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Trimalleolar fracture after open reduction and internal fixation. A suture anchor has been used for the medial malleolar fracture fixation.
Source publication
Level of Evidence: V, Expert Opinion
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Background
Tibial eminence fractures often occur during sports participation, but the optimum choice of technique for treatment is still controversial. The aim of the current work was to compare the clinical outcomes of 2 new arthroscopic anchor fixation techniques for tibial eminence fracture.
Material/Methods
We included 72 isolated tibial emine...
Citations
... 5 Various surgical modalities have been described in literature for management of medial malleolus fracture. Various implants used in medial malleolus fracture fixation include cancellous screw, 6 tension band wiring, 7 plate fixation, 8 and suture anchors 9 have been used in medial malleolus fracture fixation. Surgical procedures can be open reduction internal fixation or closed reduction percutaneous fixation. ...
Background Medial malleolus fracture is commonly seen nowadays in orthopaedic practice. There are different modalities of treatment based on fracture pattern and socioeconomic status. Undisplaced fracture can be managed by cast application. Various surgical modalities of treatment are available in treating medial malleolus fracture like tension band wiring, cancellous screw or cortical screw fixation, plate fixation, Kirschner wire, and suture anchors. The purpose of our study was to evaluate radiological outcome of medial malleolus fracture managed with open reduction internal fixation and closed reduction percutaneous fixation.
Materials and Methods Our study included 67 patients who met inclusion criteria and were divided into two groups. Group 1 included 52 patients with medial malleolar fractures cases and were treated with open reduction and internal fixation either by cancellous screw fixation or tension band wiring. Other 15 patients in group 2 were treated by closed reduction and internal fixation with cannulated cancellous screw. All postoperative patients were evaluated at 1st month, 2nd month, 3rd month, 6th month, and 1 year. We evaluated patient clinically and radiological union of fractures.
Results In our study out of 67 patients there was male preponderance and average age was 46.55 years. Right-side fractures were more compared with left-side fractures. Most common mode of injury was road traffic accident. Transverse fracture pattern was more in number in our study. Average union time in group 1 was 13.46 weeks and group 2 is 15.14 weeks. Fracture union was 96.15% in group 1 and in group 2 was 93.33%.
Conclusion In our study, average radiological union time in patients treated with open reduction internal fixation was early compared with percutaneous fixation. This could be due to direct visualization of fracture site and good approximation of fracture fragments in open reduction internal fixation technique.
... 18 This approach is similar to the standard technique for open medial malleolar fixation, likely with similar risks. 19,20 Our proposed technique describes creating a medial transmalleolar portal, thereby granting access to these hard-to-reach areas of the talus without performing a medial osteotomy. This technique also circumvents the need for extensive soft tissue dissection and avoids potential complications associated with open techniques. ...
... This technique also circumvents the need for extensive soft tissue dissection and avoids potential complications associated with open techniques. 11,17,19,20 Fixation of talus OCD with screws is ideal for nondisplaced or minimally displaced lesions with intact cartilage. 21,22 Other techniques such osteochondral autograft may be possible through the medial transmalleolar portal. ...
This article describes a technique for arthroscopic fixation of an osteochondritis dissecans (OCD) lesion of the medial talar dome with headless compression screws. This technique involves creation of a medial transmalleolar portal using a guide and drill. The medial transmalleolar portal grants perpendicular access for screw fixation of OCD lesions in addition to the potential for osteochondral autograft transplantation (OAT). Advantages include access to the medial talar dome without performing a medial malleolar osteotomy. After completion of OCD fixation, an inverted osteochondral plug can be used to backfill the portal.
... There are a variety of fracture patterns in the medial malleolus; therefore, various internal fixation techniques exist. These include 4.0-mm cortical screw fixation, 4.0mm cancellous lag screw fixation, tension band wiring, 5) suture anchor fixation, 10) and fixation using screws with anti-glide plates in different configurations. A previous study showed that a couple of 4.0-mm partial threaded cannulated screws were enough to fix a simple MMFx. ...
Backgroud:
Open reduction and internal fixation is the standard treatment for a displaced medial malleolus fracture (MMFx), achieving ankle stability and bony union to prevent post-traumatic arthritis. Previous fixation techniques including tension band wiring and unicortical screw fixation are not optimal for fixation of small fragments in MMFx due to their small size and poor manipulability. Here, we describe a novel surgical method using mini-screws only for fixation of small fragments in MMFx.
