Minimally invasive technique of fixation of closed bimalleolar fractures

Abstract

Introduction: Among ankle fractures, bimalleolar and trimalleolar fractures constitute a majority of them. These are known to have significant complications in the postoperative period after open reduction and internal fixation, either due to soft tissue trauma or loss of reduction due to inadequate fixation or compliance by the patient. We decided to do retrospective study for analysis of results of our minimally invasive technique of fixation of malleolar fractures with single 4mm cannulated or partially threaded cancellous screw fixation for medial malleolus fracture and K wire for lateral malleolus fracture. Material and methods: We conducted prospective follow up study in orthopaedic department at tertiary care hospital over a period of two years. Written informed consent was obtained from the patients and institutional ethical committee approval was also obtained. Results: Wound complication occurred in 2 patients only (of 32 patients). Malunion or nonunion occurred among 3 patients in which lateral malleolus fracture was oblique or comminuted. Average time for union was 7.8 weeks. Closed reduction was achieved in 28 patients but in 2 cases mini open technique was required for medial malleolus fracture to remove interposing soft tissue. Discussion: For these fractures, implants that could be preferred for minimally invasive surgery include K wires, cannulated cancellous screws. Another advantage is that we need to remove only one long K wire and one cannulated cancellous screw during implant removal making it a small surgery. Average time for union was 7.8weeks in our study which was comparable to other studies. Conclusion: Minimally invasive technique of fixation of ankle fractures with 2mm K wires for lateral malleolus and 4 mm cannulated cancellous screw fixation for medial malleolus gives good results with minimal complications and should be preferred in patients at high risk of soft tissue wound healing problems.