Routine intramedullary screw versus plate fixation of lateral malleolus fractures

To compare outcomes of patients treated by a single surgeon before and after adoption of routine intramedullary screw (IMS) fixation of lateral malleolus ankle fractures.

A retrospective study was performed at a Level 1 trauma center of skeletally mature patients with displaced lateral malleolus fractures treated by a single surgeon. Patients treated before and after adoption of routine IMS fixation were compared with an intention-to-treat analysis, regardless of fixation type, to evaluate for differences in clinical outcomes.

There were 123 patients included. The median patient age was 38.0 years (interquartile range 28.0-54.0) and 47.9% (59/123) were male. There were 83 patients treated before the practice change and 40 patients treated after. Patients treated after the practice change were similar in age, high-energy mechanisms, body mass index, comorbidities, and fracture type (p > 0.05). The practice change group had a shorter median follow-up time (3.8 vs. 5.6 months, p = 0.01), more IMS fixation (80% vs. 8.4%, p < 0.0001), less syndesmotic fixation (40.0% vs. 71.1%, p = 0.0009), lower implant costs ($52 vs. $307, p < 0.0001), less operative time (64.0 vs. 95.0 min, p < 0.0001), less estimated blood loss (20.0 vs. 30.0 ml, p = 0.0005), and had no difference in anatomic reductions (87.5% vs. 80.7%; p = 0.21), complications (20.0% vs. 33.7%, p = 0.11), or reoperations (10.0% vs. 16.9%, p = 0.37). The practice change group was less likely to have a symptomatic implant removal other than a syndesmotic screw (i.e. plates, IMS) (0.0% vs. 9.6%, p = 0.04).

Routine IMS fixation decreased symptomatic plate removals, costs, operative time, and blood loss.

Diagnostic, Level III.