Methods:
We conducted a retrospective consecutive study of patients who underwent surgery using mini-screws for small fragment MMFx between April 2013 and March 2018. We reviewed the patients' clinical characteristics and assessed the fracture features radiographically. Clinical outcomes were assessed by measuring the range of motion of both ankle joints and investigating symptomatic implants. We reviewed the radiographic outcomes of the medial malleolus and the functional outcomes using the Foot and Ankle Outcome Score (FAOS) at the last follow-up.
Results:
Nine patients were included in the study. The minimal follow-up period was 27 months. There was no incidental bone breakage during the procedure. All MMFx healed without reduction loss, nonunion, or implant failure at the last follow-up. Two patients had mild osteoarthritic changes of the ankle joint. The mean FAOS score of the patients was 80.99 (range, 65.44-98.42). No patients required removal of the hardware.
Conclusions:
Fixation of comminuted fractures of the medial malleolus using mini-screws for young adult patients is a straightforward and simple technique. Safe fixation of the anterior and posterior colliculi reduces the risk of implant irritation symptoms that necessitate implant removal.
... Undisplaced fracture and isolated medial malleolus fracture can be managed by cast application [3,4]. Various surgical modalities of treatment are available in treating medial malleolus fracture like tension band wiring [5], cancellous screw or cortical screw fixation [6], plate fixation, k-wire, suture anchors [10]. ...
... More studies required to know results of plate fixation in medial malleolus fracture fixation. Suture anchors have been used to manage small fracture fragment of the medial malleolus fracture without causing complication of fracture fragment or prominent hardware [10]. More studies are required to demonstrate use of suture anchors in medial malleolus fracture management. ...
Results: In our study out of 53 patients there was male preponderance and average age was 42.07 years. Right side fractures were more compared to left side fractures. Most common mode of injury was road traffic accident. Average union time in group 1 is 14.4 weeks and group 2 is 12.6 weeks. Fracture union was 100% in group 1 and in group 2 was 96.66%. All the data from the study was evaluated by Fischer exact test with P value calculated for union rates between two groups patient treated with Tension Band Wiring Vs Cannulated cancellous screw. P value <0.05 was considered statistically significant. Conclusion: In our study average union time in patients treated with cancellous screw fixation was early compared to patients treated with tension band wiring group. In cancellous screw fixation group required additional stability in the form additional k-wire or second cancellous screw with ankle joint immobilization. Background: Medial malleolus fracture is commonly seen nowadays in orthopaedic practice. There are different modalities of treatment based on fracture pattern, socioeconomic status. Undisplaced fracture can be managed by cast application. Various surgical modalities of treatment are available in treating medial malleolus fracture like tension band wiring, cancellous screw or cortical screw fixation, plate fixation, k-wire, suture anchors. The purpose of our study was to evaluate and compare radiological outcome of medial malleolar fracture managed with tension band wiring and cancellous screw fixation. Materials and Methods: Our study included 53 patients who met inclusion criteria and were divided into two groups. 25 patients with bimalleolar fractures cases were included in group 1 and treated with open reduction and tension band wiring (TBW) for medial malleolus fracture. Other 28 patients in group 2 were treated by open reduction/closed reduction with cannulated cancellous screw for medial malleolus fracture. In all the cases lateral malleolus was fixed and common factor in both the group. All post op patients were evaluated at 1st month, 2nd month, 3rd month, 6th month and 1 year. We evaluated patient clinically and radiological union of fractures. Abstract Original Article 1 1 1
... [1,2] Many fixation methods have been described, including Kirschner wire, suture anchors, intraosseous wire loop fixation, antiglide plating, fully threaded headless compression screws, partially threaded compression screws, and tension-bend wiring. [3][4][5][6][7][8] In the current study, we compared three different fixation techniques for medial malleolus fractures. To our knowledge, there is no such study so far comparing the three most commonly used fixation techniques: tensionband wire fixation, partially threaded cannulated compression screws, and fully threaded cannulated headless compression screws. ...
Objectives:
This study aims to compare the three most commonly used fixation techniques: tension-band wire fixation, partially threaded cannulated screws, and fully threaded cannulated headless compression screws.
