MINIMALLY INVASIVE OSTEOTOMY FOR BIMALLEOLAR FRACTURES

Abstract

Purpose of the study: The aim of this work was to study the functional and radiological results as well as any complications obtained after minimally invasive treatment of bimalleolar fractures.

Material and methods: The series included 100 fractures in 100 patients who underwent surgery between 1998 and 2000: 52 men and 48 women, mean age 47.1 years (range 17–96 years). According to the AO classification, the fractures were A:18, B:62, C:20. Osteosynthesis of the lateral malleolus was achieved with a Rush nail in 95 cases and with a K-wire in six. Closed osteosynthe-sis was achieved in 67 cases, an open procedure being used for 33 cases. Osteosynthesis was performed on the medial malleolus in 73 patients, 65 with a 3.5-mm screw, a K-wire for five, and a tutor-wire in two, all during an open procedure. The functional outcome was assessed at last follow-up using the Olerund and MOlander and the AOFAS scores.

Results: Mean follow-up was thirteen months (range 3–54 months). All fractures healed at mean eight weeks (range 6–24 weeks). At last follow-up, 90 ankles were radiographically anatomic. Mean function scores were: Olerund and Molander 73.5/90; AOFAS 85.8/100. Clinical outcome (Olerund and Molander) was excellent or good in 86 patients, poor in 12 and very poor in two. According to the AOFAS score, clinical outcome was excellent or good in 90 patients, poor in 9 and very poor in one. Considered by gender and type of reduction of the lateral malleolus, there was no difference in the distribution of the clinical outcome. There was however a strong correlation between the quality of the anatomic result and the functional outcome since poor anatomic results gave poor functional results in 80% of cases. The type of anatomic fracture had a certain importance since excellent and good results were obtained for type A fractures (94%) and type C fractures (90%) but 70% of the poor results were observed in type B fractures. There were few complications: two superficial infections, four cases of reflex dystrophy, and one thromboembolic event.

Conclusion: Compared with other operative techniques, the advantages of this method are basically linked to the ability to respond to all the different forms of bimalleo-lar fracture, irrespective of the anatomic type. The operative protocol is well established. The procedure is easy to perform and rapid and provides excellent results.