Fixation in bimalleolar fractures of ankle-a comparative study between fibula plating versus intramedullary nailing with medial malleolar screw
Journal Title: Indian Journal of Orthopaedics Surgery - Year 2016, Vol 2, Issue 4
Abstract
Background: A bimalleolar ankle fracture is unique in the sense that ankle is the distal most weight bearing joint and locomotion depends upon stability of the ankle mortise. The best option for management of bimalleolar ankle fracture still remains unclear because of the variability of fracture patterns and availability of variety of implants. Objectives: This study was conducted to set the indications for the two modalities of surgical fixation viz- fibular plate fixation and fibula nailing in various fracture subtypes; and to compare the functional outcome of bimalleolar ankle fracture managed by these two methods at 9 months post-operative interval. Complications associated with specific modalities of fixation were also studied. Material and Method: This was a randomized, prospective and comparative study for the methods used for management of the fracture done in Department Of Orthopedics and Traumatalogy at USSC, Indore from January 2014 to April 2016. 45 patients with bimalleolar fractures were included in the study. Clearance from ethical committee of the institute was taken. Informed consent was taken and patients were evaluated pre operatively and post operatively at 1, 3, 6 and 9 months interval with the help of Olerud Molander Ankle Score (OMAS) and radiographically. Results: Duration after which partial weight bearing was initiated was significantly shorter in group1 (fibula plating) (p<0.0001) [average 44.54 days as compared to 55.71 days]. The average time before union and hence full weight bearing was 11.89 weeks (range10.71 - 13.28 weeks) in group 1 and 13.67 weeks (range11.56-15 weeks), (p<0.0001) in group 2 (Intramedullary nailing). Functional outcome using OMAS scoring at 3 months post operatively was significantly better in group 1(p< 0.0001). While at 6 months and 9 months post operatively the functional outcomes were similar. Conclusion: We concluded that Fibula Plating is a better method of fixation in AO type B2, B3 and C2 fractures while Intramedullary Nailing in Fibula is a better method of fixation in AO type A2 fractures with respect to clinical and functional outcomes. We also concluded that if the ligament injury has been dealt with properly and repaired and the fixation is anatomically sound the period of immobilization (4 to 6 weeks) does not affect the range of motion of ankle joint in the long duration.
Authors and Affiliations
Murtuza Rassiwala, Jayant Sharma, Pramod P. Neema, Mayank Patel
Keywords
Related Articles
- EP ID EP242602
- DOI -
- Views 76
- Downloads 0
A study of clinical and functional outcome of primary total hip replacement in osteoarthritis of hip
Introduction and Objectives: Osteoarthritis is the most common disorder associated with severe hip pain and disability in adult population. Primary total hip replacement (THR) aims for immediate and long lasting effects...
Evaluation of Indigenous Antibiotic Impregnated Cement Rod in the treatment of chronic osteomyelitis of long bones
Introduction: Management of chronic osteomyelitis demands prolonged Antibiotic therapy. Antibiotics may be administered systemically or locally. Local antibiotic therapies have definite advantages. In this study we used...
Evaluation of Different Modalities of Osteosynthesis of Proximal Humerus Fractures in Adults
Background: Proximal humerus fractures account for approximately 4-5% of the fracture attendance at the hospital. The management of proximal humeral fractures has always been an enigma because of numerous muscles attachm...
Managing paediatric un-stable lateral condyle fractures of humerus with unburried Kirschner wires
Introduction: Lateral condyle fractures are one of the commonest injuries encountered in the emergency orthopaedics. The intraarticular nature of the fracture and the high incidence of non-union following fracture makes...
Comparative study between functional outcome of closed and open percutaneous K-wire fixation in gartland type II and III extension type supracondylar humerus fractures in children
Background: Supracondylar fractures of humerus is one of the most common injuries in children. It requires great attention while treating as it is associated with neuro-vascular complications pre-operatively and intra-op...