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Posterior Malleol Kırıklarında Perkütan Vida Fiksasyonu ve Konservatif Tedavinin Karşılaştırılması: Radyolojik ve Fonksiyonel Sonuçların Analizi

Year 2025, Volume: 8 Issue: 1, 46 - 50

Abstract

Amaç: Bu çalışmanın amacı küçük posterior malleol kırık fragmanı olan trimalleolar kırıklı hastalarda perkütan vida fiksasyonu uygulanan ve uygulanmayan grupların klinik ve radyolojik sonuçlarını karşılaştırılmaktı.

Materyal ve Metod: Çalışmaya Ocak 2017-Aralık 2023 tarihleri arasında posterior malleol kırıklarının perkütan vida ile tespit edildiği (Grup 1) ve edilmediği (Grup 2) hastalar (18-65 yaş) dahil edildi. Son takibe kadar çeşitli zaman aralıklarında klinik ve radyolojik değerlendirme yapılmıştır. Fonksiyonel değerlendirme Amerikan Ortopedik Ayak ve Ayak Bileği Skorları (AOFAS), Görsel Analog Skorları (VAS) ve dorsifleksiyon kısıtlılığı kullanılarak gerçekleştirilmiştir. Radyolojik değerlendirme, kırık bölgesinde boşluk ile basamaklanma ölçümü ve ayak bileği osteoartriti varlığını içeriyordu.

Bulgular: Bu çalışmada, dahil edilme kriterlerini karşılayan altmış beş hasta (Grup 1: 33, Grup 2: 32) ortalama 31.65±6.4 (24-44) ay takip edildi.Gruplar arasında klinik sonuçlar açısından anlamlı bir fark bulunmamıştır (p > 0.05). Son radyografide, Grup 1'deki ortalama boşluk ve basamaklanma Grup 2'ye göre daha düşüktü (p < 0.001). Ayak bileği osteoartrozu varlığı açısından gruplar arasında anlamlı bir fark yoktu (p = 0.658).

Sonuç: Bu çalışma küçük posterior malleol fragmanlarının perkütan vida fiksasyonunun, fiksasyon yapılmamasına kıyasla klinik sonuçları önemli ölçüde iyileştirmediğini, ancak daha iyi radyolojik sonuçlar sağladığını göstermektedir. Bulgular, travma sonrası ayak bileği osteoartritinin önlenmesinde eklem uyumunun korunmasının fiksasyondan daha önemli olabileceğini düşündürmektedir.Bu bulguları incelemek için daha fazla araştırmaya ihtiyaç vardır.

