The Application Comparison Of Kirschner Wire-titanium Cable Tension Band And Hollow Compression Screw In The Treatment Of Supination-external Rotation Ⅳ Degree Internal Malleolus Fractures

ObjectiveTo compare the clinical efficacy of kirschner wire titanium cable tension band and cannulated compression screw in the treatment of supination and external rotation IV degree medial malleolus fractures.Materials and methodsFrom September 2019 to March 2021,64 patients of supination external rotation type IV medial malleolus fractures were treated by two fixation methods in Department of Foot and Ankle Surgery,Zhengzhou Orthopaedic Hospital.There were 23 males and 41 females,aged from 15 to 77 years,with a mean age of(46.27 ± 14.37)years.According to the method of medial malleolus internal fixation,patients were divided into two groups: group A,31 patients received kirschner wire titanium cable tension band fixation;a total of 33 patients in group B were fixed with hollow center compression screws.The two groups of patients were treated by the same senior physicians,there was no difference in surgical techniques and treatment.Record two groups of patients’ age,gender,injury type,medial malleolus operation time,medial malleolus incision length,medial malleolus fracture clinical healing time,incision healing and internal fixation complications(gram,whether screw loosening,titanium needle line whether or not to take off the cover,screw fracture and whether to Pierce the skin of internal fixation),whether the area and medial malleolus postoperative pain and foreign body sensation,The American Association of Foot and Ankle Surgery(AOFAS)scoring system was used to evaluate the effect of ankle recovery after surgery.The obtained data were analyzed statistically.ResultsThere was no significant difference in age,gender and injury type between the two groups(P >0.05).No incision infection or poor healing,no nonunion or delayed union occurred in the two groups.The incision length of medial malleolus,operation time of medial malleolus and clinical healing time of medial malleolus fracture were not significantly different between the two groups(P >0.05).Comparison of postoperative complications of internal fixation: In group A,there were 2 cases of kirschner wire loosening in the medial malleolus,no case of titanium cable tension band coming off,no skin puncture with internal fixator,and the complication rate was 6.5%.In group B,there was 1 case of hollow compression screw loosening of medial malleolus after operation,and no case of screw fracture or puncture of skin with internal fixator,and the complication rate was 3.0%.There was no significant difference in the incidence of postoperative complications between the two groups(P >0.05).Comparison of postoperative AOFAS ankle function scores between the two groups: in group A,25 cases were excellent,4 cases were good,and 2cases were moderate,with an excellent and good rate of 93.5%.In group B,33 cases were excellent,3cases were good,2 cases were medium,the excellent and good rate was 93.9%.There was no significant difference in the excellent and good rates between the two groups(P >0.05).Comparison of postoperative medial malleolus comfort between the two groups: in group A,there were 28 cases without discomfort,2cases with foreign body sensation and 1 case with pain,with an incidence of 9.7%.In group B,there were31 cases without discomfort,2 cases with foreign body sensation,and no pain,with an incidence of 6.1%.There was no significant difference in postoperative medial ankle comfort between the two groups(P >0.05).ConclusionFor supination external rotation IV degree medial malleolus fracture,kirschner wire and titanium cable tension band can provide strong end compression and ideal clinical results as hollow screws.