Screw internal fixation and conservative treatment of posterior ankle fractures: differences in ankle joint function and plantar pressure

doi:10.12307/2021.200

Abstract

Abstract: BACKGROUND: When the posterior malleolus fracture involves less than 25% of the articular surface area, whether it should be actively treated with internal fixation or conservative treatment has been controversial.
OBJECTIVE: To evaluate the impact of screw fixation and conservative treatment on the ankle joint function and plantar pressure of posterior malleolus fractures involving 10%-25% of the articular surface area of the distal tibia.
METHODS: From March 2017 to May 2020, patients with three ankle fractures treated in The Fifth Affiliated Hospital of Guangzhou Medical University received computed tomography to measure the area of the posterior malleolus fracture involving 10%-25% of the distal tibia articular surface area. The patients were randomized into two groups. The 62 cases in the internal fixation group were treated with screws and 53 cases in the non-internal fixation group were treated with C-arm X-ray machine fluoroscopy assisted downward manual reduction. Plain radiographs were used to evaluate the healing of posterior ankle fractures, and the visual analogue scale score, the American Orthopaedic Association ankle-hindfoot scale score and plantar pressure evaluation results were used clinically.
RESULTS AND CONCLUSION: (1) There was no significant difference in the visual analogue scale scores of the two groups at 3 months after surgery (P > 0.05). The visual analogue scale scores of the internal fixation group were significantly lower than those in the non-internal fixation group at 6 and 12 months after the operation (P < 0.05). The visual analogue scale scores of the two groups were significantly reduced at 3, 6 and 12 months after surgery (P < 0.05). (2) There was no significant difference in the American Orthopaedic Association ankle-hindfoot function score between the two groups at 3 months after operation (P > 0.05). American Orthopaedic Association ankle-hindfoot function score of the internal fixation group was better than those in the non-internal fixation group at 6 and 12 months after the operation (P < 0.05). The American Orthopaedic Association ankle-hindfoot function scores were significantly improved in the two groups at 3, 6 and 12 months after surgery (P < 0.05). (3) Three months after the operation, the plantar pressure of the affected side of the two groups (full foot, hind foot, midfoot, and forefoot) was significantly lower than that in the contralateral foot (P < 0.05). At 6 months postoperatively, the plantar pressure of the whole foot and forefoot of the affected foot in the internal fixation group was lower than that of the contralateral foot (P < 0.05). There was no significant difference in the plantar pressure of the affected side (hind foot and midfoot) and the contralateral foot (P > 0.05). The plantar pressure of the affected side of the non-internal fixation group (full foot, hind foot, midfoot, and forefoot) was significantly lower than that of the uninvolved foot (P < 0.05). At 12 months after operation, there was no significant difference between the plantar pressure of the affected side (full foot, hind foot, midfoot, and forefoot) and the plantar pressure of the unaffected side between the two groups (P > 0.05). (4) It is indicated that in posterior malleolus fractures involving 10%-25% of the distal articular surface of the tibia, screw internal fixation has a better effect on fracture healing and maintenance of ankle alignment, and improves early clinical results. It is recommended that posterior malleolus fractures involving 10%-25% of the distal tibial articular surface can be actively treated with screw internal fixation.

Key words: ankle fracture, posterior ankle fracture, screw, internal fixation, plantar pressure, biomechanics

CLC Number:

He Yi, Zheng Cong, He Minhui, Lu Ruijun, Huang Jianrong. Screw internal fixation and conservative treatment of posterior ankle fractures: differences in ankle joint function and plantar pressure[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(27): 4379-4385.

Figures/Tables 10

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