APPLICATION OF LATERAL MALLEOLUS HOOK-PLATE IN TREATMENT OF STAGE II SUPINATION-ADDUCTION TYPE MEDIAL MALLEOLUS FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENYu ,  ZHANGHui , HUANGFuguo , XIANGZhou , FANGYue , LIULei , CENShiqiang

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

ZHANGHui, Email: caesarzh@163.com

Keywords：

Supination-adduction type ankle fracture; Medial malleolus fracture; Lateral malleolus hook-plate; Ankle joint function

DOI：

10.7507/1002-1892.20140235

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Objective To investigate the application of lateral malleolus hook-plate for the treatment of stageⅡsupination-adduction type medial malleolus fractures. Methods Between January 2011 and June 2013, 21 patients with stageⅡsupination-adduction type ankle fractures were treated with lateral malleolus hook-plate, including 12 males and 9 females with an average age of 55.5 years (range, 27-65 years). The injury causes were sprain in 17 cases and traffic accident in 4 cases. The mean time between injury and admission was 12.4 hours (range, 2-72 hours). The tibial distal medial articular surface collapse was found in 7 cases by CT examination and in 3 cases by X-ray film. Of 21 cases, there were 12 cases of low transverse fractures of lateral malleolus, 7 cases of short oblique fractures of lateral malleolus, and 2 cases of ankle joint lateral collateral ligament injury without fractures of lateral malleolus. After operation, the clinical outcome was evaluated according to the talus-leg angle, the recovery of Coin-sign continuity, inside-outside and top ankle gap, talus slope, American Orthopedic Foot and Ankle Society (AOFAS) score, Olerud-Molander score, Kofoed evaluation standards, and patient satisfaction. Results Seventeen cases were followed up 18.7 months on average (range, 12-25 months). Primary healing was obtained in 16 cases except 1 case of delayed healing. Fracture healed at an average of 14.6 weeks (range, 12-16 weeks). All cases achieved anatomical reduction, the continuity of Coin-sign, and consistency of inside and outside joint gap; no talus tilt occurred. There was no complication of reduction loss, loosening or breakage of internal fixation, or osteoarthritis during follow-up. The talus-leg angle of the affected side was significantly improved to (83.4±1.8)° at 1 week after operation from preoperative (74.8±7.1)° (t=5.370, P=0.000), but no significant difference was found when compared with normal side (83.8±2.3)° (t=0.676, P=0.509). The AOFAS score, Olerud-Molander score, and range of motion at 1 week, 3 months, and 1 year after operation were significantly improved when compared with preoperative ones (P < 0.05). According to Kofoed evaluation standard, the outcome was excellent in 15 cases and good in 2 cases; the excellent and good rate was 100%. According to patient satisfaction, the outcome was excellent in 13 cases, good in 3 cases, and poor in 1 case; the excellent and good rate was 94.1%. Conclusion The use of lateral malleolus hook-plate for fixation of stageⅡsupination-adduction type medial malleolus fracture not only can effectively maintain anatomical reduction and supporting function, but also can prevent re-collapsing of the reset joint surface. The surgical method can not increase soft tissue complication, so it is a safe and effective method.

Citation： CHENYu, ZHANGHui, HUANGFuguo, XIANGZhou, FANGYue, LIULei, CENShiqiang. APPLICATION OF LATERAL MALLEOLUS HOOK-PLATE IN TREATMENT OF STAGE II SUPINATION-ADDUCTION TYPE MEDIAL MALLEOLUS FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1077-1081. doi: 10.7507/1002-1892.20140235 Copy

