Journal List > J Korean Fract Soc > v.33(1) > 1142197

J Korean Fract Soc. 2020 Jan;33(1):16-21. Korean.
Published online Jan 23, 2020.  https://doi.org/10.12671/jkfs.2020.33.1.16
Copyright © 2020 The Korean Fracture Society. All rights reserved.
Treatment of Isolated Lateral Malleolar Fractures Using Locking Compression Plate Fixation and Tension Band Wiring Fixation
Woojin Shin, M.D., Seondo Kim, M.D. and Jiyeon Park, M.D.
Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea.

Correspondence to: Woojin Shin, M.D. Department of Orthopedic Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju 62284, Korea. Tel: +82-62-602-6162, Fax: +82-62-602-6936, Email: neolimp@naver.com
Received Nov 29, 2019; Revised Jan 03, 2020; Accepted Jan 03, 2020.

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

The purpose of this study was to compare the clinical and radiological outcomes of locking compression plate (LCP)-screw fixation and tension band wiring (TBW) fixation in isolated lateral malleolar fractures.

Materials and Methods

From May 2016 to August 2018, 52 patients with isolated lateral malleolar fracture were retrospectively reviewed. They were divided into 30 cases of the LCP fixation group (Group I) and 22 cases of the TBW fixation group (Group II). The clinical and radiological results of those groups were compared. Pearson chi-square tests and independent t-tests were used in the statistical analysis.

Results

The mean length of the surgical incision was 8.3 cm in Group I and 4.9 cm in Group II. Radiological union was obtained at a mean of 8.4 weeks in both groups. The mean American Orthopaedic Foot and Ankle Society score was 90 (range, 85–97) and 92 (range, 85–100) in Groups I and II, respectively, at the last follow up.

Conclusion

Both the LCP-screw and TBW techniques revealed excellent results in isolated lateral malleolar fractures. The tension band technique may be a fine alternative method of fixation in the treatment of isolated lateral malleolar fracture.

Keywords: Ankle; Lateral malleolus fracture; Operative procedure; Locking plate fixation; Tension band wiring fixation

Figures


Fig. 1
(A) A 54-year-old female patient was diagnosed with isolated lateral malleolar fracture according to the simple radiography. (B) Surgical fixation with locking-plate screw on the postoperative radiography. (C) Bone-union was achieved within 12 months of surgery.
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Fig. 2
(A) A 32-year-old male patient was diagnosed with isolated lateral malleolar fracture according to the simple radiography. (B) Surgical fixation with the tension band wire on the postoperative radiography. (C) Bone-union was achieved within 12 months of surgery.
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Tables

Notes

Financial support:None.

Conflict of interests:None.

References
1. Thordarson DB, Motamed S, Hedman T, Ebramzadeh E, Bakshian S. The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am 1997;79:1809–1815.
2. Lindsjö U. Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res 1985;(199):28–38.
3. Cole PA, Craft JA. Treatment of osteoporotic ankle fractures in the elderly: surgical strategies. Orthopedics 2002;25:427–430.
4. Ostrum RF, Litsky AS. Tension band fixation of medial malleolus fractures. J Orthop Trauma 1992;6:464–468.
5. Kanakis TE, Papadakis E, Orfanos A, Andreadakis A, Xylouris E. Figure eight tension band in the treatment of fractures and pseudarthroses of the medial malleolus. Injury 1990;21:393–397.
6. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349–353.
7. Bauer M, Bengnér U, Johnell O, Redlund-Johnell I. Supination-eversion fractures of the ankle joint: changes in incidence over 30 years. Foot Ankle 1987;8:26–28.
8. 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;69:596–604.
9. Segal D, Wiss DA, Whitelaw GP. Functional bracing and rehabilitation of ankle fractures. Clin Orthop Relat Res 1985;(199):39–45.
10. Belcher GL, Radomisli TE, Abate JA, Stabile LA, Trafton PG. Functional outcome analysis of operatively treated malleolar fractures. J Orthop Trauma 1997;11:106–109.
11. Hewchuck A, Goldman F, Wargon C. The Herbert cannulated bone screw in rearfoot arthrodesis. J Foot Ankle Surg 1994;33:266–270.
12. Michelson JD, Helgemo SL Jr. Kinematics of the axially loaded ankle. Foot Ankle Int 1995;16:577–582.
13. Mitchell WG, Shaftan GW, Sclafani SJ. Mandatory open reduction: its role in displaced ankle fractures. J Trauma 1979;19:602–615.
14. Thordarson DB, Markolf K, Cracchiolo A 3rd. Stability of an ankle arthrodesis fixed by cancellous-bone screws compared with that fixed by an external fixator. A biomechanical study. J Bone Joint Surg Am 1992;74:1050–1055.
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;26:281–285.
16. Winkler B, Weber BG, Simpson LA. The dorsal antiglide plate in the treatment of Danis-Weber type-B fractures of the distalfibula. Clin Orthop Relat Res 1990;(259):204–209.
17. Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury 2003;34 Suppl 2:B63–B76.
18. Frigg R, Appenzeller A, Christensen R, Frenk A, Gilbert S, Schavan R. The development of the distal femur Less Invasive Stabilization System (LISS). Injury 2001;32 Suppl 3:SC24–SC31.
19. Frigg R. Locking Compression Plate (LCP). An osteosynthesis plate based on the Dynamic Compression Plate and the Point Contact Fixator (PC-Fix). Injury 2001;32 Suppl 2:63–66.
20. Schulz AP, Reimers N, Wipf F, et al. Evidence based development of a novel lateral fibula plate (VariAx fibula) using a real CT bone data based optimization process during device development. Open Orthop J 2012;6:1–7.
21. Kim HJ, Oh JK, Hwang JH, Park YH. The use of T-LCP (locking compression plate) for the treatment of the lateral malleolar fractures. Eur J Orthop Surg Traumatol 2013;23:233–237.
22. Hahnloser D, Platz A, Amgwerd M, Trentz O. Internal fixation of distal radius fractures with dorsal dislocation: pi-plate or two 1/4 tube plates? A prospective randomized study. J Trauma 1999;47:760–765.
23. Schepers T, Van Lieshout EM, De Vries MR, Van der Elst M. Increased rates of wound complications with locking plates in distal fibular fractures. Injury 2011;42:1125–1129.
24. Brunner CF, Weber BG. In: Special techniques in internal fixation. New York: Springer; 1982. pp. 123-127.
25. Winkler B, Weber BG, Simpson LA. In: Planning and reduction technique in fracture surgery. New York: Springer-Verlag; 1989. pp. 735-762.
26. Mirza A, Moriarty AM, Probe RA, Ellis TJ. Percutaneous plating of the distal tibia and fibula: risk of injury to the saphenous and superficial peroneal nerves. J Orthop Trauma 2010;24:495–498.