Zhenhua Fang, Waizy Hazibullah, Ming Xie, Wusheng Kan
Department of Foot and Ankle Surgery, WuHan Orthopedic Hospital, WuHan PuAi Hospital Affiliated TongJi Medical College, HuaZhong University of Science and Technology - 430 033 WuHan, China.
Indian J Orthop. 2013 Jul;47(4):364-9. doi: 10.4103/0019-5413.114918.
The goal of managing the comminuted fracture of lateral malleolus is to restore length, rotation and alignment which might be more challenging with extensive comminution around the area of the distal tip. The common osteosynthesis techniques such as the one-third tubular plate, tension band wiring, K-wires, screws, or intramedullary nail may be insufficient in cases with a comminuted lateral malleolus. The anatomical hook plate is an alternative implant in such cases. We present our results of the comminuted lateral malleolar fractures (Weber A, B), managed by open reduction and internal fixation (ORIF) with an anatomical hook plate of lateral malleolus (Königsee Implant Company, Germany).
We retrospectively reviewed 20 patients of comminuted fracture of distal lateral malleolus between 2008 and 2010. There were 12 males and 8 females, right side was involved in 18 patients and left in 2. The mean age was 51.9 years (range 18-75 years). The fractures were categorized by Denis-Weber classification type A (n=1), B1 (n=1), B2 (n=13) and B3 (n=5). Nineteen cases were of closed injury and one of open injury (Gustilo Anderson type II). These patients underwent ORIF with a lateral malleolus anatomical hook plate. Followup including radiographs and clinical examinations were performed. The American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were documented at followups.
The mean followup was 21.4 months (range 16-27 months). The average AOFAS score was 94.3 (range 78-100) points. A stable anatomic reduction and bony union were obtained in all the cases. The average time was 3.1 months (range 2.5-4 months). Four cases had complications like posttraumatic osteoarthritis, hardware impingement and superficial wound infection.
A reasonably good stability can be obtained in distal most comminuted fractures of lateral malleolus with a lateral malleolus anatomical hook plate. We believe this method to be a reasonable treatment option for a distal lateral comminuted malleolar fracture when other common fixations are insufficient to fix the fragments.
处理外踝粉碎性骨折的目标是恢复长度、旋转和对线，而在远端尖端区域周围存在广泛粉碎时，这可能更具挑战性。常见的骨固定技术，如三分之一管状钢板、张力带钢丝、克氏针、螺钉或髓内钉，在治疗外踝粉碎性骨折时可能并不充分。在这种情况下，解剖型钩钢板是一种替代植入物。我们展示了使用外踝解剖型钩钢板（德国柯尼希湖植入物公司）切开复位内固定（ORIF）治疗外踝粉碎性骨折（Weber A、B型）的结果。
我们回顾性分析了2008年至2010年间20例外侧远端外踝粉碎性骨折患者。其中男性12例，女性8例，右侧受累18例，左侧2例。平均年龄为51.9岁（范围18 - 75岁）。骨折根据Denis - Weber分类为A 型（n = 1）、B1型（n = 1）、B2型（n = 13）和B3型（n = 5）。19例为闭合性损伤，1例为开放性损伤（Gustilo Anderson II型）。这些患者接受了外踝解剖型钩钢板切开复位内固定术。术后进行了包括X线片和临床检查在内的随访。随访时记录了美国矫形足踝协会（AOFAS）踝后足评分。
平均随访时间为21.4个月（范围16 - 27个月）。平均AOFAS评分为94.3分（范围78 - 100分）。所有病例均获得了稳定的解剖复位和骨愈合。平均时间为3.1个月（范围2.5 - 4个月）。4例出现创伤后骨关节炎、内固定物撞击和浅表伤口感染等并发症。
使用外踝解剖型钩钢板可在大多数外踝远端粉碎性骨折中获得较好的稳定性。我们认为，当其他常见固定方法不足以固定骨折碎片时，这种方法是治疗外侧远端粉碎性踝部骨折的合理选择。
