Çetin IŞIK, Osman TECİMEL, RAMAZAN AKMEŞE, Ahmet FIRAT, Mesut TAHTA, MURAT BOZKURT

The comparison of plate-screw and tension band techniques in the osteosynthesis of Danis-Weber Type A and B lateral malleolar fractures

Amaç: Çalışmada izole Danis-Weber Tip A ve B lateral malleol kırıklarında plak-vida ile gergi bandı tekniklerinin klinik ve radyolojik sonuçlarının karşılaştırılması amaçlandı. Çalışma planı: Kasım 2005-Aralık 2010 tarihleri arasında, izole Danis- Weber tip A ve B lateral malleol kırığı tanısıyla 4 farklı merkez ve 6 ayrı klinikte opere olmuş 135 olgu (82 tip B, 53 tip A kırık) geriye dönük olarak değerlendirildi. Grup 1de yer alan 81 (55 tip B, 26 tip A) hastada lateralden 1/3 tübüler plak ve vida tekniği; Grup 2de yer alan 54 (27 tip B, 27 tip A) hastada ise gergi bandı tekniği ile cerrahi tespit uygulandı. Gruplar klinik ve radyolojik sonuçlarına göre karşılaştırıldı. İstatistiksel analizde Student-t testi kullanıldı. Bulgular: Grup 1de cerrahi insizyon skarı tip Ada ortalama 4.9 cm (4.5-5.4), tip Bde 6.8 cm (5.6-7.5) iken; Grup 2de 4 cm (3.5-5.2) ve 5.3 cm (5.0-5.9) olarak ölçüldü. Radyolojik kaynama Grup 1de ortalama 10 haftada (7-13) sağlanırken, Grup 2de 9 haftada (7-12) sağlandı. Grup 1de 12 hastada takiplerde implantlar çıkarılırken; Grup 2de sadece bir hastada implantların çıkarılmasına gerek görüldü. AOFAS Skoru grup 1de ortalama 90 (72-100) iken; Grup 2de 92 (70-100) olarak ölçüldü. Çıkarımlar: Danis-Weber Tip A ve B kırıklarında kullanılan her iki cerrahi teknik de, mükemmel sonuç vermektedir. Gergi bandı tekniği bu tip kırıklarda ucuz ve kabul edilebilir bir tedavi seçeneği olabilir.

Danis-Weber Tip A ve B lateral malleol kırıklarında plak-vida ve gergi bandı tekniği sonuçlarının karşılaştırılması

Objective: The aim of this study was to compare the clinical and radiological results of plate-screw and tension band fixation in isolated Danis-Weber Type A and B lateral malleolar fractures. Methods: A total of 135 cases of lateral malleolar fractures (82 Danis-Weber Type B and 53 Type A) operated on in 4 different centers and 6 orthopaedic clinics between November 2005 and December 2010 were reviewed retrospectively. Eigthy-one patients (55 Type B and 26 Type A) had lateral 1/3 tubular plate and screw fixation (Group 1), while the remaining 54 patients (27 Type B and 27 Type A) were operated on with tension band technique (Group 2). The clinical and radiological results of the groups were compared. Student t test was used in statistical analysis. Results: The mean length of surgical incision scar was 4.9 cm (4.5-5.4 cm) for Type A fractures and 6.8 cm (5.6-7.5 cm) for Type B in Group 1 and 4.0 cm (3.5-5.2 cm) for Type A and 5.3 cm (5.0-5.9 cm) for Type B fractures in Group 2. Radiological union was obtained at mean of 10 weeks (7-13 weeks) in Group 1 and 9 weeks (7-12) in Group 2. The implant had to be removed in 12 patients in Group 1 and in one patient in Group 2. The mean AOFAS Score was 90 (72-100) and 92 (70-100) in Groups 1 and 2, respectively. Conclusion: Both plate-screw and tension band techniques revealed excellent results in isolated Danis-Weber Type A and B fractures. The tension band technique may be an alternative fixation method in the treatment of these fractures.

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1. Ryd L, Bengtsson S. Isolated fracture of the lateral malleolus requires no treatment: 49 prospective cases of supination- eversion type 2 ankle fractures. Acta Orthop Scand 1992;63: 443-6.
2. Lindsjö U. Operative treatment of ankle fracture-disloca- tions. Clin Orthop 1985;199:28-38.
3. Brunner CF, Weber BG. Antiglade plate with supplementary compression. In: Brunner CF, Weber BG, editors. Special Techniques in internal fixation. New York: Springer-Verlag; 1982. p. 123-33.
4. Ostrum RF, Litsky AS. Tension band fixation of medial malleolus fractures. J Orthop Trauma 1992;6:464-8. 5. Kanakis TE, Papadakis E, Orfanos A, Andreadakis A, Xylouris E. Figure eight tension band in the treatment of fractures and pseudarthroses of the medial malleolus. Injury 1990;21:393-7.
6. Mak KH, Chan KM. Leung PC, Ankla fracture treated with the AO principle-an experience with 116 cases. Injury 1985;16: 265-72.
7. DeSouza LJ, Gustilo RB, Meyer TJ. Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg Am 1985;67:1066-74.
8. Winkler B, Weber BG, Simpson LA. The dorsal antiglide plate in the treatment of Danis-Weber Type-B fractures of the distal fibula. Clin Orthop Relat Res 1990;(259):204-9.
9. Panchbhavi VK, Vallurupalli S, Morris R. Comparison of augmentation methods for internal fixation of osteoporotic ankle fractures. Foot Ankle Int 2009;30:696-703.
10. Mast J, Jakob R, Ganz R. Planning and reduction techniques in fracture surgery. New York: Springer-Verlag; 1989. p. 735-62.
11. Eckerwall G, Persson BM. Fracture of lateral malleolus. Comparison of 2 fixation methods in cadavers. Acta Orthop Scand 1993;64:595-7.
12. Schaffer JJ, Manoli A. The Antiglade plate for distal fibular fixation. A biomechanical comparison with fixation with a lateral plate. J Bone Joint Surg 1987;69:596-604.
13. Kim HJ, Oh JK, Oh CW, Hwang JH, Biswal S. Anterior transposition of the superficial peroneal nevre branch during the internal fixation of the lateral malleolus. J Orthop Trauma 2010;68:421-4.
14. Olcay E, Ozturk A, Aksoy B, Ari Z, Bulbul M, Sahinoglu K. Surgical anatomy and safe zones of the superficial peroneal branch of the peroneal nerve in the ankle. [Article in Turkish] Acta Orthop Traumatol Turc 1998;32:340-3.
15. Mirza A, Moriarty AM, Probe RA, Ellis TJ. Percutaneous plating of the distal tibia and fibula: Risk of injury to the saphenous and superficial peroneal nerves. J Orthop Trauma 2010:24:495-8.