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Minimally invasive percutaneous plate osteosynthesis for ankle fractures: a prospective observational cohort study

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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Abstract

Background

The gold standard for the surgical management of ankle fractures is through open reduction and internal fixation. The rate of wound problems has been reported to be as high as 18 %, especially in patients with poor vascular supply or in diabetics. Minimally invasive percutaneous plate osteosynthesis (MIPPO) has been described as a potential solution for these patients.

Patients and methods

This is a prospective observational cohort study. From October 2009 to February 2010, and following ethical approval of our research, adult patients admitted at our level I trauma center with a closed lateral malleolar displaced unstable fracture (Lauge-Hansen supination-external rotation) with or without a medial-sided injury and patients with an undisplaced fracture associated with medial clear space opening on external rotation stress radiographs were recruited and managed using MIPPO technique. All patients were followed up for a minimum of 12 months post-surgery (12–20 with a mean of 16.5 months). Trauma mechanism, comorbidities, classifications, trauma-surgery interval, image intensifier duration, surgery duration, complications, and function American Orthopaedic Foot and Ankle Society (AOFAS) were analyzed.

Results

Thirty-two patients were recruited of which 20 fulfilled the inclusion criteria (16 females, 4 males) and were available for follow-up. Ten fractures (50 %) were classified as 44-B1, 7 fractures (35 %) as 44-B2, and 3 fractures (15 %) as 44-B3 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification (100 % were supination-external rotation injuries). At 8 weeks post-surgery, all fractures had healed. The duration of surgery ranged between 15 and 73 min (average 32.8) from skin incision to closure. There were 2 complications (1 malunion and 1 skin necrosis requiring implant removal). At 12-month follow-up, AOFAS average was 88.3 (72–100 standard deviation of 6.8 points).

Conclusion

MIPPO technique proved to be a viable option for lateral malleolar fracture treatment with a low complication rate and high functional outcome at 1 year. It is particularly useful in patients with a high risk of wound complication.

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Abbreviations

MIPPO:

Minimally invasive percutaneous plate osteosynthesis

AOFAS:

American Orthopaedic Foot and Ankle Society

AO:

Arbeitsgemeinschaft für Osteosynthesefragen

AP:

Antero-posterior view

CI:

Confidence interval

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

Ethical approval was granted by the local ethics committee (CAAE: 0034.0.240-11).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Federal University of Minas Gerais and Felício Rocho Hospital, Belo Horizonte, MG, Brazil

    Robinson Esteves Santos Pires

  2. Department of Orthopaedic Surgery, Denver Health Medical Center, Colorado University, Denver, CO, USA

    Cyril Mauffrey

  3. Department of Orthopaedic Surgery, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

    Robinson Esteves Santos Pires & Marco Antônio Percope de Andrade

  4. Department of Orthopaedic Surgery, Felício Rocho Hospital, Belo Horizonte, MG, Brazil

    Leonardo Brandão Figueiredo

  5. Department of Orthopaedic Surgery, Miguel Couto Hospital, Rio de Janeiro, RJ, Brazil

    Vincenzo Giordano

  6. Department of Orthopaedic Surgery, Federal University of São Paulo, São Paulo, SP, Brazil

    João Carlos Belloti & Fernando Baldy dos Reis

Authors
  1. Robinson Esteves Santos Pires
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  2. Cyril Mauffrey
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  3. Marco Antônio Percope de Andrade
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  4. Leonardo Brandão Figueiredo
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  5. Vincenzo Giordano
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  6. João Carlos Belloti
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  7. Fernando Baldy dos Reis
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Corresponding author

Correspondence to Robinson Esteves Santos Pires.

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Pires, R.E.S., Mauffrey, C., de Andrade, M.A.P. et al. Minimally invasive percutaneous plate osteosynthesis for ankle fractures: a prospective observational cohort study. Eur J Orthop Surg Traumatol 24, 1297–1303 (2014). https://doi.org/10.1007/s00590-013-1295-x

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  • DOI: https://doi.org/10.1007/s00590-013-1295-x

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