1.	Gumann G, Hamilton GA.Arthroscopically assisted treatment of ankle injuries.Clin Podiatr Med Surg, 2011, 28(3):523-538.
2.	Greenwald AS, Matejczyk MB, Keppler L, et al.Preliminary observations on the weight-bearing surfaces of the human ankle joint.Surg Forum, 1976, 27(62):505-506.
3.	McConnell T, Tornetta P 3rd.Marginal plafond impaction in association with supination-adduction ankle fractures:a report of eight cases.J Orthop Trauma, 2001, 15(6):447-449.
4.	Siegel J, Tornetta P 3rd.Extraperiosteal plating of pronation-abduction ankle fractures.J Bone Joint Surg (Am), 2007, 89(2):276-281.
5.	俞光荣, 樊健, 周家钤, 等.旋后内收型Ⅱ度踝关节骨折的治疗策略.中华创伤杂志, 2011, 27(4):336-340.
6.	Boraiah S, Paul O, Parker RJ, et al.Osteochondral lesions of talus associated with ankle fractures.Foot Ankle Int, 2009, 30(6):481-485.
7.	Phillips WA, Schwartz HS, Keller CS, et al.A prospective, randomized study of the management of severe ankle fractures.J Bone Joint Surg (Am), 1985, 67(1):67-78.
8.	Kitaoka HB, Alexander IJ, Adelaar RS, et al.Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes.Foot Ankle Int, 1994, 15(7):349-353.
9.	Olerud C, Molander H.A scoring scale for symptom evaluation after ankle fracture.Arch Orthop Trauma Surg, 1984, 103(3):190-194.
10.	Kofoed H, Sørensen TS.Ankle arthroplasty for rheumatoid arthritis and osteoarthritis:prospective long-term study of cemented replacements.J Bone Joint Surg (Br), 1998, 80(2):328-332.
11.	Yufit P, Seligson D.Malleolar ankle fractures.A guide to evaluation and treatment.Orthopaedics and Trauma, 2010, 24(4):286-297.
12.	Labib S, Hage WD, Sutton KM, et al.The effect of ankle position on the static tension in the achilles tendon before and after operative repair:a biomechanical cadaver study.Foot Ankle Int, 2007, 28(4):478-481.
13.	Parada SA, Krieg JC, Benirschke SK, et al.Bicortical fixation of medial malleolar fractures.Am J Orthop (Belle Mead NJ), 2013, 42(2):90-92.
14.	King CM, Cobb M, Collman DR, et al.Bicortical fixation of medial malleolar fractures:a review of 23 cases at risk for complicated bone healing.J Foot Ankle Surg, 2012, 51(1):39-44.
15.	Thomas P Rüedi, Richard E Buckley, Christopher G Moran.骨科治疗的AO原则.王满宜, 曾炳芳, 译.2版.上海:上海科学技术出版社, 2010:660-662.
16.	Ebraheim NA, Ludwig T, Weston JT, et al.Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry.Foot Ankle Int, 2014, 35(5):471-477.
17.	Michelson JD.Ankle fractures resulting from rotational injuries.J Am Acad Orthop Surg, 2003, 11(6):403-412.
18.	Werner CM, Lorich DG, Gardner MJ, et al.Ankle fractures:it is not just a "simple" ankle fracture.Am J Orthop, 2007, 36(9):466-469.
19.	孙涛, 王丹, 周智勇, 等.外踝解剖型钩状钢板在Weber A型踝部骨折固定中的生物力学分析.中国修复重建外科杂志, 2008, 22(7):824-827.
20.	余华, 李少星, 赵长义, 等.胫骨远端关节面缺损有限元模型的生物力学分析.中国组织工程研究, 2013, 17(43):7571-7580.
21.	McCann PA, Jackson M, Mitchell ST, et al.Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia.Int Orthop, 2011, 35(3):413-418.
22.	贾斌, 张勇, 曹国庆, 等.手术治疗旋后-内收型Ⅱ度踝关节骨折.临床骨科杂志, 2011, 14(2):159.

