title: Augmented osteosynthesis of OTA 44-B fractures in older patients: a technique allowing early weightbearing.
abstract: OBJECTIVE
  To determine the effectiveness of an augmented technique of osteosynthesis in allowing early weightbearing in older patients with OTA 44-B (Danis-Weber B) fractures.
  
  
  METHODS
  Case series.
  
  
  METHODS
  University Level I trauma center.
  
  
  METHODS
  Thirty-six patients, nonconsecutive, with OTA 44-B fractures.
  
  
  METHODS
  Augmented internal fixation using an intramedullary wire, lateral plate, and screw augmentation with polymethylmethacrylate.
  
  
  METHODS
  
  
  
  RESULTS
  Healed fracture with no loss of reduction.
  
  
  RESULTS
  American Orthopaedic Foot and Ankle Society score; percentage of patients who returned to prefracture function.
  
  
  RESULTS
  All patients began weightbearing as tolerated in a removable brace at a mean of 13.5 days postoperatively. Thirty patients were available for follow-up at a minimum of 12 months (range, 12-14 months). All fractures healed with no loss of reduction. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 84.9 (range, 74-100), and 90% of patients returned to prefracture function. There were two infections, one in a 74-year-old diabetic woman and the other in a 92-year-old woman with pre-existing arterial insufficiency and a small ulcer over the tip of the second toe.
  
  
  CONCLUSIONS
  Augmented internal fixation consisting of intramedullary wire, lateral plate, and screw augmentation with polymethylmethacrylate may allow for very early weightbearing without risk of secondary loss of reduction or disruption of the ankle mortise in older patients with OTA 44-B (Danis-Weber B) malleolar fractures.
authors: Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland.
authors: Mathieu
authors: M
authors: Assal
authors: Panayiotis
authors: P
authors: Christofilopoulos
authors: Anne
authors: A
authors: Lübbeke
authors: Richard
authors: R
authors: Stern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000503:physiopathology / Q000601:surgery*; D004434:Early Ambulation / Q000379:methods*; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000187:drug effects / Q000502:physiology*; D050723:Fractures, Bone / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D009984:Orthopedic Fixation Devices; D016348:Osseointegration; D010012:Osteogenesis; D011109:Polymethacrylic Acids / Q000008:administration & dosage; D011446:Prospective Studies; D020127:Recovery of Function; D014193:Trauma Centers; D016474:Weight-Bearing
chemical_list: D011109:Polymethacrylic Acids; C030613:polymethacrylic acid