J Korean Orthop Assoc.  2016 Feb;51(1):77-84. 10.4055/jkoa.2016.51.1.77.

Features of Lateral Malleolar Fractures in Elderly Patients and Clinical Outcome of Locking Compression Plate Fixation

• Hwang SM
• Jung HG
• Chung HJ
• Eom JS
• Lee DO
• Cho JH
• Park JT

• KMID: 2154352
• DOI: http://doi.org/10.4055/jkoa.2016.51.1.77

Abstract

PURPOSE
Several studies have reported on the biomechanical advantages of a locking compression plate (LCP) for treatment of lateral malleolar fracture. However, few studies have reported clinical outcome after treatment of lateral malleolar fracture using a LCP in elderly patients. Thus, this study investigated the trends of lateral malleolar fractures in elderly patients and evaluated the clinical and radiological outcome of treating them using a 'locking compression distal fibula plate'.
MATERIALS AND METHODS
Twenty-one patients (male: 3, female: 18) over 65 years old, who were followed-up for at least one year were enrolled in this study. They were treated surgically with open reduction and internal fixation using a LCP for lateral malleolar fracture from 2011 to 2014. Lauge-Hansen and Danis-Weber classification were used for preoperative classification of fractures. Visual analog scale (VAS) pain scores, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, 4-graded subjective satisfaction and post-operative range of motion were used for the clinical evaluation. Time to bone union, non-union, mal-union, metal failure and implant loosening were assessed for radiographic outcomes.
RESULTS
The mean age of patients was 71.2 years old, pain VAS and AOFAS score was 1.6 points and 94.2 points, respectively and 18 cases (85.7%) showed more than satisfaction in subjective satisfaction. Comminuted fracture was observed in 8 cases (38.1%) and lag screw insertion was performed in 7 ankles (33.3%). The mean bony union period was 3.6 months. There were 5 cases of mal-union, no case of non-union and metal failure.
CONCLUSION
Satisfaction level of elderly patients with lateral malleolar fracture was significantly associated with only pain at the final follow-up. Fixation with a LCP distal fibula plate can sometimes lead to metal irritation but largely resulted in good clinical outcome without serious complication.

Keyword

ankle; aged; lateral malleolus fracture; comminuted fractures; locking compression plate

MeSH Terms

Aged*
Ankle
Ankle Fractures
Classification
Female
Fibula
Follow-Up Studies
Foot
Fractures, Comminuted
Humans
Range of Motion, Articular
Visual Analog Scale

Figure

• 

  Figure 1 A 71-year-old woman with a tri-malleolar ankle fracture. (A) Preoperative X-ray shows a severe comminuted fracture. (B) The patient was treated using a locking compression plate for distal fibula without interfragment lag screw fixation although malunion was observed at the final follow-up.

• 

  Figure 2 A 67-year-old woman shows a tri-malleolar ankle fracture. (A) Preoperative X-ray shows a lower level fracture line and transverse fracture line. (B) The patient was treated using a locking compression plate for distal fibula without interfragment screw fixation.

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