title: Medial malleolus screws: out in one view and out.
abstract: Cartilage damage or mechanical blocking from screw penetration into intra-articular cartilage can reduce the chances of successful outcomes during medial malleolus fixation. There have been diverging opinions among surgeons concerning the reliability of radiographic assessment of fracture fixation and malleolus screw positioning. Therefore, this radiographic study examines the location of medial malleolus lag screws relative to the ankle mortise articular surface. In three Sawbones models, Kirschner wires were overdrilled with a 4.0-mm cannulated cortical screw simulating screws that would be intra- and extra-articular when performing open reduction and internal fixation of a medial malleolar fracture. Under fluoroscopy, images were evaluated to determine whether known intra-articular screws appeared extra-articular in any radiographic view. No image from models with known intra-articular penetration appeared extra-articular in any view or under "live" fluoroscopy. At 20° internal rotation, a screw with a known extra-articular position appeared to be within the cartilage. Intra-operative fluoroscopy is necessary to ensure proper extra-articular placement of screws. If a screw is pictured extra-articular in any radiograph, then it can be assumed that the screw is indeed out of the joint.
authors.affiliation: Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St., First Floor ACB, Louisville, KY, 40202, USA. jeff.c.wera@gmail.com.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wera
authors.affiliation: Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St., First Floor ACB, Louisville, KY, 40202, USA.
authors.forename: David
authors.initials: D
authors.lastname: Seligson
authors.affiliation: Orthopaedic Surgery, Baptist Health Care and Andrews Institute, 1717 North E Street, Suite 208, Pensacola, FL, 325011, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Riehl
mesh_terms: D064386:Ankle Fractures / Q000601:surgery*; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001863:Bone Screws / Q000009:adverse effects; D001864:Bone Wires / Q000009:adverse effects; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D006801:Humans; D011183:Postoperative Complications; D016896:Treatment Outcome
keywords: Ankle radiography; Fracture; Internal fixation; Medial malleolus