title: Combination of hook plate and tibial pro-fibular screw fixation of osteoporotic fractures: a clinical evaluation of operative strategy.
abstract: BACKGROUND
  Internal fixation of osteoporotic ankle fractures is technically difficult and may fail because of unreliable purchase. This study was undertaken to determine if a combination of a hook plate and tibial pro-fibular screws can provide secure fixation until fracture union.
  
  
  METHODS
  Thirty-one patients between the ages of 55 and 90 years had open reduction and internal fixation of ankle fractures between April, 2001, and April, 2003. Sixteen patients with an average age of 71.4 years had ankle fracture fixation with a combination of hook plate and tibial pro-fibular screws for the distal fibular fracture, and 15 patients with an average age of 71.9 years had fixation of their ankle fractures with standard fixation technique using AO/ASIF principles but no tibial pro-fibular screws. All patients were followed with clinical and radiologic assessment at 2 weeks, 6 weeks, and 12 weeks postoperatively. At an average of 15.8 months after injury, patients also completed a mailed questionnaire with the Olerud-Molander ankle score and the AOFAS ankle-hindfoot score for preoperative and postoperative status.
  
  
  RESULTS
  All patients who had tibial pro-fibular screw fixation had fracture union without hardware failure or complications. In the standard fixation group two patients had wound breakdown and one had a valgus malunion with screw pull out. The AOFAS and Olerud-Molander scores for the standard open reduction and internal fixation were 57.3 and 82.8 before injury and 37 and 43.8 postoperatively, respectively. The AOFAS and Olerud-Molander scores for the hook plate and tibial pro-fibular fixation group were 55.9 and 81.3 before injury and 42.4 and 50.3 postoperatively, respectively.
  
  
  CONCLUSIONS
  The combination of hook plate and tibial pro-fibular screws in osteoporotic ankle fractures in a series of patients has not been reported before. This novel technique provides stable fixation for osteoporotic ankle fractures in elderly patients until union is achieved with good clinical scores.
authors.affiliation: University of Texas Medical Branch, 301 University Blvd., Rt. 0165, Galveston, TX 77555-0165, USA. vkpanchb@utmb.edu
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Panchbhavi
authors.forename: Milan G
authors.initials: MG
authors.lastname: Mody
authors.forename: William T
authors.initials: WT
authors.lastname: Mason
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D003131:Combined Modality Therapy; D005592:Fracture Fixation / Q000295:instrumentation*; D050723:Fractures, Bone / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D012189:Retrospective Studies