Klinik Araştırma
BibTex RIS Kaynak Göster

Comparison of cannulated screw, tension band, and mini-fragment t-plate fixation in medial malleolus fractures

Yıl 2023, Cilt: 2 Sayı: 2, 36 - 41, 31.08.2023
https://doi.org/10.58651/jomtu.1325159

Öz

Background: The study aimed to compare the clinical results of cannulated screw (KS), tension band, and mini-fragment T-plate (MTP) fixation in medial malleolus fractures.
Materials and Methods: The present study employed a retrospective cohort design to investigate the outcomes of patients who underwent treatment for medial malleolus fractures at our clinic between January 2016 and January 2019. A total of 90 patients were included in the study, and they received one of three fixation methods: cannulated screw, tension band, or mini-fragment T-plate. The evaluation of ankle and foot functions was conducted using the American Orthopedic Foot and Ankle Surgery score, number of fluoroscopy shots, duration of surgery, and ankle joint range of motion measurements.
Results: After a 12-month follow-up, there was no significant difference between the groups (p=0,263, p=0,432 and P=0,376) in terms of the AOFAS score. The ankle joint range of motion was similar in all groups. According to the radiographs, the compression ability was weaker in the mini-plate group than in the other groups. The mean duration of surgery was shorter in the cannulated screw group (p<0.001). The mean number of scopy shots was not similar between the groups (p<0.001). One patient in the mini-fragment T-plate group developed a superficial infection and recovered with a 2-week oral antibiotic treatment. In the tension band group, one patient experienced skin problems successfully resolved with a one-week treatment regimen. Additionally, three patients treated with cannulated screws required screw removal after fracture union due to their dissatisfaction with screw prominence. No patient underwent revision surgery.
Conclusions: The findings of the study revealed that patients treated with tension bands and cannulated screws demonstrated better clinical outcomes. However, it was observed that these techniques were less favorable compared to the mini-plate procedure due to their potential for tissue irritation.

Kaynakça

  • Ahmed, M., Sohal, H.S., Garg, R.S., Jindal, S., Wadhwani, J. & Bansal, V. (2017). Minifragment T-plate fixation: an alternative method for medial malleolus fracture fixation. Journal of Foot and Ankle Surgery (Asia Pacific), 3(1), 10-14.
  • Aiyer, A.A., Zachwieja, E.C., Lawrie, C.M. & Kaplan, J.R. (2019). Management of isolated lateral malleolus fractures. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 27(2), 50-59.
  • Alam, N. & Parviz, S. (2007). Comparative study of malleolar fractures by tension-band and malleolar screw. BOS J, 12(1), 13-19.
  • Amanatullah, D.F., McDonald, E., Shellito, A., Lafazan, S., Cortes, A., Curtiss, S. & Wolinsky, P. R. (2012). Effect of mini-fragment fixation on the stabilization of medial malleolus fractures. Journal of Trauma and Acute Care Surgery, 72(4), 948-953.
  • Ballmer, F., Hertel, R., Noetzli, H. & Masquelet, A. (1999). The medial malleolar network: a constant vascular base of the distally based saphenous neurocutaneous island flap. Surgical and Radiologic Anatomy, 21(5), 297-303.
  • Barnes, H., Cannada, L.K., & Watson, J.T. (2014). A clinical evaluation of alternative fixation techniques for medial malleolus fractures. Injury, 45(9), 1365-1367.
  • Bucholz, R.W., Henry, S. & Henley, M.B. (1994). Fixation with bioabsorbable screws for the treatment of fractures of the ankle. JBJS, 76(3), 319-324.
  • Carter, T.H., Duckworth, A. & White, T. (2019). Medial malleolar fractures: current treatment concepts. The Bone & Joint Journal, 101(5), 512-521.
  • De Souza, L., Gustilo, R.B., & Meyer, T.J. (1985). Results of operative treatment of displaced external rotation-abduction fractures of the ankle. JBJS, 67(7), 1066-1074.
  • Deniz, G. & Akpancar, S. (2019). Fractures in Geriatric Cases. Geriatrik Bilimler Dergisi, 2(1), 14-19.
  • Dumigan, R.M., Bronson, D.G. & Early, J.S. (2006). Analysis of fixation methods for vertical shear fractures of the medial malleolus. Journal of Orthopaedic Trauma, 20(10), 687-691.
  • Faul, F., Erdfelder, E., Buchner, A. & Lang, A.G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149-1160.
  • Gilbert, B.J., Horst, F. & Nunley, J.A. (2004). Potential donor rotational bone grafts using vascular territories in the foot and ankle. JBJS, 86(9), 1857-1873.
  • Herscovici, D., Scaduto, J. & Infante, A. (2007). Conservative treatment of isolated fractures of the medial malleolus. The Journal of Bone & Joint Surgery British Volume, 89(1), 89-93.
  • Kitaoka, H.B., Alexander, I.J., Adelaar, R.S., Nunley, J.A., Myerson, M.S. & Sanders, M. (1994). Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot & Ankle International, 15(7), 349-353.
  • Koca, K., Erşen, Ö., Akpancar, S., Akyıldız, F., & Gürer, L. (2017). Demographic features of patients with extremity and spine fractures in emergency departments. Eurasian Journal of Emergency Medicine, 16(1), 19.
  • Kochai, A., Türker, M., Çiçekli, Ö., Özdemir, U., Bayam, L., Erkorkmaz, Ü. & Şükür, E. (2018). A comparative study of three commonly used fixation techniques for isolated medial malleolus fracture. Joint Diseases & Related Surgery, 29(2), 104-109.
  • Lee, S., Lin, J., Hamid, K.S. & Bohl, D.D. (2019). Deltoid ligament rupture in ankle fracture: diagnosis and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 27(14), e648-e658.
  • Öçgüder, D.A., Fırat, A., Özdemir, M. & Tecimel, O. (2017). Is the use of headless compression screws appropriate in arthroscopic ankle arthrodesis? Joint Diseases and Related Surgery, 28(3), 171-176.
  • Ricci, W.M., Tornetta, P. & Borrelli Jr, J. (2012). Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws. Journal of Orthopaedic Trauma, 26(10), 602-606.
  • Sneppen, O. (1969). Long-term course in 119 cases of pseudarthrosis of the medial malleolus. Acta Orthopaedica Scandinavica, 40(6), 807-816.
  • Tekin, A.Ç., Çabuk, H., Dedeoğlu, S.S., Saygılı, M. S., Adaş, M., Büyükkurt, C.D., . . . Tekin, Z.N. (2016). Anterograde headless cannulated screw fixation in the treatment of medial malleolar fractures: evaluation of a new technique and its outcomes. Medical Principles and Practice, 25(5), 429-434.

