EFFECTIVENESS OF SPRING HOOK PLATE FOR POSTERIOR MALLEOLUS FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGBinggang , LIUNa ,  ZHANGLifeng

The Second Hospital of Tangshan, Tangshan Orthopeadics Hospital Affiliated to North China University of Science and Technology, the Trauma Department of Orthopedics Center of Hebei, Tangshan Hebei, 063000, P. R. China;

Corresponding author：

ZHANGLifeng, Email: wangbg_sy@yeah.net

Keywords：

Posterior malleolus fracture; Spring hook plate; Cannulated screw; Internal fixation

DOI：

10.7507/1002-1892.20160248

Video：

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Objective To investigate the effectiveness of spring hook plate for posterior malleolus fracture by comparing with cannulated screw. Methods Between March 2012 and September 2013, 100 cases of posterior malleolus fracture were treated. Fracture was fixed with spring hook plate in 50 cases (research group) or with cannulated screw in 50 cases (control group). There was no significant difference in gender, age, cause of injury, associated injury, and injury to operation time between 2 groups P>0.05). The operation time, intraoperative blood loss, union time of fracture, ankle range of motion (ROM), and complications were recorded and compared. The ankle joint function was evaluated by the ankle hindfoot scale of American Orthopedic Foot and Ankle Society (AOFAS). Results There was no significant difference in operation time and intraoperative blood loss between 2 groups P>0.05). The patients were followed up 6-12 months (mean, 9.8 months) in the control group and 6-12 months (mean, 9.2 months) in the research group. The X-ray films showed that fracture union was achieved in 2 groups; the union time of the research group[(9.5±1.4) weeks] was significantly shorter than that of the control group[(10.5±1.3) weeks] (t=2.029, P=0.017). The ROM was (25.1±3.2)° for dorsal extension and was (45.3±2.3)° for plantar flexion in the research group at 6 months after operation, which were significantly better than those of the control group[(22.2±2.3)° and (41.2±2.5)°] (t=-3.950, P=0.001; t=-5.212, P=0.000). The ankle hindfoot scale of AOFAS was 85.1±8.6 in the control group at 6 months; the results were excellent in 15 cases, good in 20 cases, and moderate in 15 cases with an excellent and good rate of 70%. The ankle hindfoot scale of AOFAS was 89.4±7.9 in the research group; the results were excellent in 20 cases, good in 22 cases, and moderate in 8 cases with an excellent and good rate of 84%; there was significant difference between 2 groups (t=-2.191, P=0.042; χ²=0.413, P=0.018). Incision infection occurred in 3 cases of the control group and in 2 cases of the research group, which was cured after dressing change; screw loosening and fracture displacement occurred in 3 and 4 cases of the control group, but did not in the research group. The complication rate of the control group and the research group was 20% and 4% respectively, showing significant difference between 2 groups (χ²=6.061, P=0.028). Conclusion Spring hook plate can shorten the time of union, increase the ROM of the ankle after operation, get good functional restoration, and decrease the rate of complication compared with cannulated screw fixation.

Citation： WANG Binggang, LIU Na, ZHANG Lifeng. EFFECTIVENESS OF SPRING HOOK PLATE FOR POSTERIOR MALLEOLUS FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(10): 1210-1214. doi: 10.7507/1002-1892.20160248 Copy

1.	Erdem MN, Erken HY, Burc H, et al. Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures. Foot Ankle Int, 2014, 35(10):1022-1030.
2.	Veltman ES, Halma JJ, de Gast A. Longterm outcome of 886 posterior malleolar fracture:A systematic review of the literature. Foot Ankle Surg, 2016, 22(2):73-77.
3.	Leung KH, Fang CX, Lau TW, et al. Preoperative radiography versus computed tomography for surgical planning for ankle fractures. J Orthop Surg (Hong Kong), 2016, 24(2):158-162.
4.	Wang Y, Wang J, Luo CF. Modified posteromedial approach for treatment of posterior pilon variant fracture. BMC Musculoskelet Disord, 2016, 17:328.
5.	Yamamoto N, Ogawa K, Terada C, et al. Minimally invasive plate osteosynthesis using posterolateral approach for distal tibial and tibial shaft fractures. Injury, 2016, 47(8):1862-1866.
6.	Verhage SM, Boot F, Schipper IB, et al. Open reduction and internal fixation of posterior malleolar fractures using the posterolateral approach. Bone Joint J, 2016, 98-B(6):812-817.
7.	Erdem MN, Erken HY, Burc H, et al. Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures. Foot Ankle Int, 2014, 25(10):1022-1030.
8.	Amorosa LF, Brown GD, Greisberg J. A surgical approach to posterior pilon fractures. J Orthop Trauma, 2010, 24(3):188-193.
9.	Ortiz CA, Wagner P, Wagner E. State-of-the-art in ankle fracture management in chile. Foot Ankle Clin, 2016, 21(2):367-389.
10.	Miller AN, Carroll EA, Parker RJ, et al. Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res, 2010, 468(4):1129-1135.
11.	Mingo-Robinet J, López-Durán L, Galeote JE, et al. Ankle fractures with posterior malleolar fragment:management and results. J Foot Ankle Surg, 2011, 50(2):141-145.
12.	魏世隽, 蔡贤华, 刘曦明, 等. 后内侧入路低切迹多向锁定接骨板内固定治疗累及内踝的胫骨后 Pilon 骨折. 中国修复重建外科杂志, 2014, 28(5):557-561.
13.	赵宏谋, 梁晓军, 俞光荣, 等. 后踝骨折复位程度对胫距关节接触情况的影响. 中华创伤杂志, 2014, 30(10):1035-1039.
14.	Fitzpatrick DC, Otto JK, Mckinley TO, et al. Kinematic and contact stress analysis of posterior malleolus fractures of the ankle. J Orthop Trauma, 2004, 18(5):271-278.
15.	Mangnus L, Meijer DT, Stufkens SA, et al. Posterior malleolar fracture patterns. J Orthop Trauma, 2015, 29(9):428-435.
16.	张振宇, 王伟, 李元城, 等. 联合修复下胫腓联合前韧带及固定后踝骨块对下胫腓联合稳定性的影响. 中国修复重建外科杂志, 2014, 28(4):448-451.
17.	Bartoníček J, Rammelt S, Kostlivý K, et al. Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg, 2015, 135(4):505-516.
18.	顾文奇, 施忠民, 梅国华, 等. 双钢板内固定治疗腓骨远端粉碎性骨折. 中国修复重建外科杂志, 2014, 28(1):56-59.
19.	李永舵, 刘书茂, 贾金生, 等. 后踝骨折内固定方法的选择:生物力学及临床应用研究. 北京大学学报(医学版), 2011, 43(5):718-723.
20.	Odak S, Ahluwalia R, Unnikrishnan P, et al. Management of Posterior Malleolar Fractures:A Systematic Review. J Foot Ankle Surg, 2016, 55(1):140-145.
21.	Kumar N, Shama V. Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction:a functional outcome study in military personnel. Strategies Trauma Limb Reconstr, 2015, 10(2):79-85.

