Moreover, anatomically preformed implants with polyaxial locking mechanisms revealed promising results in the treatment of complex FX including distal femur, tibia, radius, clavicle and the radial head. In this context biomechanical cadaver specimen studies suggest an advantage of locking plates in osteoporotic bone. In the past a few clinical trials revealed that early weightbearing and functional treatment avoiding a plaster cast may shorten the immobilization period but may provoke a loss of reduction depending on morphology, initial stability of the FX as well as on patient’s age and comorbidities. Therefore, the main goal of any post-operative therapy is to reduce time of recovery to a minimum and to achieve full physical performance as early as possible. Most patients suffering from ankle FX are in the middle of their individual working life (5th decade) and usually demand early return to daily activities. īesides fracture healing especially postoperative joint rehabilitation determines functional outcome and thereby return to sports, work and normal daily activities. Nevertheless operative treatment is associated with typical complications such as non- or malunion, post-traumatic arthritis and especially soft tissue problems ranging from delayed wound healing to deep infection and severe soft tissue defects. Several techniques for internal ankle fixation are commonly used, ranging from lag screw fixation to plate osteosynthesis with non-locking to locking screw systems up to biodegradable types. In this context open reduction and internal fixation (ORIF) presents the standard of care for displaced ankle FX in adults. In the current literature multiple studies compare conservative and surgical treatment in malleolar FX. Registered 20 April 2020, retrospectively on ( NCT04370561).Īnkle fractures (FX) are common injuries, accounting for 9% of all fractures of the human skeleton. Furthermore, our data show that ORIF using polyaxial locking plates in combination with an early postoperative weight bearing presents a safe, stable treatment option for ankle fractures so that patients benefit especially in the early stages of recovery. The results of the presented study demonstrate a significant better clinical functional outcome in the early postoperative follow-up in patients treated with a polyaxial locking plate. Significant better clinical results regarding OMAS ( p < 0.02, < 0.04), KPSS ( p < 0.04) and FAOS ( p < 0.02, < 0.03) were observed 6 and 12 weeks after surgery in group II. Four minor complications occurred in Group I (16%) compared to two minor complications in group II (10%). Twenty-five patients were treated with DePuy Synthes® one-third semitubular plate (55.6% group I) while 20 patients received an anatomically preformed polyaxial locking plate (44.4%, group II). Seven patients (13.5%) were excluded, so that 45 patients were available for follow up. Resultsįifty-two patients (31 W/21 M) with a mean age of 43 yrs. Clinical and radiological follow-up were performed 6 and 12 weeks, 6 months and 1 year postoperatively. Superficial wound infection, delayed wound healing, mechanically prominent implant, skin irritations were considered as minor and deep wound infection, material loosening, loss of reduction were regarded as major complications requiring revision surgery. Secondary outcome parameter were postoperative complications. Primary outcome parameter was function of the ankle joint, assessed by the Olerud and Molander ankle score, Foot and Ankle outcome score and Karlsson and Peterson Scoring System for Ankle function. Patients were randomized to either the DePuy Synthes® one-third semitubular plate (Group I) or NEWCLIP TECHNICS, Active Ankle® polyaxial locking plate (Group II). In this prospective study, all patients with distal fibula fractures (AO 44 B1.1, B1.2, B1.3), with indication for surgery were included. The aim of the study was to analyze whether ORIF of ankle fractures using either a standard semitubular plate or a new polyaxial locking plate system result in a better clinical outcome. In this context open reduction internal fixation techniques allowing for early full weight bearing might not only improve the clinical outcome but also shorten the period of disability in working life. In the modern western world appraisal of economical points such as treatment and disability after trauma present a financial burden.
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