Features of Lateral Malleolar Fractures in Elderly Patients and Clinical Outcome of Locking Compression Plate Fixation

Seok-Min Hwang; Hong-Geun Jung; Hyung-Jin Chung; Joon-Sang Eom; Dong-Oh Lee; Jung-Hyun Cho; Jong-Tae Park

doi:10.4055/jkoa.2016.51.1.77

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Hwang, Jung, Chung, Eom, Lee, Cho, and Park: Features of Lateral Malleolar Fractures in Elderly Patients and Clinical Outcome of Locking Compression Plate Fixation

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(1): 77-84.

Published online: 23 February 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.1.77

Features of Lateral Malleolar Fractures in Elderly Patients and Clinical Outcome of Locking Compression Plate Fixation

Seok-Min Hwang, M.D.^*, Hong-Geun Jung, M.D., Hyung-Jin Chung, M.D.^†, Joon-Sang Eom, M.D., Dong-Oh Lee, M.D., Jung-Hyun Cho, M.D., Jong-Tae Park, M.D.^‡

Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea.

^*Department of Orthopedic Surgery, Seoul Red Cross Hospital, Seoul, Korea.

^†Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

^‡Busan Korea Hospital, Busan, Korea.

Correspondence to: Hong-Geun Jung, M.D. Department of Orthopedic Surgery, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea. TEL: +82-2-2030-7609, FAX: +82-2-2030-7369, Jungfoot@hanmail.net

Received 31 July 2015 Revised 14 August 2015 Accepted 11 September 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Several studies have reported on the biomechanical advantages of a locking compression plate (LCP) for treatment of lateral malleolar fracture. However, few studies have reported clinical outcome after treatment of lateral malleolar fracture using a LCP in elderly patients. Thus, this study investigated the trends of lateral malleolar fractures in elderly patients and evaluated the clinical and radiological outcome of treating them using a 'locking compression distal fibula plate'.

Materials and Methods

Twenty-one patients (male: 3, female: 18) over 65 years old, who were followed-up for at least one year were enrolled in this study. They were treated surgically with open reduction and internal fixation using a LCP for lateral malleolar fracture from 2011 to 2014. Lauge-Hansen and Danis-Weber classification were used for preoperative classification of fractures. Visual analog scale (VAS) pain scores, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, 4-graded subjective satisfaction and post-operative range of motion were used for the clinical evaluation. Time to bone union, non-union, mal-union, metal failure and implant loosening were assessed for radiographic outcomes.

Results

The mean age of patients was 71.2 years old, pain VAS and AOFAS score was 1.6 points and 94.2 points, respectively and 18 cases (85.7%) showed more than satisfaction in subjective satisfaction. Comminuted fracture was observed in 8 cases (38.1%) and lag screw insertion was performed in 7 ankles (33.3%). The mean bony union period was 3.6 months. There were 5 cases of mal-union, no case of non-union and metal failure.

Conclusion

Satisfaction level of elderly patients with lateral malleolar fracture was significantly associated with only pain at the final follow-up. Fixation with a LCP distal fibula plate can sometimes lead to metal irritation but largely resulted in good clinical outcome without serious complication.

Keywords: ankle, aged, lateral malleolus fracture, comminuted fractures, locking compression plate

Figures and Tables

Figure 1

A 71-year-old woman with a tri-malleolar ankle fracture. (A) Preoperative X-ray shows a severe comminuted fracture. (B) The patient was treated using a locking compression plate for distal fibula without interfragment lag screw fixation although malunion was observed at the final follow-up.

Figure 2

A 67-year-old woman shows a tri-malleolar ankle fracture. (A) Preoperative X-ray shows a lower level fracture line and transverse fracture line. (B) The patient was treated using a locking compression plate for distal fibula without interfragment screw fixation.

Table 1

Elderly Patient Demographics and Hospital Data

Values are presented as number only, median (range), or number (%).

Table 2

Classification of Ankle Fracture

ER, external rotation.

Table 3

Data from All Patients

^*Classified by Lauge-Hansen classification. FU, follow-up; VAS, visual analog scale; AOFAS, American Orthopaedic Foot and Ankle Society; F, female; M, male; SER, supination external rotation type; SA, supination adduction type.

Table 4

Clinical Correlations between Satisfaction Level of Elderly Patients and Other Related Factors

Values are presented as number (%) or median (range). ^*This mark means statistical significance, p<0.05. ^†Ankles. VAS, visual analog scale.

Notes

This project (Ref: AOTAP12-19) was supported by AOTrauma Asia Pacific.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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