-31.
3. Hughes JL, Weber H, Willenegger H, Kuner EH. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Relat Res. 1979(138):111-9.
4. Ali MS, McLaren CA, Rouholamin E, O'Connor BT. Ankle fractures in the elderly: nonoperative or operative treatment. J Orthop Trauma. 1987;1(4):275-80.
5. Phillips WA, Schwartz HS, Keller CS, Woodward HR, Rudd WS, Spiegel PG, et al. A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg Am. 1985;67(1):67-78.
6. Schaffer JJ, Manoli A, 2nd. The antiglide plate for distal fibular fixation. A biomechanical comparison with fixation with a lateral plate. J Bone Joint Surg Am. 1987;69(4):596-604.
7. Michelson JD. Fractures about the ankle. J Bone Joint Surg Am. 1995;77(1):142-52.
8. Lindsjo U. Classification of ankle fractures: the Lauge-Hansen or AO system? Clin Orthop Relat Res. 1985(199):12-6.

9. Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950;60(5):957-85.
10. Ostrum RF. Posterior plating of displaced Weber B fibula fractures. J Orthop Trauma. 1996;10(3):199-203.
11. Beauchamp CG, Clay NR, Thexton PW. Displaced ankle fractures in patients over 50 years of age. J Bone Joint Surg Br. 1983;65(3):329-32.
12. Switaj PJ, Wetzel RJ, Jain NP, Weatherford BM, Ren Y, Zhang LQ, et al. Comparison of modern locked plating and antiglide plating for fixation of osteoporotic distal fibular fractures. Foot Ankle Surg. 2016;22(3):158-63.
13. Brunner CF, Weber BG. Anti-glide Plate. In: Brunner CF, Weber BG, editors. Special Techniques in Internal Fixation. 1: Springer-Verlag Berlin Heidelberg; 1982. p. 115-33.
14. Ahn J, Kim S, Lee JS, Woo K, Sung KS. Incidence of Peroneal Tendinopathy After Application of a Posterior Antiglide Plate for Repair of Supination External Rotation Lateral Malleolar Fractures. J Foot Ankle Surg. 2016;55(1):90-3.
15. Weber M, Krause F. Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures: the effect of plate and screw position. Foot Ankle Int. 2005;26(4):281-5.
16. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79(4):371-83.
17. Boyd RP, Nawaz SZ, Khaleel A. A new assessment for syndesmosis injury - The 'Chertsey test'. Injury. 2016;47(6):1293-6.
18. Pepe M, Kocadal O, Gunes Z, Calisal E, Ceritoglu K, Aktekin CN. A Radiographic Dye Method for Intraoperative Evaluation of Syndesmotic Injuries. Foot Ankle Int. 2017;38(12):1380-6.
19. Pakarinen H, Flinkkila T, Ohtonen P, Hyvonen P, Lakovaara M, Leppilahti J, et al. Intraoperative assessment of the stability of the distal tibiofibular joint in supination-external rotation injuries of the ankle: sensitivity, specificity, and reliability of two clinical tests. J Bone Joint Surg Am. 2011;93(22):2057-61.
20. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg. 2007;46(2):65-74.
21. Winkler B, Weber BG, Simpson LA. The dorsal antiglide plate in the treatment of Danis-Weber type-B fractures of the distal fibula. Clin Orthop Relat Res. 1990(259):204-9.
22. Minihane KP, Lee C, Ahn C, Zhang LQ, Merk BR. Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: a biomechanical study. J Orthop Trauma. 2006;20(8):562-6.
23. Zahn RK, Frey S, Jakubietz RG, Jakubietz MG, Doht S, Schneider P, et al. A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study. Injury. 2012;43(6):718-25.
24. Hallbauer J, Klos K, Rausch S, Grafenstein A, Wipf F, Beimel C, et al. Biomechanical comparison of a lateral polyaxial locking plate with a posterolateral polyaxial locking plate applied to the distal fibula. Foot Ankle Surg. 2014;20(3):180-5.
25. Hallbauer J, Klos K, Grafenstein A, Simons P, Rausch S, Muckley T, et al. Does a polyaxial-locking system confer benefits for osteosynthesis of the distal fibula: A cadaver study. Orthop Traumatol Surg Res. 2016;102(5):645-9.
26. Brown OL, Dirschl DR, Obremskey WT. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma. 2001;15(4):271-4.
27. Treadwell JR, Fallat LM. The antiglide plate for the Danis-Weber type-B fibular fracture: a review of 71 cases. J Foot Ankle Surg. 1993;32(6):573-9.
28. Wissing JC, van Laarhoven CJ, van der Werken C. The posterior antiglide plate for fixation of fractures of the lateral malleolus. Injury. 1992;23(2):94-6.
29. Lamontagne J, Blachut PA, Broekhuyse HM, O'Brien PJ, Meek RN. Surgical treatment of a displaced lateral malleolus fracture: the antiglide technique versus lateral plate fixation. J Orthop Trauma. 2002;16(7):498-502.