Comparison Of Two Different Plating Technique For Lateral Malleolar Fractures

Yıl 2018, Cilt: 51 Sayı: 1, 20 - 25, 30.03.2018

Kubilay Uğurcan Ceritoğlu Hakan Yolaçan

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

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• Michelson JD. Fractures about the ankle. J Bone Joint Surg Am. 1995;77(1):142-52.
• Lindsjo U. Classification of ankle fractures: the Lauge-Hansen or AO system? Clin Orthop Relat Res. 1985(199):12-6.
• Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950;60(5):957-85.
• Ostrum RF. Posterior plating of displaced Weber B fibula fractures. J Orthop Trauma. 1996;10(3):199-203.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• Boyd RP, Nawaz SZ, Khaleel A. A new assessment for syndesmosis injury - The 'Chertsey test'. Injury. 2016;47(6):1293-6.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.