The Outcome Between Anatomical Locking Plates And Interlocking Intramedullary Nail In The Lateral Malleolus Fractures

Ankle fractures are the most common articular fracture,requring a anatmoicreduction and avoiding traumatic and degenerative arthritis. Lateral malleolus fracturesare the most common in the ankle injure.Its anatmoic reduction is critical tosurgey.Fixation of displaced fractures in the lateral malleolus is typically treated withplate osteosynthesis.Although it is associated with complication,support a anatmoicreduction.The fibular interlocking intramedullary nail is an alternative and stablemethod of fixation give good radiological and functional Outcomes with a minimalincision and tissue dissection, and has the potential to reduce the incidence ofcomplications.Objective: To compare the clinical effects of in treating lateral malleolus fracturesbetween anatomical locking plates and interlocking intramedullary nail.Methods: This retrospective study was conducted on a total of40cases of lateralmalleolus fractures were treated in our department October2011to June2013.All theoperations were completed by the same goup of the surgeon.With the anatomicallocking plates (Group A) were applied in20cases，and interlocking intramedullarynails(Group B) in15cases.Operative time, Fracture union time,Preoperativehospitalization and Ankle function outcome (Olerud and Molander ankle socore), incidence of postoperative complications including incision complications, discomfortfixation, internal fixation loose an failure were analyzed and compared by theSPSS20.0.Results:All the patients were followed up for averagely10.5±1.4month(from6to12months).39patients were fibular union. The difference in operative time was notstatistically significant (p>0.05), while the difference in fracture union time、anklefunction score and the Preoperative hospitalization was statistically significant (p <0.05).The average healing time of Group A was11.40±1.76weeks, Group B was10.07±1.94weeks.Functional assessment according to Olerud and Molander ankle score was89.32±11.49points in Group A and81.00±13.78in Group B.The difference in incisioncomplications and internal fixation loose and failure have no statistical sense(P>0.05),but the difference in incidence of discomfort fixation was statisticallysignificant (p <0.05).Only one patient complain the symptoms related to the metalworkin the intramedullary nail group. But several postoperative complications occured inlocking plates group.4patients with poor incision healing, the10patients feeldiscomfort and removal the metalwork.One case due to the fixation loosen werereported.A patient was nonunion.Conclusions:Locking plate fixation is the conventional mothed to treat most unstablelateral malleolus fractures..Although it is associated with some complications,it supporta anatmoic reduction and the ankle function score is good.For patients with the poor softtissue conditions,fibula interlocking intramedullary nail is more appropriate.Comparionto the plate,fabula nail gives less functional outcomes and reduction,but it give avery low risk of complications.It requires a minimal incision and potects the soft tissueto accelerate the fracture healing,especially for elderly patients with osteoporosis,multiple segments of the distal fibula fracture.