Involvement of the posterior malleolus in fractures of the ankle
probably adversely affects the functional outcome and may be associated
with the development of post-traumatic osteoarthritis. Anatomical
reduction is a predictor of a successful outcome. The purpose of this study was to describe the technique and short-term
outcome of patients with trimalleolar fractures, who were treated
surgically using a posterolateral approach in our hospital between
2010 and 2014. The study involved 52 patients. Their mean age was 49 years (22
to 79). There were 41 (79%) AO 44B-type and 11 (21%) 44C-type fractures.
The mean size of the posterior fragment was 27% (10% to 52%) of
the tibiotalar joint surface.Aims
Patients and Methods
The aim of this study was to quantify the stability
of fracture-implant complex in fractures after fixation. A total
of 15 patients with an undisplaced fracture of the femoral neck,
treated with either a dynamic hip screw or three cannulated hip
screws, and 16 patients with an AO31-A2 trochanteric fracture treated
with a dynamic hip screw or a Gamma Nail, were included. Radiostereometric
analysis was used at six weeks, four months and 12 months post-operatively
to evaluate shortening and rotation. Migration could be assessed in ten patients with a fracture of
the femoral neck and seven with a trochanteric fracture. By four
months post-operatively, a mean shortening of 5.4 mm (-0.04 to 16.1)
had occurred in the fracture of the femoral neck group and 5.0 mm
(-0.13 to 12.9) in the trochanteric fracture group. A wide range
of rotation occurred in both types of fracture. Right-sided trochanteric
fractures seem more rotationally stable than left-sided fractures. This prospective study shows that migration at the fracture site
occurs continuously during the first four post-operative months,
after which stabilisation occurs. This information may allow the
early recognition of patients at risk of failure of fixation. Cite this article:
The proximal femoral nail (PFN) is a recently introduced intramedullary system, designed to improve treatment of unstable trochanteric fractures of the hip. In a multicentre prospective clinical study, the intra-operative use, complications and outcome of treatment using the PFN (n = 211) were compared with those using the gamma nail (GN) (n = 213). The intra-operative blood loss was lower with the PFN (220 ml Generally, the results of treatment of unstable trochanteric fractures were comparable for the PFN and GN. The pitfalls and complications were similar, and mainly surgeon- or fracture-related, rather than implant-related.