STAPLE FOR MEDIAL MALLEOLAR FRACTURE FIXA TION

Purpose of the study Rigid medial and lateral fixation should stabiliz e the syndesmosis without further additional suplementation. We used T itanium staples for medial malleolar fixation. Material This study inc luded 21 medial malleolar fractures (6 isolated medial malleolar fract ures). Ankle fractures were classified according to Weber's system for lateral malleolar fracture. Technical Tension band was used for Weber A lateral malleolar fracture and a plate far Weber B and C. One Weber A fracture was stabilized by staples. After reduction with clamps, th ree staples are placed perpendicular to the fracture line. All medial malleolar fractures were treated by staples including comminutive frac tures or fractures who extended proximally into the tibia pilon. Only three transversal fractures of the anterior rim were treated by staple s. Closure was made without any drainage. A below the knee cast was pl aced for 6 weeks. Results All fractures healed without further displac ement. According to Weber Score, eleven ankle had an excellent result, seven a good result and three a bad result. We never removed the stap les except in one case of technical error.Discussion Titanium staple p resent an attractive alternative for medial malleolar fixation. Plaste r cast don't impair ankle function. Titanium staples are easy to use, are of little bulk and removal is not necessary. Skie ef al. described three types of anterior rim fracture: one transversal and two oblique . The small size of the fragment makes reduction difficult to maintain , and impacted staple tends to displace laterally this small fragment. In this serie we stapled only transverse fracture of the anterior rim (three times). But even in this case, it is difficult to maintain red uction during stapling. In case of lass of reduction, removal of the s taple is responsible for fragmentation of the small fragment, Excludin g the anterior rim fracture, other fractures, including T fractures an d fractures who extend to the tibial pilon can be treated by this tech nique. Conclusion Titanium staple is easy to use in medial malleolar f ractures excluding anterior rim fractures.