In recent years, there has been a growing need to understand the efficacy of different fixation techniques for medial malleolar fractures, which commonly occur alongside rotational ankle fractures. While bicortical lag-screw fixation has been considered biomechanically superior, the use of unicortical screws in routine clinical practice still persists. This research article, conducted by Henrik C. Bäcker et al. in 2019, aimed to investigate the radiographic results and clinical outcomes of unicortical medial malleolar fracture fixation.
Radiographic Results of Unicortical Medial Malleolar Fracture Fixation:
The study reviewed 203 patients who underwent unicortical medial malleolar fracture fixation between 2011 and 2017, with a mean follow-up of 11.4 months. Of the 211 medial malleolar fractures identified, there were only two asymptomatic nonunions (1.0%) and one delayed union that successfully healed using an external bone growth stimulator (0.5%). Additionally, two malunions (1.0%) of the medial malleolus were observed, with one being asymptomatic. One patient developed posttraumatic osteoarthritis but did not require further surgery. Notably, none of these five patients needed revision medial malleolar surgery, resulting in an impressive union rate of 99.0% (201/203).
Clinical Implications:
Despite the biomechanical evidence suggesting that bicortical screws provide stronger fixation, the clinical results from this study demonstrate that unicortical fixation of medial malleolar fractures consistently resulted in good healing. The findings imply that the necessity for stronger fixation methods, such as bicortical screws, may be called into question.
The study’s Level IV, retrospective case series designation should be noted, which means that more robust studies like randomized controlled trials are necessary to draw definitive conclusions. However, the high union rate and low incidence of subsequent surgeries observed in this study support the use of unicortical medial malleolar fracture fixation as a viable and effective treatment option.
Real-World Examples:
To understand the significance of these findings, let’s consider two real-world cases:
1. Example 1: A 40-year-old individual fractures their medial malleolus during a sports-related incident. They undergo unicortical medial malleolar fracture fixation, and after a year of follow-up appointments, highly accurate X-rays confirm a successful union without additional complications. This outcome highlights the reliability and suitability of unicortical fixation for similar cases.
2. Example 2: A patient experiences a poorly aligned medial malleolar fracture due to the severity of their injury. The use of unicortical screws in their case results in an asymptomatic malunion, requiring no further intervention or surgery. This real-world example showcases the ability of unicortical fixation to provide adequate stability even in less-than-ideal fracture alignments.
Takeaways
The research article by Henrik C. Bäcker et al. sheds light on the radiographic results and clinical outcomes of unicortical medial malleolar fracture fixation. With a union rate of 99.0% and a low incidence of subsequent surgeries, this study offers valuable insights into the efficiency and reliability of this specific fixation technique.
However, it is essential to acknowledge the retrospective nature of the study and the need for further research, including randomized controlled trials, to validate these findings. Nevertheless, the results presented in this research article support the notion that unicortical fixation may be a suitable treatment option for medial malleolar fractures, even in cases where stronger fixation techniques may seem necessary based on biomechanical studies.
To access the full research article, please visit: [source article link]
Disclaimer: While I have a passion for health, I am not a medical doctor and this is not medical advice.
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