Wang Xipeng, Nie Kun, Liu Jiangtao, Jiang Cong
Department of Orthopaedic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Surg. 2025 Jun 16;12:1581909. doi: 10.3389/fsurg.2025.1581909. eCollection 2025.
This study aimed to compare the clinical efficacy of modified T-plate internal fixation vs. conventional cannulated lag screws in treating medial malleolus fractures of the distal tibia in elderly patients, with a focus on surgical outcomes, functional recovery, and complication profiles.
A prospective cohort analysis was conducted on a sample of 46 elderly patients (aged ≥ 60 years) with isolated medial malleolus fractures treated at a single orthopedic center between April 2020 and December 2022. Patients were allocated to either modified T-plate internal fixation ( = 23) or cannulated lag screw internal fixation ( = 23). The postoperative conditions, including operative time, blood loss, and complications, as well as the long-term rehabilitation outcomes, such as AOFAS ankle and hindfoot score at 3, 6, and 12 months, were systematically compared.
The modified T-plate group exhibited significantly superior early functional recovery, with higher AOFAS ankle and hindfoot score at 3 months (63.5 ± 8.0 vs. 55.3 ± 13.3, = 0.015) and 6 months (74.6 ± 8.9 vs. 67.8 ± 12.5, = 0.041), though operative time was longer (85.6 ± 12.3 vs. 72.4 ± 10.8 min, < 0.001). No significant differences were observed in intraoperative blood loss (120.5 ± 25.6 vs. 115.8 ± 22.4 ml, = 0.511), overall complication rates (8.7% vs. 17.4%, = 0.381), or long-term outcomes of AOFAS ankle and hindfoot score at 12 month (89.0 ± 8.7 vs. 87.9 ± 7.6, = 0.628). Both groups demonstrated comparable safety profiles, with no severe complications during a mean 14.4-month follow-up.
Modified T-plate fixation has been shown to facilitate early functional rehabilitation in elderly patients with distal tibial medial malleolus fractures. Although this method requires marginally longer operative time, it offers equivalent long-term outcomes and safety to traditional lag screws internal fixation. Notably, it is particularly advantageous for osteoporotic patients, as it addresses the challenges posed by bone fragility and compromised healing capacity.
本研究旨在比较改良T形钢板内固定与传统空心拉力螺钉治疗老年患者胫骨干骺端内侧踝关节骨折的临床疗效，重点关注手术效果、功能恢复和并发症情况。
对2020年4月至2022年12月在单一骨科中心接受治疗的46例（年龄≥60岁）孤立性内侧踝关节骨折老年患者进行前瞻性队列分析。患者被分配至改良T形钢板内固定组（n = 23）或空心拉力螺钉内固定组（n = 23）。系统比较术后情况，包括手术时间、失血量和并发症，以及长期康复结果，如3个月、6个月和12个月时的美国足踝外科协会（AOFAS）踝关节与后足评分。
改良T形钢板组早期功能恢复显著更优，3个月时AOFAS踝关节与后足评分更高（63.5±8.0 vs. 55.3±13.3，P = 0.015），6个月时也是如此（74.6±8.9 vs. 67.8±12.5，P = 0.041），尽管手术时间更长（85.6±12.3 vs. 72.4±10.8分钟，P<0.001）。术中失血量（120.5±25.6 vs. 115.8±22.4 ml，P = 0.511）、总体并发症发生率（8.7% vs. 17.4%，P = 0.381）或12个月时AOFAS踝关节与后足评分的长期结果（89.0±8.7 vs. 87.9±7.6，P = 0.628）均未观察到显著差异。两组安全性相当，在平均14.4个月的随访期间均未出现严重并发症。
改良T形钢板固定已被证明有助于老年胫骨干骺端内侧踝关节骨折患者的早期功能康复。虽然这种方法手术时间略长，但与传统拉力螺钉内固定相比，长期结果和安全性相当。值得注意的是，它对骨质疏松患者特别有利，因为它解决了骨脆性和愈合能力受损带来的挑战。
