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. 2020 Mar-Apr;36(3):438-444.
doi: 10.12669/pjms.36.3.1671.

Therapeutic effects of internal fixation with support plates and cannulated screws via the posterolateral approach on supination external rotation stage IV ankle fracture

Zhongbing Liu  1 , Genling Tang  2 , Shuguang Guo  3 , Bin Cai  4 , Qingsong Li  5
Affiliations

Therapeutic effects of internal fixation with support plates and cannulated screws via the posterolateral approach on supination external rotation stage IV ankle fracture

Zhongbing Liu et al. Pak J Med Sci. 2020 Mar-Apr.

Abstract

Objective: To evaluate the therapeutic effects of internal fixation with support plates and cannulated screws via the posterolateral approach on supination external rotation stage IV ankle fracture.

Methods: Eighty-five patients with SER-IV° ankle fracture and large posterior malleolar fracture treated from June 2016 to June 2018 in our hospital, were randomly divided into a support plate group (n=47) and a cannulated screw group (n=38). The treatment outcomes were compared regarding surgical time, amount of bleeding, time of fracture healing, postoperative complications, as well as the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and excellent rate one year later.

Results: The surgical time and intraoperative blood loss of cannulated screw group were significantly lower than those of support plate group (P<0.05). There were four cases of posterior lateral incision redness complicated with obvious bloody exudation in support plate group on the postoperative 2nd day. One case developed into superficial incision infection subsequently, and one case suffered from deep infection. After dressing and treatment with sensitive antibiotics, stitch removal was delayed, and primary healing was obtained. In cannulated screw group, there were two cases of posterior lateral incision redness complicated with obvious bloody exudation on the postoperative 3rd day, without skin incision infection. One case had cannulated screw loosening two months after surgery, and the posterior malleolar fracture block was slightly displaced. The incidence of surgical complications in support plate and cannulated screw groups were 8.51% and 7.89%, respectively (P>0.05). The AOFAS scores of cannulated screw ((81.71 ± 12.39) points) and support plate groups ((86.62 ± 10.12) points) were significantly different (P<0.05).

Conclusion: For patients with posterior malleolar fracture or osteoporosis, fixation using support plate is recommended. Cannulated screw fixation is suitable for for patients with poor conditions of skin soft tissues or basic diseases such as diabetes intolerant to long surgery.

Keywords: Cannulated screw; Stage IV ankle fracture; Supination external rotation; Support plate.

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Conflict of interest statement

Conflict of interest: None.

Figures

Fig.1
Fig.1
Imaging results a 47-year-old female patient who suffered from 3.5 h of car accident-induced right ankle swelling and pain complicated with limitation of motion before surgery. A: Frontal X-ray film of ankle joint; B: lateral X-ray film; C: CT scan cross-section image; D: CT scan sagittal image.
Fig.2
Fig.2
Surgical method for cannulated screw group. A: Postoperative frontal X-ray film of ankle joint; B: lateral X-ray film.
Fig.3
Fig.3
Surgical method for support plate group. A: Postoperative frontal X-ray film of ankle joint; B: lateral X-ray film.
See this image and copyright information in PMC

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