Evolution of a traditional technique: Comparison of a 4-mm lag screw and Kirschner wire technique versus a 4-mm lag screw and Kirschner technique with anti-gliding miniplate fixation for the treatment of medial malleolar fractures

BACKGROUND: In this study, we aimed to compare a 4-mm lag screw and Kirschner wire technique versus a 4-mm lag screw and Kirschner wire (K-wire) technique with additional miniplate fixation for the treatment of medial malleolar fractures.
METHODS: A total of 23 patients who were diagnosed with isolated fractures of the medial malleolus and operated in our center were retrospectively analyzed. The patients were divided into two groups: Group A, medial malleolar fracture fixed with a 4-mm cannulated screw and a K-wire (n=11) and Group B, a 4-mm cannulated screw and K-wire used for fixation with miniplate fixation for extra stability (n=12). Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score at 2, 6, 12, and 24 months postoperatively. At 12–24 months, the presence of pain and tenderness in the medial malleolus with palpation was evaluated using the visual analog scale (VAS) pain scores.
RESULTS: The mean time to union was 2.23±0.56 (range, 1.8–2.9) months in Group A and 2.46±0.45 (range, 1.9–3.1) months in Group B, indicating no statistically significant difference between the two groups (p>0.05). The mean AOFAS score at 2 months postoperatively was 60.40±7.78 (range, 46–79) in Group A and 73.60±10.80 (range, 53–87) in Group B, indicating a statistically significant difference between the groups (p<0.01). However, there was no statistically significant difference in the mean AOFAS scores at 6 and 12 months between the groups (p>0.05). The mean VAS pain scores at 12–24 months postoperatively did not significantly differ between the groups (p>0.05).
CONCLUSION: Our study results suggest that the treatment of medial malleolar fractures with a cannulated screw and K-wire with additional stabilization using a miniplate ensures favorable early outcomes with early return to daily living activities. However, both techniques have similar outcomes in the mid-term.

Geleneksel bir tekniðin geliþimi: Medial malleol kýrýklarýnýn tedavisinde 4 mm’lik kanüllü vida ve Kirschner teli tekniði ile 4 mm’lik kanüllü vida, Kirschner teli tekniði ve kayma önleyici mini plak tespitinin karþýlaþtýrýlmasý

AMAÇ: Cerrahi tedavi yapýlan izole medial malleol kýrýklarýnda kanüllü vida, Kirschner teli fiksasyonu ile beraber mini plak vida kombinasyonunu deðerlendirmektir.
GEREÇ VE YÖNTEM: A grubunda medial malleol kýrýðý 4 mm kanülle vida ve Kirschner teli ile fikse edilmiþ grup, B grubunda ise medial malleol kýrýðý 4 mm kanüllü vida ve Kirschner teli ile fikse edilen ve ekstra stabilite için mini plak ile fiksasyon yapýlan gruptur. AOFAS skorlamasý ameliyat sonrasý 2, 6 ve 12. ayda alýnan skorlar göz önüne alýndý. Medial malleol üzerinde palpasyonla hassasiyet ameliyat sonrasý 12. ayda VAS of pain skalasý ile deðerlendirildi.
BULGULAR: Ýndependent t samples teste göre A ve B grubu arasýnda istatistiksel anlamlý bir fark vardýr (p<0.05). Ameliyat sonrasý altýncý ayda A grubu ile B grubu arasýnda independent t samples teste göre istatistiksel olarak anlamlý fark yoktur (p=0.27). Ameliyat sonrasý 6, 12 ve 24. ayda A grubu ile B grubu arasýnda independent t samples teste göre istatistiksel olarak anlamlý fark yoktur. Ýki grup arasýnda VAS of pain skorunda Fisher’s exact testine göre istatisksel olarak anlamlý fark bulunamadý.
TARTIÞMA: Medial malleol kýrýklarýnda kanulle vida, K-teli ile primer tespit edilen miniplak ile ek stabilte saðlanan olgularda erken dönem sonuçlarý ve erken dönemde günlük hayata dönüþ sadece kanülle vida ve K-teli yapýlan olgulara göre daha iyi ve hýzlýdýr. Orta dönemde iki teknik arasýnda anlamlý bir fark yoktur.