References

  • 1.Jaskulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: Their role in the prognosis of malleolar fractures. J Trauma - Inj Infect Crit Care 1989;29:1565–70. https://doi.org/10.1097/00005373-198911000-00018
  • 2.Uluöz M, Gökmen M. A new technique for syndesmotic screw placement in ankles. Ann Med Res 2023;30:1013–8.
  • 3.Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Jt Surg 2006;88:1085–92. https://doi.org/10.2106/JBJS.E.00856
  • 4.Odak S, Ahluwalia R, Unnikrishnan P, et al. Management of Posterior Malleolar Fractures: A Systematic Review. J Foot Ankle Surg 2016;55:140–5. https://doi.org/10.1053/j.jfas.2015.04.001
  • 5.Yu T, Ying J, Liu J, et al. Percutaneous posteroanterior screw fixation for Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture: Operative technique and randomized clinical results. J Orthop Surg 2021;29:2309499021997996. https://doi.org/10.1177/2309499021997996.
  • 6.Gardner MJ, Brodsky A, Briggs SM, et al. Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res 2006;447:165–71. https://doi.org/10.1097/01.blo.0000203489.21206.a9
  • 7.Van Hooff CCD, Verhage SM, Hoogendoorn JM. Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures. Foot Ankle Int 2015;36:673–8. https://doi.org/10.1177/1071100715570895.
  • 8.Harper MC, Hardin G. Posterior malleolar fractures of the ankle associated with external rotation-abduction injuries. Results with and without internal fixation. J Bone Jt Surg - Ser A 1988;70:1348–56. https://doi.org/10.2106/00004623-198870090-00012
  • 9.Holzer N, Salvo D, Marijnissen ACA, et al. Radiographic evaluation of posttraumatic osteoarthritis of the ankle: The Kellgren-Lawrence scale is reliable and correlates with clinical symptoms. Osteoarthr Cartil 2015;23:363–9. https://doi.org/10.1016/j.joca.2014.11.010
  • 10.Stringfellow TD, Walters ST, Nash W, et al. Management of posterior malleolus fractures: A multicentre cohort study in the United Kingdom. Foot Ankle Surg 2021;27:629–35. https://doi.org/10.1016/j.fas.2020.08.003
  • 11.McDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle. An end result study. Clin Orthop Relat Res 1977:37–45.
  • 12.Batar S, Şişman A. Comparison of anteroposterior and posteroanterior screw fixation techniques for posterior malleolar fractures: a retrospective and clinical study. Ulus Travma ve Acil Cerrahi Derg 2023;29:1376–81. https://doi.org/10.14744/tjtes.2023.66204
  • 13.Xu HL, Li X, Zhang DY, et al. A retrospective study of posterior malleolus fractures. Int Orthop 2012;36:1929–36. https://doi.org/10.1007/s00264-012-1591-9
  • 14.Gökmen MY, Uluöz M, Dülgeroğlu TC. Anterior Plate-Supported Cannulated Screw Surgery for Ankle Arthrodesis: Clinical and Radiologic Results in Patients with Trauma-Related End-Stage Ankle Osteoarthritis. Med Sci Monit 2024;30:e944452. https://doi.org/10.12659/MSM.944452
  • 15.Uluöz M, Gökmen MY, Varmış HO. Arthrodesis in the treatment of ankle osteoarthritis due to neglected malleolar fractures in the elderly. Med (United States) 2024;103:e40861 https://doi.org/10.1097/MD.0000000000040861
  • 16.Verhage SM, Krijnen P, Schipper IB, et al. Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures. Arch Orthop Trauma Surg 2019;139:323–9. https://doi.org/10.1007/s00402-018-3056-0

Comparison of Percutaneous Screw Fixation and Conservative Treatment of Posterior Malleolar Fractures: A Radiological and Functional Outcomes Analysis

Year 2025, Volume: 8 Issue: 1, 46 - 50

Abstract

ABSTRACT
Aim: The aim of this study was to compare the clinical and radiological results in patients with trimalleolar fractures with a small posterior malleolar fragment of the ankle joint with and without percutaneous screw fixation.

Materials and Methods: The study involved patients (18-65 years) with (Group 1) or without (Group 2) percutaneous screw fixation of posterior malleolus fractures between January 2017 and December 2023. Clinical and radiological evaluation was conducted at various time points up to the last follow-up. Functional evaluation was conducted using American Orthopaedic Foot and Ankle Scores (AOFAS), Visual Analogue Scores (VAS), and dorsiflexion restriction. Radiological evaluation included the measurement of the gap and step between at the fracture site and presence of ankle osteoarthritis.

Results: In this study, sixty-five patients (Group 1: 33, Group 2: 32) who met the inclusion criteria were followed up for a mean of 31.65±6.4 (24–44) months. There were no significant differences in the clinical results between the groups (p > 0.05). At the final radiograph, the mean gap and step distances in Group 1 were lower than in Group 2 (p < 0.001). There was no significant difference between the groups regarding the presence of ankle osteoarthrosis (p = 0.658).

Conclusion: This study indicates that while percutaneous screw fixation of small posterior malleolus fragments does not significantly improve clinical outcomes compared to non-fixation, it does result in better radiological alignment. The findings suggest that maintaining joint congruity may be more crucial than fixation in preventing posttraumatic ankle osteoarthritis. Further research is needed to explore these findings.