Medial malleol kırıklarında kanüle vida, gergi bandı ve minifragment t-plak fiksasyonun karşılaştırılması

Yıl 2023, Cilt: 2 Sayı: 2, 36 - 41, 31.08.2023
https://doi.org/10.58651/jomtu.1325159

Öz

Amaç: Çalışmamızın amacı medial malleol kırıklarında kanüle vida, gergi bandı ve minifragment t-plak fiksasyonun klinik sonuçlarının karşılaştırılmasıdır.
Materyal ve Metot: Çalışmamız retrospektif kohort çalışması olarak planlandı. Ocak 2016 ile Ocak 2019 yılları arasında kliniğimizde medial malleol kırığı nedeniyle kanüle vida, gergi bandı ve minifragment t-plak fiksasyonu ile tedavi edilen 90 hasta çalışmaya dahil edildi. Hastalar ayak bileği ve ayağın işlevini değerlendirmek için American Orthopaedic Foot and Ankle Surgery skoru, skopi sayısı, ameliyat süresi, ayak bileği eklem hareket açıklığı değerleri kullanılarak karşılaştırıldı.
Bulgular: 12 aylık takip sonrasında her gruplar arası AOFAS skorunda anlamlı fark görülmedi (p=0.263, P=0,432 ve P=0,376). Ayak bileği eklem hareket açıklığının tüm gruplarda benzer olduğu görüldü. Çekilen grafilerde kompresyon yeteneğinin miniplak grubunda diğer gruplara göre daha zayıf olduğu görüldü. Ortalama ameliyat süresinin kanüle vida grubunda daha kısa olduğu görüldü (p<0.001). Ortalama floroskopi uygulama sayısının gruplar arasında benzer olmadığı görüldü (p<0.001). Çalışmamızda Minifragment T-plak grubunda 1 hastada 2 haftalık oral antibiyotik tedavisi ile iyileşen yüzeyel enfeksiyon, Gergi bandı grubunda 1 hastada 1 haftalık tedaviye cevap veren deri problemleri gelişti. Kanüle vida ile tedavi edilen 3 hastada ise vida basısından dolayı memnuniyetsizlik oluştuğu için kaynama sonrası vidaları çıkarıldı. Hiçbir bir hastaya revizyon cerrahisi uygulanmadı.
Sonuç: Gergi bandı ve kanüle vida yapılan hastalarda daha iyi klinik sonuçlara sahip olduğunu fakat doku irritasyonu açısından mini plağa göre dezavantajlı olduğu görülmektedir.

