title: Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry.
abstract: BACKGROUND
  Evaluation of operative techniques used for medial malleolar fractures by classifying fracture geometry has not been well documented.
  
  
  METHODS
  One hundred eleven patients with medial malleolar fractures (transverse n = 63, oblique n = 29, vertical n = 7, comminuted n = 12) were included in this study. Seventy-two patients had complicating comorbidities. All patients were treated with buttress plate, lag screw, tension band, or K-wire fixation. Treatment outcomes were evaluated on the basis of radiological outcome (union, malunion, delayed union, or nonunion), need for operative revision, presence of postoperative complications, and AOFAS Ankle-Hindfoot score.
  
  
  RESULTS
  For transverse fractures, tension band fixation showed the highest rate of union (79%), highest average AOFAS score (86), lowest revision rate (5%), and lowest complication rate (16%). For oblique fractures, lag screws showed the highest rate of union (71%), highest average AOFAS score (80), lowest revision rate (19%), and lowest complication rate (33%) of the commonly used fixation techniques. For vertical fractures, buttress plating was used in every case but 1, achieving union (whether normal or delayed) in all cases with an average AOFAS score of 84, no revisions, and a 17% complication rate. Comminuted fractures had relatively poor outcomes regardless of fixation method.
  
  
  CONCLUSIONS
  The results of this study suggest that both tension bands and lag screws result in similar rates of union for transverse fractures of the medial malleolus, but that tension band constructs are associated with less need for revision surgery and fewer complications. In addition, our data demonstrate that oblique fractures were most effectively treated with lag screws and that vertical fractures attained superior outcomes with buttress plating.
  
  
  METHODS
  Level III, retrospective comparative series.
authors: Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH, USA.
authors: Nabil A
authors: NA
authors: Ebraheim
authors: Todd
authors: T
authors: Ludwig
authors: John T
authors: JT
authors: Weston
authors: Trevor
authors: T
authors: Carroll
authors: Jiayong
authors: J
authors: Liu
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies
keywords: ankle injuries; ankle injuries radiography; distal tibia fractures; fracture fixation methods; medial malleolus; treatment outcome