References

  • 1.Jaskulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: Their role in the prognosis of malleolar fractures. J Trauma - Inj Infect Crit Care 1989;29:1565–70. https://doi.org/10.1097/00005373-198911000-00018
  • 2.Uluöz M, Gökmen M. A new technique for syndesmotic screw placement in ankles. Ann Med Res 2023;30:1013–8.
  • 3.Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Jt Surg 2006;88:1085–92. https://doi.org/10.2106/JBJS.E.00856
  • 4.Odak S, Ahluwalia R, Unnikrishnan P, et al. Management of Posterior Malleolar Fractures: A Systematic Review. J Foot Ankle Surg 2016;55:140–5. https://doi.org/10.1053/j.jfas.2015.04.001
  • 5.Yu T, Ying J, Liu J, et al. Percutaneous posteroanterior screw fixation for Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture: Operative technique and randomized clinical results. J Orthop Surg 2021;29:2309499021997996. https://doi.org/10.1177/2309499021997996.
  • 6.Gardner MJ, Brodsky A, Briggs SM, et al. Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res 2006;447:165–71. https://doi.org/10.1097/01.blo.0000203489.21206.a9
  • 7.Van Hooff CCD, Verhage SM, Hoogendoorn JM. Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures. Foot Ankle Int 2015;36:673–8. https://doi.org/10.1177/1071100715570895.
  • 8.Harper MC, Hardin G. Posterior malleolar fractures of the ankle associated with external rotation-abduction injuries. Results with and without internal fixation. J Bone Jt Surg - Ser A 1988;70:1348–56. https://doi.org/10.2106/00004623-198870090-00012
  • 9.Holzer N, Salvo D, Marijnissen ACA, et al. Radiographic evaluation of posttraumatic osteoarthritis of the ankle: The Kellgren-Lawrence scale is reliable and correlates with clinical symptoms. Osteoarthr Cartil 2015;23:363–9. https://doi.org/10.1016/j.joca.2014.11.010
  • 10.Stringfellow TD, Walters ST, Nash W, et al. Management of posterior malleolus fractures: A multicentre cohort study in the United Kingdom. Foot Ankle Surg 2021;27:629–35. https://doi.org/10.1016/j.fas.2020.08.003
  • 11.McDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle. An end result study. Clin Orthop Relat Res 1977:37–45.
  • 12.Batar S, Şişman A. Comparison of anteroposterior and posteroanterior screw fixation techniques for posterior malleolar fractures: a retrospective and clinical study. Ulus Travma ve Acil Cerrahi Derg 2023;29:1376–81. https://doi.org/10.14744/tjtes.2023.66204
  • 13.Xu HL, Li X, Zhang DY, et al. A retrospective study of posterior malleolus fractures. Int Orthop 2012;36:1929–36. https://doi.org/10.1007/s00264-012-1591-9
  • 14.Gökmen MY, Uluöz M, Dülgeroğlu TC. Anterior Plate-Supported Cannulated Screw Surgery for Ankle Arthrodesis: Clinical and Radiologic Results in Patients with Trauma-Related End-Stage Ankle Osteoarthritis. Med Sci Monit 2024;30:e944452. https://doi.org/10.12659/MSM.944452
  • 15.Uluöz M, Gökmen MY, Varmış HO. Arthrodesis in the treatment of ankle osteoarthritis due to neglected malleolar fractures in the elderly. Med (United States) 2024;103:e40861 https://doi.org/10.1097/MD.0000000000040861
  • 16.Verhage SM, Krijnen P, Schipper IB, et al. Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures. Arch Orthop Trauma Surg 2019;139:323–9. https://doi.org/10.1007/s00402-018-3056-0
There are 16 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Articles
Authors

Mehmet Maden 0000-0001-5298-6674

Tayfun Bacaksız 0000-0002-8090-4370

İhsan Akan 0000-0002-9473-7307

Özgür Doğan Aydin 0000-0003-0048-7309

Cem Özcan 0000-0003-1716-9884

Publication Date
Submission Date February 26, 2025
Acceptance Date March 7, 2025
Published in Issue Year 2025 Volume: 8 Issue: 1

Cite

APA Maden, M., Bacaksız, T., Akan, İ., Aydin, Ö. D., et al. (n.d.). Comparison of Percutaneous Screw Fixation and Conservative Treatment of Posterior Malleolar Fractures: A Radiological and Functional Outcomes Analysis. Journal of Cukurova Anesthesia and Surgical Sciences, 8(1), 46-50.

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