| Objective To analyze the effectiveness of buttress plates and cannulated screws in the treatment of type IV large posterior malleolus fractures of ankle with supination-external rotation via the posterolateral approach.Methods Between August 2016 to August 2018,72 patients(41 males and 31 females;age from 21 to 67 years,mean age 42.86 years)was selected from the Department of Trauma and Orthopaedics of the Third Affiliated Hospital of Anhui Medical University(Hefei First People's Hospital)with type IV large posterior malleolus fractures of ankle with supination-external rotation were treated by cannulated screw or buttress plate fixation by the posterolateral approach.According to the different fixation methods of posterior malleolar fracture,the cases were divided into two groups: buttress plate group and cannulated screw group.The posterior malleolus fractures were fixed with buttress plate,including 23 males and 17 females.The posterior malleolus fractures were fixed with cannulated screw,including 18 males and 14 females.The results were assessed by comparing the operative time,perioperative blood loss,the bone healing time and the postoperative complications.Ankle joint function was evaluated according AOFAS scoring system.Results All the patients were followed for ?12months(13.13 months on avarege).After the follow-up period(range 12 to 16 months),no incision dehiscence,delayed fracture healing,non-healing phenomenon was observed.In the buttress plate group,there were 3 cases of posterior lateral incision redness with obvious bloody exudation on the 2nd postoperative day,1 case developed into incision superficial infection,1 case developed deep infection.The 2 cases obtained the first stage of healing after their incision treated with dressing and sensitive antibiotics.One case of the cannulated nail group had a posterior lateral incision redness with obvious bloody exudation on the third day after operation,and no skin incision infection occurred in the later stage.In the cannulated nail group,there were 3 cases of nail screw loosening after 2 months of postoperation.The posterior malleolar fracture fragment was slightly displaced backward and downward(2mm,3mm,3mm).The incidence of surgical complications(3/40)was 7.5% in the buttress plate group and 12.5% in the cannulated nail group(4/32).The difference was not statistically significant(P>0.05).The patients in the buttress plate group had a preoperative time(6.75±1.85)days,the bone healing time(11.53±1.06)weeks,the operation time(138.53±14.59)min and the intraoperative blood loss(144.83±15.02)m L and the patients with the cannulated screws group preoperative time(6.28±1.67)days,the bone healing time(11.97±1.20)weeks,operation time(130.91±15.44)min,and intraoperative blood loss(124.69±16.00)m L.There was no significant difference in preoperative time and bone healing time between the two groups(P>0.05).There was significant difference in the operation time and intraoperative blood loss between the two groups(P<0.05).According to the AOFAS scoring system,the outcomes in buttress plate group were rated as excellent in 15 cases,good in 19,fair in 5,and poor in only 1 case,for an excellent and good rate of 85.0%.And the outcomes in cannulated screw group were rated as excellent in 11 cases,good in 15,fair in 4,and poor in only 2 case,for an excellent and good rate of 81.3%.There was no significant difference between the two groups in the excellent rate of the AOFAS score(P>0.05).There was significant difference between the two groups in the AOFAS score(P<0.05).Conclusion A posterolateral approach with buttress plate internal fixation could be more effective technique for reduction and fixation of type IV large posterior malleolus fragments of ankle with supination-external rotation,although the operation time and intraoperative blood loss were higher than the cannulated nail group.There is a certain risk of incision infection in the buttress plate group,but in the long run,the better ankle function and prognosis can be obtained.In addition,we recommend the plate fixation for the patients with posterior malleolar fracture comminuted or osteoporosis.For patients with poor skin and soft tissue conditions or basic diseases such as diabetes,cannulated nail was recommended. |
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