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Indian Journal of Orthopaedics Surgery


Fixation in bimalleolar fractures of ankle-a comparative study between fibula plating versus intramedullary nailing with medial malleolar screw


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Author Details: Murtuza Rassiwala, Jayant Sharma, Pramod P. Neema, Mayank Patel

Volume : 2

Issue : 4

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 331

Article End Page : 339


Abstract

Background: A bimalleolar ankle fracture is unique in the sense that ankle is the distal most weight bearing joint and locomotion depends upon stability of the ankle mortise. The best option for management of bimalleolar ankle fracture still remains unclear because of the variability of fracture patterns and availability of variety of implants.
Objectives: This study was conducted to set the indications for the two modalities of surgical fixation viz- fibular plate fixation and fibula nailing in various fracture subtypes; and  to compare the functional outcome of bimalleolar ankle fracture managed by these two methods at 9 months post-operative interval. Complications associated with specific modalities of fixation were also studied.
Material and Method: This was a randomized, prospective and comparative study for the methods used for management of the fracture done in Department Of Orthopedics and Traumatalogy at USSC, Indore from January 2014 to April 2016. 45 patients with bimalleolar fractures were included in the study. Clearance from ethical committee of the institute was taken. Informed consent was taken and patients were evaluated pre operatively and post operatively at 1, 3, 6 and 9 months interval with the help of Olerud Molander Ankle Score (OMAS) and radiographically.
Results: Duration after which partial weight bearing was initiated was significantly shorter in group1 (fibula plating) (p<0.0001) [average 44.54 days as compared to 55.71 days].
The average time before union and hence full weight bearing was 11.89 weeks (range10.71 - 13.28 weeks) in group 1 and 13.67 weeks (range11.56-15 weeks), (p<0.0001) in group 2 (Intramedullary nailing).
Functional outcome using OMAS scoring at 3 months post operatively was significantly better in group 1(p< 0.0001). While at 6 months and 9 months post operatively the functional outcomes were similar.
Conclusion: We concluded that Fibula Plating is a better method of fixation in AO type B2, B3 and C2 fractures while Intramedullary Nailing in Fibula is a better method of fixation in AO type A2 fractures with respect to clinical and functional outcomes. We also concluded that if the ligament injury has been dealt with properly and repaired and the fixation is anatomically sound the period of immobilization (4 to 6 weeks) does not affect the range of motion of ankle joint in the long duration.

Keywords:
Plating, Nailing, Bimalleolar ankle Fractures, Olerud Molander score