Patients and methods:
Ninety patients with medial malleolus fractures were included in the study. Patients were divided into three groups. Group A included patients who underwent tension-band wire fixation (n=26), Group B partially threaded cannulated compression screws (n=32), and Group C fully threaded cannulated headless compression screws (n=32). The type of medial malleolus fracture, healing rates, implant-related complications, rate of infection, hardware removal, weight-bearing restrictions, mean interval time from the injury to the surgery, and Body Mass Indexes (BMIs) were investigated. The patients' radiographs (standard anteroposterior, lateral, and mortise) were reviewed. The American Orthopedic Foot and Ankle Society (AOFAS) scoring system was used for clinical evaluation.
Results:
No significant difference was observed between the three groups in terms of age, gender, BMI, follow-up period, and fracture type. Union rate for group C was significantly shorter than groups A and B. There was no implant failure or irritation in group C and this was statistically significant comparing to group A and B (p=0.037). However, there was no significant difference between group A and B (p=0.41). There were no significant differences in the three groups according to AOFAS. Patients with low BMI in groups A and B had a high rate of implant-related complications. There was a significant correlation between low BMI and implant-related complication (p<0.001).
Conclusion:
Union rate in the group who were operated with fully threaded cannulated headless compression screws was significantly shorter than the other groups. This study has shown that tension band wiring and partially threaded cannulated compression screws can cause irritation of soft tissues and pain over the hardware implantation site. Patients with low BMI are vulnerable for implant-related complications.
... No cases have been published on this phenomenon with the Arthrex (Naples, FL) no. 2 FiberTape for its original design for lateral ankle instability augmentation with the InternalBrace6, Achilles detach/reattach procedure with the SpeedBridge6, or other studies that utilize this type of product. Loveday et al. [13] offer a technique based level 5 study utilizing a titanium suture anchor TWINFIX Ti 5.0 mm with braided suture no. 2 ULTRABRAID Smith & Nephew (Andover, MA). This study has a similar idea to the Arthrex (Naples, FL) KTB with the idea that is a simplified approach and would offer less irritation. ...
... This study has a similar idea to the Arthrex (Naples, FL) KTB with the idea that is a simplified approach and would offer less irritation. The authors however discuss the technique without any supporting data [13] that we can compare with our findings. Patel et al. [14] offer a sled type technique with 2 prongs distally, a "U" shaped construct with two screws, and washers proximally for added stability. ...
The traditional stainless steel wire tension band (WTB) has been popularized for small avulsion fractures at the medial malleolus. Despite the tension band principle creating a stable construct, complications continue to arise utilizing the traditional stainless steel WTB with patients experiencing hardware irritation at the tension band site and subsequent hardware removal. Coupled with hardware irritation is fatigue failure with the wire. The goal of this investigation was to retrospectively compare this traditional wire technique to an innovative knotless tension band (KTB) technique in order to decrease costly complications. A total of 107 patients were reviewed with a minimum follow-up of 1 year. Outcome measures include descriptive data, fracture classification, results through economic costs, and fixation results (including hardware status, healing status, pain status, and time to healing). The KTB group had a 13% lower true cost as compared to the WTB group while the fixation results were equivocal for the measured outcomes. Our results demonstrate that the innovative KTB is comparable to the traditional WTB while offering a lower true cost, an irritation free reduction all without the frustration of returning to the operating room for additional hardware removal, which averages approximately to $8,288.
... No cases have been published on this phenomenon with the Arthrex (Naples, FL) no. 2 FiberTape for its original design for lateral ankle instability augmentation with the InternalBrace6, Achilles detach/reattach procedure with the SpeedBridge6, or other studies that utilize this type of product. Loveday et al. [13] offer a technique based level 5 study utilizing a titanium suture anchor TWINFIX Ti 5.0 mm with braided suture no. 2 ULTRABRAID Smith & Nephew (Andover, MA). This study has a similar idea to the Arthrex (Naples, FL) KTB with the idea that is a simplified approach and would offer less irritation. ...
... This study has a similar idea to the Arthrex (Naples, FL) KTB with the idea that is a simplified approach and would offer less irritation. The authors however discuss the technique without any supporting data [13] that we can compare with our findings. Patel et al. [14] offer a sled type technique with 2 prongs distally, a "U" shaped construct with two screws, and washers proximally for added stability. ...
