Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
Clin Orthop Surg. 2021 Sep;13(3):307-314. doi: 10.4055/cios20293. Epub 2021 Jun 3.
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.
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.
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.
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.
切开复位内固定是治疗外侧腓骨骨折（MMFx）的标准方法，可实现踝关节稳定性和骨愈合，以预防创伤后关节炎。以前的固定技术，包括张力带钢丝和单皮质螺钉固定，由于其尺寸小且操作性差，对于 MMFx 中的小碎片固定不是最佳选择。在这里，我们描述了一种使用微型螺钉固定 MMFx 中小碎片的新型手术方法。
我们对 2013 年 4 月至 2018 年 3 月期间接受微型螺钉治疗小片段 MMFx 的患者进行了回顾性连续研究。我们回顾了患者的临床特征，并对骨折特征进行了影像学评估。通过测量两个踝关节的活动范围和检查有症状的植入物来评估临床结果。我们在最后一次随访时评估了内踝的影像学结果和使用足踝结果评分（FAOS）的功能结果。
本研究纳入了 9 例患者。最小随访时间为 27 个月。手术过程中没有意外的骨断裂。所有 MMFx 在最后一次随访时均愈合，无复位丢失、不愈合或植入物失败。2 例患者有踝关节轻度骨关节炎改变。患者的 FAOS 平均评分为 80.99（范围，65.44-98.42）。无患者需要取出内固定物。
对于年轻成年患者，使用微型螺钉固定粉碎性内踝骨折是一种简单直接的技术。安全固定前、后踝可降低因植入物刺激症状而需要取出植入物的风险。