Kaynakça

  • Ahmed, M., Sohal, H.S., Garg, R.S., Jindal, S., Wadhwani, J. & Bansal, V. (2017). Minifragment T-plate fixation: an alternative method for medial malleolus fracture fixation. Journal of Foot and Ankle Surgery (Asia Pacific), 3(1), 10-14.
  • Aiyer, A.A., Zachwieja, E.C., Lawrie, C.M. & Kaplan, J.R. (2019). Management of isolated lateral malleolus fractures. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 27(2), 50-59.
  • Alam, N. & Parviz, S. (2007). Comparative study of malleolar fractures by tension-band and malleolar screw. BOS J, 12(1), 13-19.
  • Amanatullah, D.F., McDonald, E., Shellito, A., Lafazan, S., Cortes, A., Curtiss, S. & Wolinsky, P. R. (2012). Effect of mini-fragment fixation on the stabilization of medial malleolus fractures. Journal of Trauma and Acute Care Surgery, 72(4), 948-953.
  • Ballmer, F., Hertel, R., Noetzli, H. & Masquelet, A. (1999). The medial malleolar network: a constant vascular base of the distally based saphenous neurocutaneous island flap. Surgical and Radiologic Anatomy, 21(5), 297-303.
  • Barnes, H., Cannada, L.K., & Watson, J.T. (2014). A clinical evaluation of alternative fixation techniques for medial malleolus fractures. Injury, 45(9), 1365-1367.
  • Bucholz, R.W., Henry, S. & Henley, M.B. (1994). Fixation with bioabsorbable screws for the treatment of fractures of the ankle. JBJS, 76(3), 319-324.
  • Carter, T.H., Duckworth, A. & White, T. (2019). Medial malleolar fractures: current treatment concepts. The Bone & Joint Journal, 101(5), 512-521.
  • De Souza, L., Gustilo, R.B., & Meyer, T.J. (1985). Results of operative treatment of displaced external rotation-abduction fractures of the ankle. JBJS, 67(7), 1066-1074.
  • Deniz, G. & Akpancar, S. (2019). Fractures in Geriatric Cases. Geriatrik Bilimler Dergisi, 2(1), 14-19.
  • Dumigan, R.M., Bronson, D.G. & Early, J.S. (2006). Analysis of fixation methods for vertical shear fractures of the medial malleolus. Journal of Orthopaedic Trauma, 20(10), 687-691.
  • Faul, F., Erdfelder, E., Buchner, A. & Lang, A.G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149-1160.
  • Gilbert, B.J., Horst, F. & Nunley, J.A. (2004). Potential donor rotational bone grafts using vascular territories in the foot and ankle. JBJS, 86(9), 1857-1873.
  • Herscovici, D., Scaduto, J. & Infante, A. (2007). Conservative treatment of isolated fractures of the medial malleolus. The Journal of Bone & Joint Surgery British Volume, 89(1), 89-93.
  • Kitaoka, H.B., Alexander, I.J., Adelaar, R.S., Nunley, J.A., Myerson, M.S. & Sanders, M. (1994). Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot & Ankle International, 15(7), 349-353.
  • Koca, K., Erşen, Ö., Akpancar, S., Akyıldız, F., & Gürer, L. (2017). Demographic features of patients with extremity and spine fractures in emergency departments. Eurasian Journal of Emergency Medicine, 16(1), 19.
  • Kochai, A., Türker, M., Çiçekli, Ö., Özdemir, U., Bayam, L., Erkorkmaz, Ü. & Şükür, E. (2018). A comparative study of three commonly used fixation techniques for isolated medial malleolus fracture. Joint Diseases & Related Surgery, 29(2), 104-109.
  • Lee, S., Lin, J., Hamid, K.S. & Bohl, D.D. (2019). Deltoid ligament rupture in ankle fracture: diagnosis and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 27(14), e648-e658.
  • Öçgüder, D.A., Fırat, A., Özdemir, M. & Tecimel, O. (2017). Is the use of headless compression screws appropriate in arthroscopic ankle arthrodesis? Joint Diseases and Related Surgery, 28(3), 171-176.
  • Ricci, W.M., Tornetta, P. & Borrelli Jr, J. (2012). Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws. Journal of Orthopaedic Trauma, 26(10), 602-606.
  • Sneppen, O. (1969). Long-term course in 119 cases of pseudarthrosis of the medial malleolus. Acta Orthopaedica Scandinavica, 40(6), 807-816.
  • Tekin, A.Ç., Çabuk, H., Dedeoğlu, S.S., Saygılı, M. S., Adaş, M., Büyükkurt, C.D., . . . Tekin, Z.N. (2016). Anterograde headless cannulated screw fixation in the treatment of medial malleolar fractures: evaluation of a new technique and its outcomes. Medical Principles and Practice, 25(5), 429-434.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Araştırma Makaleleri
Yazarlar

İsmail Güzel 0000-0003-2740-4139

Serkan Akpancar 0000-0001-6673-1082

Yayımlanma Tarihi 31 Ağustos 2023
Gönderilme Tarihi 10 Temmuz 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 2 Sayı: 2

Kaynak Göster

APA Güzel, İ., & Akpancar, S. (2023). Comparison of cannulated screw, tension band, and mini-fragment t-plate fixation in medial malleolus fractures. Journal of Medical Topics and Updates, 2(2), 36-41. https://doi.org/10.58651/jomtu.1325159