Do type B malleolar fractures need a positioning screw?

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomechanics of Bone Fractures

Background:

• Type B malleolar fractures are typically stable.
• Some Type B fractures exhibit residual instability post-fixation, necessitating further stabilization.
• Predicting and managing this instability is crucial for optimal patient outcomes.

Purpose of the Study:

• To determine the incidence of residual instability in Type B malleolar fractures after internal fixation.
• To identify factors that may predict pre-operative instability.
• To evaluate the effectiveness of additional screw fixation for unstable fractures.

Main Methods:

• Retrospective analysis of 111 malleolar fractures operated between 1995-1997.
• Focus on 90 Type B fractures, assessing for residual instability post-internal fixation.
• Evaluation of fracture patterns, pre-operative findings, and treatment with additional positioning screws.

Main Results:

• 19% (17/90) of Type B fractures showed residual instability.
• Trimalleolar fractures with initial joint dislocation were more frequently unstable.
• Additional positioning screw fixation resulted in good or excellent outcomes in 16/17 patients.

Conclusions:

• Residual ankle joint instability can occur after internal fixation of Type B malleolar fractures.
• Trimalleolar fractures with pre-existing dislocation are at higher risk.
• Additional positioning screw treatment generally leads to satisfactory results.