Highlights
- •The majority of the global population live in resource-limited countries, where implant cost may limit surgical treatment of ankle fractures.As the fibula carries only 6.4-17% of bodyweight in stance, the biomechanical strength required of fibular fixation constructs is in question.
- •We demonstrate a novel screw-only technique (SOT) with two fibula pro tibia screws to neutralize an interfragmentary screw.
- •The screw-only fixation had a lower implant cost (mean $592 for screw only fixation versus mean $1,949.97 for the standard treatment).
- •All patients maintained an anatomic mortise throughout the postoperative period, but there was a higher rate of hardware removal in the SOT group.
Abstract
Introduction
Ankle fractures are one of the most common injuries sustained worldwide, with the
majority being isolated lateral malleolus fractures. The majority of the world's population
live in Low and Middle Income Countries (LMIC), where implant cost may limit surgical
treatment of ankle fractures. We investigate if Weber B ankle fractures could be effectively
treated with a lower-cost technique using two screws between the fibula and the tibia
to neutralize an interfragmentary lag screw.
Methods
After IRB approval, consecutive patients from January 1, 2020 to December 31, 2020
with Weber-B ankle fractures were treated using AO technique (AOT) with plate osteosynthesis
neutralizing an interfragmentary screw. Syndesmotic injuries, as well as injuries
to the medial malleolus or foot were treated according to the surgeon's preferences.
From January 1, 2021 to December 31, 2021 these injuries were treated with a screw-only
technique (SOT) with two fibula pro tibia screws to neutralize an interfragmentary
screw. Patient demographics including age, sex, BMI, smoking status, associated rheumatoid
arthritis, and associated diabetes mellitus were recorded. The primary outcome variable
was a stable radiographic mortise at six weeks post-surgery, secondary outcome variables
included clinical union, infection, hardware removal, and implant cost for lateral
malleolar fixation charged to the hospital.
Results
Seventeen AOT and 10 SOT constructs were included. Demographic characteristics were
similar between groups. All fractures maintained a stable mortise with clinical union
at 6 weeks without infection. There was a statistically significant difference in
hardware removal (17.6% AOT, 50% SOT, p = 0.012). The average implant cost to the
hospital of the lateral malleolar fixation was significantly less in the SOT group
($592 (SD $229)), compared to the AOT group ($1,949.97 (SD $562)), (p < 0.0001).
Conclusion
We introduce proof of concept of a novel lower-cost fixation strategy for Weber B
ankle fractures that maintained a stable mortise with clinical union at six weeks
post-surgery. However, there was a significantly higher rate of hardware removal following
fixation with a screw-only construct.
Keywords
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Article info
Publication history
Published online: October 17, 2022
Accepted:
October 16,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