1. Gumann G, Hamilton GA.Arthroscopically assisted treatment of ankle injuries.Clin Podiatr Med Surg, 2011, 28(3):523-538.
2. Greenwald AS, Matejczyk MB, Keppler L, et al.Preliminary observations on the weight-bearing surfaces of the human ankle joint.Surg Forum, 1976, 27(62):505-506.
3. McConnell T, Tornetta P 3rd.Marginal plafond impaction in association with supination-adduction ankle fractures:a report of eight cases.J Orthop Trauma, 2001, 15(6):447-449.
4. Siegel J, Tornetta P 3rd.Extraperiosteal plating of pronation-abduction ankle fractures.J Bone Joint Surg (Am), 2007, 89(2):276-281.
5. 俞光荣, 樊健, 周家钤, 等.旋后内收型Ⅱ度踝关节骨折的治疗策略.中华创伤杂志, 2011, 27(4):336-340.
6. Boraiah S, Paul O, Parker RJ, et al.Osteochondral lesions of talus associated with ankle fractures.Foot Ankle Int, 2009, 30(6):481-485.
7. Phillips WA, Schwartz HS, Keller CS, et al.A prospective, randomized study of the management of severe ankle fractures.J Bone Joint Surg (Am), 1985, 67(1):67-78.
8. Kitaoka HB, Alexander IJ, Adelaar RS, et al.Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes.Foot Ankle Int, 1994, 15(7):349-353.
9. Olerud C, Molander H.A scoring scale for symptom evaluation after ankle fracture.Arch Orthop Trauma Surg, 1984, 103(3):190-194.
10. Kofoed H, Sørensen TS.Ankle arthroplasty for rheumatoid arthritis and osteoarthritis:prospective long-term study of cemented replacements.J Bone Joint Surg (Br), 1998, 80(2):328-332.
11. Yufit P, Seligson D.Malleolar ankle fractures.A guide to evaluation and treatment.Orthopaedics and Trauma, 2010, 24(4):286-297.
12. Labib S, Hage WD, Sutton KM, et al.The effect of ankle position on the static tension in the achilles tendon before and after operative repair:a biomechanical cadaver study.Foot Ankle Int, 2007, 28(4):478-481.
13. Parada SA, Krieg JC, Benirschke SK, et al.Bicortical fixation of medial malleolar fractures.Am J Orthop (Belle Mead NJ), 2013, 42(2):90-92.
14. King CM, Cobb M, Collman DR, et al.Bicortical fixation of medial malleolar fractures:a review of 23 cases at risk for complicated bone healing.J Foot Ankle Surg, 2012, 51(1):39-44.
15. Thomas P Rüedi, Richard E Buckley, Christopher G Moran.骨科治疗的AO原则.王满宜, 曾炳芳, 译.2版.上海:上海科学技术出版社, 2010:660-662.
16. Ebraheim NA, Ludwig T, Weston JT, et al.Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry.Foot Ankle Int, 2014, 35(5):471-477.
17. Michelson JD.Ankle fractures resulting from rotational injuries.J Am Acad Orthop Surg, 2003, 11(6):403-412.
18. Werner CM, Lorich DG, Gardner MJ, et al.Ankle fractures:it is not just a "simple" ankle fracture.Am J Orthop, 2007, 36(9):466-469.
19. 孙涛, 王丹, 周智勇, 等.外踝解剖型钩状钢板在Weber A型踝部骨折固定中的生物力学分析.中国修复重建外科杂志, 2008, 22(7):824-827.
20. 余华, 李少星, 赵长义, 等.胫骨远端关节面缺损有限元模型的生物力学分析.中国组织工程研究, 2013, 17(43):7571-7580.
21. McCann PA, Jackson M, Mitchell ST, et al.Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia.Int Orthop, 2011, 35(3):413-418.
22. 贾斌, 张勇, 曹国庆, 等.手术治疗旋后-内收型Ⅱ度踝关节骨折.临床骨科杂志, 2011, 14(2):159.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF LATERAL MALLEOLUS HOOK-PLATE IN TREATMENT OF STAGE II SUPINATION-ADDUCTION TYPE MEDIAL MALLEOLUS FRACTURE

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