Non-union of a 'stable' AO type B ankle fracture

A Specialized Fibular Locking Plate for Lateral Malleolar Fractures

We evaluated the outcomes and complications of a specialized fibular locking plate in the treatment of lateral malleolar fractures. The study included 27 patients (13 males and 14 females; mean age 46, range 16 to 73 years) with a minimum 1-year follow-up period. The study included 9 (33%) isolated lateral malleolar, 6 (23%) bimalleolar, 10 (37%) trimalleolar fractures, and 2 (7%) pilon fractures, all of which were treated using a specialized fibular locking plate for internal fixation. Bony union was monitored, and the patients' objective satisfaction was evaluated using the EQ-5D questionnaire (EuroQol Group). The patients were followed up after 1 year, and bony union was confirmed using a simple radiograph. The EQ-5D median ± standard deviation was 70 ± 15 (range 40 to 90) points at discharge, 80 ± 13 (range 40 to 90) at 6 weeks, 85 ± 11 (range 50 to 90) at 3 months, 90 ± 8 (range 60 to 90) at 6 months, and 90 ± 9 (range 70 to 95) at 1 year. Therefore, the EQ-5D score increased with time. No significant difference was found when stratified by sex or age (Mann-Whitney U test, p < .05). Eight complications (29%) developed: 1 superficial infection at the operative site, 1 case (3%) of osteomyelitis, 2 cases (7%) of an osteochondral lesion of the talus, and 5 cases (19%) of metallosis. A specialized fibular locking plate has the advantages of being an easy procedure, providing good patient satisfaction, and achieving complete bony union in all patients. However, additional complications developed compared with other well-known methods for fibular fracture treatment.

Internal fixation of the fibula in ankle fractures: a prospective, randomized and comparative study: plating versus nailing

AIM

Open reduction and internal plate fixation of the fibula is the gold standard treatment for ankle fractures. The aim of this study was to perform a prospective randomized study to compare bone union, complications and functional results of two types of internal fixation of the fibula (plating and the Epifisa FH intramedullary nail).

MATERIALS AND METHODS

Inclusion criteria were: closed fractures, isolated displaced fractures of the lateral malleolus, inter- and supra-tubercular bimalleolar fractures, and trimalleolar fractures. This study included 71 patients (mean age 53 ± 19): plate fixation group (n=35) and intramedullary nail fixation group (n=36). In seven cases, intramedullary nailing was technically impossible and was converted to plate fixation (the analysis of this sub-group was performed independently). Two patients died and two patients were lost to follow-up. The final comparative series included 32 cases of plate fixation and 28 cases of intramedullary nail fixation. Union, postoperative complications and Kitaoka and Olerud-Molander functional scores were analyzed after one year of follow-up.

RESULTS

There was no significant difference in the rate of union (P=0.5605) between the two types of fixation. There were significantly fewer complications (7% versus 56%) and better functional scores (96 versus 82 for the Kitaoka score; 97 versus 83 for the Olerud-Molander score) with intramedullary nailing than with plate fixation.

CONCLUSION

Intramedullary nailing of the lateral malleolus in non-comminuted ankle fractures without syndesmotic injury is a reproducible technique with very few complications that provides better functional results than plate fixation.

LEVEL OF EVIDENCE

II (randomized prospective study).

Misdiagnosis of OTA type B (Weber B) ankle fractures leading to nonunion

Little is known about the specific etiology of nonunion of stable Orthopaedic Trauma Association (OTA) type B fractures. In the present retrospective cohort study, we investigated all patients with a nonunion in a level 1 trauma center during an 8.5-year period. Patient history, clinical findings, radiographic features, and therapeutic aspects were critically evaluated to be able to predict the nonunion. In the predefined period, 388 patients were treated for a stable OTA type B fracture. Eight patients (2.1%) developed a nonunion. Retrospectively, the radiographic features in 6 of the 8 patients and clinical findings in 1 of the 8 patients could predict the nonunion. We conclude that in almost every nonunion occurring after a "stable" OTA type B fracture in the present study were, in fact, originally unstable fractures.

Non-union of Weber B distal fibula fractures: a case series

Non-union of distal fractures of the fibula type Weber B is rare. Undisplaced and minimally displaced isolated lateral malleolar fractures (Weber B) usually unite without operative intervention. We present three cases of lateral malleolus non-union in healthy individuals. Two were treated with internal fixation plus bone grafting. The third patient remained asymptomatic and therefore did not undergo surgery for the fracture.