1. Erdem MN, Erken HY, Burc H, et al. Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures. Foot Ankle Int, 2014, 35(10):1022-1030.
2. Veltman ES, Halma JJ, de Gast A. Longterm outcome of 886 posterior malleolar fracture:A systematic review of the literature. Foot Ankle Surg, 2016, 22(2):73-77.
3. Leung KH, Fang CX, Lau TW, et al. Preoperative radiography versus computed tomography for surgical planning for ankle fractures. J Orthop Surg (Hong Kong), 2016, 24(2):158-162.
4. Wang Y, Wang J, Luo CF. Modified posteromedial approach for treatment of posterior pilon variant fracture. BMC Musculoskelet Disord, 2016, 17:328.
5. Yamamoto N, Ogawa K, Terada C, et al. Minimally invasive plate osteosynthesis using posterolateral approach for distal tibial and tibial shaft fractures. Injury, 2016, 47(8):1862-1866.
6. Verhage SM, Boot F, Schipper IB, et al. Open reduction and internal fixation of posterior malleolar fractures using the posterolateral approach. Bone Joint J, 2016, 98-B(6):812-817.
7. Erdem MN, Erken HY, Burc H, et al. Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures. Foot Ankle Int, 2014, 25(10):1022-1030.
8. Amorosa LF, Brown GD, Greisberg J. A surgical approach to posterior pilon fractures. J Orthop Trauma, 2010, 24(3):188-193.
9. Ortiz CA, Wagner P, Wagner E. State-of-the-art in ankle fracture management in chile. Foot Ankle Clin, 2016, 21(2):367-389.
10. Miller AN, Carroll EA, Parker RJ, et al. Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res, 2010, 468(4):1129-1135.
11. Mingo-Robinet J, López-Durán L, Galeote JE, et al. Ankle fractures with posterior malleolar fragment:management and results. J Foot Ankle Surg, 2011, 50(2):141-145.
12. 魏世隽, 蔡贤华, 刘曦明, 等. 后内侧入路低切迹多向锁定接骨板内固定治疗累及内踝的胫骨后 Pilon 骨折. 中国修复重建外科杂志, 2014, 28(5):557-561.
13. 赵宏谋, 梁晓军, 俞光荣, 等. 后踝骨折复位程度对胫距关节接触情况的影响. 中华创伤杂志, 2014, 30(10):1035-1039.
14. Fitzpatrick DC, Otto JK, Mckinley TO, et al. Kinematic and contact stress analysis of posterior malleolus fractures of the ankle. J Orthop Trauma, 2004, 18(5):271-278.
15. Mangnus L, Meijer DT, Stufkens SA, et al. Posterior malleolar fracture patterns. J Orthop Trauma, 2015, 29(9):428-435.
16. 张振宇, 王伟, 李元城, 等. 联合修复下胫腓联合前韧带及固定后踝骨块对下胫腓联合稳定性的影响. 中国修复重建外科杂志, 2014, 28(4):448-451.
17. Bartoníček J, Rammelt S, Kostlivý K, et al. Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg, 2015, 135(4):505-516.
18. 顾文奇, 施忠民, 梅国华, 等. 双钢板内固定治疗腓骨远端粉碎性骨折. 中国修复重建外科杂志, 2014, 28(1):56-59.
19. 李永舵, 刘书茂, 贾金生, 等. 后踝骨折内固定方法的选择:生物力学及临床应用研究. 北京大学学报(医学版), 2011, 43(5):718-723.
20. Odak S, Ahluwalia R, Unnikrishnan P, et al. Management of Posterior Malleolar Fractures:A Systematic Review. J Foot Ankle Surg, 2016, 55(1):140-145.
21. Kumar N, Shama V. Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction:a functional outcome study in military personnel. Strategies Trauma Limb Reconstr, 2015, 10(2):79-85.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF SPRING HOOK PLATE FOR POSTERIOR MALLEOLUS FRACTURE

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