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Purpose <p>To compare outcomes of patients treated by a single surgeon before and after adoption of routine intramedullary screw (IMS) fixation of lateral malleolus ankle fractures.</p> Methods <p>A retrospective study was performed at a Level 1 trauma center of skeletally mature patients with displaced lateral malleolus fractures treated by a single surgeon. Patients treated before and after adoption of routine IMS fixation were compared with an intention-to-treat analysis, regardless of fixation type, to evaluate for differences in clinical outcomes.</p> Results <p>There were 123 patients included. The median patient age was 38.0&#xa0;years (interquartile range 28.0–54.0) and 47.9% (59/123) were male. There were 83 patients treated before the practice change and 40 patients treated after. Patients treated after the practice change were similar in age, high-energy mechanisms, body mass index, comorbidities, and fracture type (<i>p</i> &gt; 0.05). The practice change group had a shorter median follow-up time (3.8 vs. 5.6&#xa0;months, <i>p</i> = 0.01), more IMS fixation (80% vs. 8.4%, <i>p</i> &lt; 0.0001), less syndesmotic fixation (40.0% vs. 71.1%, <i>p</i> = 0.0009), lower implant costs ($52 vs. $307, <i>p</i> &lt; 0.0001), less operative time (64.0 vs. 95.0&#xa0;min, <i>p</i> &lt; 0.0001), less estimated blood loss (20.0 vs. 30.0&#xa0;ml, <i>p</i> = 0.0005), and had no difference in anatomic reductions (87.5% vs. 80.7%; <i>p</i> = 0.21), complications (20.0% vs. 33.7%, <i>p</i> = 0.11), or reoperations (10.0% vs. 16.9%, <i>p</i> = 0.37). The practice change group was less likely to have a symptomatic implant removal other than a syndesmotic screw (i.e. plates, IMS) (0.0% vs. 9.6%, <i>p</i> = 0.04).</p> Conclusion <p>Routine IMS fixation decreased symptomatic plate removals, costs, operative time, and blood loss.</p> Level of evidence <p>Diagnostic, Level III.</p>

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Routine intramedullary screw versus plate fixation of lateral malleolus fractures

  • 期刊论文

  • 发表日期：

    2025年5月31日

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  • Byron Ward,
  • Joshua Parry

摘要

Purpose

To compare outcomes of patients treated by a single surgeon before and after adoption of routine intramedullary screw (IMS) fixation of lateral malleolus ankle fractures.

Methods

A retrospective study was performed at a Level 1 trauma center of skeletally mature patients with displaced lateral malleolus fractures treated by a single surgeon. Patients treated before and after adoption of routine IMS fixation were compared with an intention-to-treat analysis, regardless of fixation type, to evaluate for differences in clinical outcomes.

Results

There were 123 patients included. The median patient age was 38.0 years (interquartile range 28.0–54.0) and 47.9% (59/123) were male. There were 83 patients treated before the practice change and 40 patients treated after. Patients treated after the practice change were similar in age, high-energy mechanisms, body mass index, comorbidities, and fracture type (p > 0.05). The practice change group had a shorter median follow-up time (3.8 vs. 5.6 months, p = 0.01), more IMS fixation (80% vs. 8.4%, p < 0.0001), less syndesmotic fixation (40.0% vs. 71.1%, p = 0.0009), lower implant costs ($52 vs. $307, p < 0.0001), less operative time (64.0 vs. 95.0 min, p < 0.0001), less estimated blood loss (20.0 vs. 30.0 ml, p = 0.0005), and had no difference in anatomic reductions (87.5% vs. 80.7%; p = 0.21), complications (20.0% vs. 33.7%, p = 0.11), or reoperations (10.0% vs. 16.9%, p = 0.37). The practice change group was less likely to have a symptomatic implant removal other than a syndesmotic screw (i.e. plates, IMS) (0.0% vs. 9.6%, p = 0.04).

Conclusion

Routine IMS fixation decreased symptomatic plate removals, costs, operative time, and blood loss.

Level of evidence

Diagnostic, Level III.