Minimally invasive percutaneous plate osteosynthesis for lateral malleolus fractures

Abstract

Background Lateral malleolus fracture is one of the most common fractures that may occur as a part of ankle joint trauma. Open reduction and internal fixation is considered as the state of the art for displaced lateral malleolar fractures in order to obtain congruent ankle mortise. But in certain conditions, soft-tissue status together with patient comorbidities may impede this technique. Minimally invasive percutaneous plate osteosynthesis (MIPPO) for lateral malleolus may be a suitable solution for ankle fractures with soft-tissue problems. Patients and methods Through the period between May 2012 and May 2016 in Ain Shams University hospitals, a prospective study on 51 patients with displaced lateral malleolus fractures as a part of ankle trauma with bad soft-tissue condition has been managed through the MIPPO approach. All patients have been evaluated as regards the grade of soft-tissue injury, timing of surgery from trauma, duration of the procedure, time to union, postoperative ankle function, and reported superficial peroneal nerve injury. Open fractures, associated pilon fractures, and established Charcot neuropathic joints had been excluded from the study. Results The minimum follow-up for all the patients was 12 months and maximum was 25 months with a mean of 13.7 months postoperatively. Thirty patients (58.8%) were grade III according to Tscherne classification of closed soft-tissue injury. Mean time of surgery from trauma was 45.9 h (12 h to 6 days). The average procedure time was 56 min (20–80 min). The average time to union was within 7 weeks (5–10 weeks), all patients had good-to-excellent ankle function with a mean of 89.9 according to the American Orthopedic Foot and Ankle Score, and no superficial peroneal nerve injury was documented. Conclusion MIPPO for lateral malleolus is an effective and safe technique, provided that ankle mortise congruity is obtained.