Comparison Of Two Different Plating Technique For Lateral Malleolar Fractures

Öz

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.

Anahtar Kelimeler

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

Lateral Malleol Kırıkları Tespitinde İki Farklı Plak Uygulama Yönteminin Karşılaştırılması

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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