The traditional stainless steel wire tension band (WTB) has been popularized for small avulsion fractures at the medial malleolus. Despite the tension band principle creating a stable construct, complications continue to arise utilizing the traditional stainless steel WTB with patients experiencing hardware irritation at the tension band site and subsequent hardware removal. Coupled with hardware irritation is fatigue failure with the wire. The goal of this investigation was to retrospective compare this traditional wire technique to an innovative knotless tension band (KTB) technique in order to decrease costly complications. A total of 107 patients (WTB n=89, KTB n=18) were reviewed with a minimum follow up of 1-year and a mean age of 46.2±16.4 years for the WTB and 43.2±11.1 years for the KTB at the time of surgery (p=0.442). Outcome measures include descriptive data, fracture classification, results through economic costs (including initial product costs, return to operating room costs for irritation/revision/removal of hardware), and fixation results (including hardware status, healing status, pain status, and time to healing). The KTB group had a 13% lower true cost as compared to the WTB group while the fixation results was equivocal for the measured outcomes. Our results demonstrate that the innovative KTB is comparable to the traditional WTB while offering a lower true cost, an irritation free reduction all without the frustration of returning to the operating room for additional hardware removal, which averages approximately $8,288.
... Painful hardware and reoperation have been reported in up to 15% of patients (5,8). Low-profile constructs using braided suture have been described in published studies for medial malleolar fracture fixation, including a tension band construct; however, they have not shown superior strength profiles compared with traditional tension band methods (1,12). Furthermore, the studies have shown that the mechanical behavior is changed by the knot configuration when using braided suture in a tension band construct (13). ...
The present study introduces a knotless tension band construct and compares its biomechanical behavior with that of a traditional stainless steel tension band construct. Fourth-generation composite tibial Sawbones(®) were used in the present study. Fracture models were created to mimic Orthopaedic Trauma Association type 44-B2.2 ankle fractures. A total of 20 specimens were randomized evenly into a stainless steel tension band group (control group); or a knotless tension band group. The fixation constructs were mechanically tested, and the stiffness and failure strengths were calculated. Two failure strengths were determined: the engineering-based failure strength, defined as the greatest tensile load tolerated by the construct; and the clinical failure strength, defined as the force required to displace the fracture by 2 mm. We used 2-tailed independent samples t tests to compare and identify significant differences. The knotless tension band construct was 7.7% stronger and 33.2% stiffer and required a 36.7% greater force to displace the fracture by 2 mm. Independent sample t tests confirmed that differences in mean stiffness (p = .003) and clinical failure strength (p = .003) were statistically significant. Although the mean engineering strength for the knotless group was greater than that for the stainless steel group, this difference was not statistically significant (p = .170). This knotless tension band construct could potentially offer both clinical and biomechanical advantages compared with the current stainless steel standard.
Unstable medial malleolar fractures are treated with either standard open reduction internal fixation (ORIF) or a percutaneous approach. The percutaneous approach avoids the potentially excessive soft tissue dissection associated with an open approach but can also result in inadequate anatomic reduction. No studies have compared the incidence of radiographic healing of medial malleolar fractures between an open approach and percutaneous fixation. A retrospective comparative study was performed at a single institution across multiple sites. Electronic medical records and digital radiographs were reviewed for 845 patients who had undergone either ORIF or percutaneous screw fixation (PSF) of a medial malleolar fracture. The interval to fracture healing was measured. Logistic regression analysis was used. Of the 490 included patients, 458 (93.44%) underwent standard ORIF and 32 (6.53%) underwent PSF. Patients who underwent ORIF were 5 times more likely to have a healed fracture at 8 weeks than were patients who had undergone PSF (p < .001). Compared with standard ORIF, PSF of medial malleolar fractures leads to an increased risk of an unhealed fracture at 8 weeks. This was likely due to a combination of soft tissue interposition within the fracture site and inadequate fluoroscopic reliability, leading to poor anatomic reduction and inaccurate fixation.
Background: Intercondylar eminence fractures of the tibia are often treated by arthroscopic surgery, but the fixation methods are controversial. Objective: To compare curative effect of hollow screw and suture fixation in treatment of tibial intercondylar eminence fractures under arthroscopy. Methods: A total of 46 patients with tibial intercondylar eminence fractures were recruited from the Third People's Hospital of Yancheng, China from June 2010 to January 2013. According to the patient's willing and physician's suggestions, the involved patients were divided into hollow screw group (n=25) and suture fixation group (n=21), undergoing hollow screw and suture fixation under arthroscopy, respectively. Results and Conclusion: According to Ikeuchi grade, the excellent and good rate after fixation showed no significant differences between the two groups (P > 0.05), but the functional training time in hollow screw group was significantly shorter than that in suture fixation group (P < 0.05). Hollow screw treatment under the arthroscopy is better than suture fixation in treatment of intercondylar eminence fractures of the tibia.
