PERCUTANEOUS INTRAMEDULLARY FIXATION OF LATERAL MALLEOLUS FRACTURES -TECHNIQUE AND REPORT OF EARLY RESULTS

Twenty-four patients with Weber B and low Weber C displaced lateral ma lleolus fractures who underwent closed reduction and percutaneous inte rnal fixation with an intramedullary, fully threaded, self -tapping sc rew were retrospectively reviewed. Nineteen of these patients were fol lowed for an average of 63.4 weeks. A good radiographic reduction was obtained in 87.5% of patients, a fair reduction in 8.3%, and a poor re duction in 4.2%. The reduction that was obtained was maintained in all patients. Fracture union was achieved in 95.5% of patients, with an a verage time to union of 8.2 weeks. In all patients the average time to full weight bearing was 6.8 weeks, whereas that in patients with isol ated lateral malleolus fractures was 4.5 weeks. There were no deep wou nd infections or complaints of painful hardware. At latest follow-up, functional results were excellent in 42.1%, good in 42.1%, fair in 5.3 %, and poor in 10.5% of patients. If reduction of the lateral malleolu s fracture can be obtained in a closed fashion (with the aid of an ima ge intensifier), we believe that fixation may be performed with an axi al screw percutaneously. This technique requires minimal soft-tissue d issection, thereby decreasing wound complications and painful hardware sites that are occasionally observed after open techniques. This clos ed technique also eliminates screw penetration of the ankle joint and damage to the peroneal tendons, which can be risks when a plate or lag screws are employed as internal fixation. Surgical time is also reduc ed and tourniquet use is optional. If an acceptable reduction cannot b e obtained using this technique, open reduction and internal fixation should be performed.