• 1

    Chiang CC, Tzeng YH, Lin CC, et al: Minimally invasive versus open distal fibular plating for AO/OTA 44-B ankle fractures. Foot Ankle Int 37: 611, 2016.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 2

    Gönen E, Ateş Y: Uzun kemik cisim kırıklarının cerrahi tedavisinde minimal invaziv yöntemler. TOTBİD Dergisi 11: 78, 2012.

  • 3

    Bingol I, Yalcin N, Bicici V, et al: Minimally invasive percutaneous plate osteosynthesis does not increase complication rates in extra-articular distal tibial fractures. Open Orthop J 9: 73, 2015.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Huang ZY, Liu L, Tu CQ, et al: Comparison of three plate system for lateral malleolar fixation. BMC Musculoskelet Disord 15: 360, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 5

    Gonzalez T, Chien B, Ghorbanhoseini M, et al: Minimally invasive surgical approach to distal fibula fractures: a technique tip. Arch Bone Jt Surg 5: 39, 2017.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Pires RE, Mauffrey C, de Andrade MA, et al: Minimally invasive percutaneous plate osteosynthesis for ankle fractures: a prospective observational cohort study. Eur J Orthop Surg Traumatol 24:1297, 2014.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Hess F, Sommer C: Minimally invasive plate osteosynthesis of the distal fibula with the locking compression plate: first experience of 20 cases. J Orthop Trauma 25: 110, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 8

    Carlile GS, Giles NC: Surgical technique for minimally invasive fibula fracture fixation. Foot Ankle Surg 17: 119, 2011.

  • 9

    Neubauer T, Heidari N, Weinberg AM, et al: The risk of nerve injury with minimally invasive plate osteosynthesis of distal fibula fractures: an anatomic study. Arch Orthop Trauma Surg 131: 1409, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 10

    van den Bekerom MP, Hogervorst M, Bolhuis HW, et al: Operative aspects of the syndesmotic screw: review of current concepts. Injury 39: 491, 2008.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 11

    McBryde A, Chiasson B, Wilhelm A, et al: Syndesmotic screw placement: a biomechanical analysis. Foot Ankle Int 18: 262, 1997.

  • 12

    De Souza LJ, Gustilo RB, Meyer TJ: Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg Am 67: 1066, 1985.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Kaye RA: Stabilisation of ankle syndesmosis injuries with a syndesmotic screw. Foot Ankle 9: 290, 1989.

  • 14

    Olerud C: The effects of the syndesmotic screw on the extension capacity of the ankle joint. Arch Orthop Trauma Surg 104: 299, 1985.

  • 15

    Riegels-Nielsen P, Greiff J: The stability of the tibiofibular syndesmosis following rigid internal fixation for type C malleolar fractures: an experimental and clinical study. Injury 14: 357, 1983.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Zhenhua F, Waizy H, Ming X, et al: Lateral malleolus hook plate for comminuted Weber A and B fractures: a retrospective study. Indian J Orthop 47: 364, 2013.

    • Crossref
    • Web of Science
    • Search Google Scholar
    • Export Citation

Minimally Invasive Surgical Approach Using an Equal-Sized Plate as an External Guide to Lateral Malleolar Fractures

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  • 1 Department of Orthopaedics and Traumatology, University of Giresun, School of Medicine, Giresun, Turkey.
  • | 2 Department of Orthopaedics and Traumatalogy, University of Gaziosmanpaşa, School of Medicine, Giresun, Turkey.
  • | 3 Department of Orthopaedics and Traumatalogy, Giresun Training Hospital, Giresun, Turkey.
  • | 4 Department of Orthopaedics and Traumatalogy, Acıbadem Eskişehir Hospital,Eskişehir, Turkey.
  • | 5 Department of Anatomy, University of Giresun, School of Medicine, Girensun, Turkey.
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Background:

For minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques applied to fractures of the lateral malleolus, there is no external guide for inserting the plate, determining the incision, and inserting the screws as used for fractures in other regions. With MIPPO, fluoroscopy exposure is unavoidable. The MIPPO technique is advantageous for patients; however, the unavoidable problem with this method for the surgical team is repeated exposure to fluoroscopy. To expose the surgical team to least radiation, we used a novel technique with an equal-sized plate as an external guide. We present the results of patients treated with this technique.

Methods:

Patients with isolated lateral malleolar fracture who underwent MIPPO using an equal-sized anatomical lateral malleolar plate as an external guide were retrospectively investigated. VAS scores on postoperative day 1 and AOFAS scores at final evaluation were noted.

Results:

Twenty-six patients were included in the study. Mean ± SD follow-up was 42.46 ± 14.11 months. Mean ± SD VAS score on postoperative day 1 was 3.76 ± 2.58. On final evaluation, prominent implant was identified in two patients, with mean ± SD AOFAS score of 98.00 ± 2.17. No other complications were observed.

Conclusions:

Using an equal-sized plate as external guide may ensure less use of fluoroscopy while determining the incisions. Until an external guide is produced commercially for minimally invasive fixation of lateral malleolar fractures, this method ensures determination of incisions and insertion of screws without requiring the use of fluoroscopy and may be reliably used for minimally invasive surgery.

Corresponding author: Kürşad Aytekin, MD, PhD, Departments of Orthopaedics & Traumatology and Anatomy, Giresun Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji ABD, Giresun, Merkez 28100, Turkey. (E-mail: kursadaytekin@gmail.com)