Comparison on efficacy of hollow screws and "L" type plate for treatment of middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture

Abstract

Objective To compare the clinical efficacy of hollow screws and L type plate for the treatment of middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture. Methods A retrospective case control study was performed on the clinical data of 73 patients with middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture treated from January 2010 to January 2017. There were 47 males and 26 females, with the mean age of 38.5 years (range, 23-70 years). According to the posterior malleolus fixation method, 38 cases adopted the internal fixation with three hollow screws (screw group), and 35 cases with L type plate fixation (plate group). The middle and lower 1/3 spiral fracture of tibia were treated with medial anatomical plate internal fixation. The intraoperative blood loss, operation time, infection, fracture healing time, and complications were recorded. The Baird-Jackson score was used to evaluate the ankle joint function. Results There were no significant differences in the blood loss and operation time between the two groups (P>0.05). A total of 71 patients were followed up for 6-18 months (mean, 15.8 months). Two cases in the screw group were lost to follow up. The wounds healed well after operation in two groups, and no signs of wound infection were found. All fractures healed well without delayed union or nonunion. There was no significant difference in fracture healing time between the two groups (P>0.05). No obvious reduction loss in posterior ankle fracture was found during follow-up. In the plate group, one patient was seen vertical shape toe deformity after operation, which might be related to muscle spasm of flexor hallucis longus, and the condition was not improved after removing the plate. At the last follow up, ankle joint function was evaluated according to the Baird-Jackson scoring system: in the screw group, 18 cases were excellent, 13 cases were good, four cases were allowed to pass, and one case was poor, with the excellent and good rate of 82%; in the plate group, 17 cases were excellent, 13 cases were good, four cases were allowed to pass, and one case was poor, with the excellent and good rate of 86%(P>0.05). Conclusion The clinical efficacy of hollow screws and L type plate is not significantly different, both of which can provide rigid fixation, reduce the incidence of hip dysfunction and improve quality of life of patients with middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture. Key words: Ankle; Tibial fractures; Fracture fixation, internal