Hansen Classification Research Articles

Posterior Malleolus Fracture Fixation In Lateral Decubitus Position: Surgical Technique and Results in 60 Patients

The present study shows how posterior malleolus fractures (PMFs) and distal fibular fractures were fixed using the posterolateral approach with the patient in lateral decubitus position, not previously described in the literature. This technique has been used in 60 consecutive patients (42 women and 18 men; mean age 54.7; range 21-92 years), 33 of which presented as fracture dislocations from March, 2021 to December, 2023. After PMFs fixation in lateral decubitus position, release of the sacral support allowed patients to be placed supine (without de-sterilizing the operative field), in order to proceed with medial malleolus or posteromedial fragment fixation. Fractures were classified according to the Lauge Hansen classification as SER4 (n = 50), PER4 (n = 7), SAD (n = 1), and PAB (n = 2). Fractures were classified according to Rammelt & Bartonicek, as type B (n = 40), C (n = 13), and D (n = 7). During the same period of time 14 fractures involving the PM, classified as type A, were treated with indirect fixation, whilst 6 geriatric and/or poor mobility patients with fracture dislocations were treated with retrograde hindfoot nail fixation. Follow-up period ranged from 4-36 months (mean = 14.4; SD = 8.8). Complications occurred in 5 patients (8.3%; 3 had delayed (medial) wound healing, one developed CRPS and one required implants removal and arthroscopy because of metal irritation and stiffness). No deep infections, thromboembolic events, fracture malreductions or malunions were recorded and all patients returned to the preinjury mobilization status. In conclusion, PM fracture fixation was feasible and safely performed with patients in lateral decubitus position.

Prospective study of outcome of trimalleolar ankle fractures

<p class="abstract">Trimalleolar fracture are complex and challenging to treat. We conducted a study on 15 patients with trimalleolar fracture. Fractures were classified based on Lauge Hansen classification. They were treated with open reduction and internal fixation (ORIF) with plate and screws for posterior malleolus and lateral malleolus, tension band wire (TBW)/cannulated cancellous (CC) screw for medial malleolus functional and radiological outcomes were assessed by Olerud and Molender score and Kristenson’s criteria respectively. Functional outcome was satisfactory in 93% of cases and radiological outcome in 86%. Early treatment without delay, anatomical reduction of fracture with stable fixation of every fracture component, stringent post operative mobilization should help to improve outcome in operated trimalleolar fracture patients.</p>

Cerrahi Tedavi uygulanmış Ayak Bileği Kırıklarının Klinik, Radyolojik ve Fonksiyonel Sonuçlarının Değerlendirilmesi

Objective: The ankle is an important joint in the walking function of the body.
 Surgical treatment is required in cases where displaced and unstable fractures and
 joint compatibility cannot be achieved by conservative methods. The main goal of
 surgical treatment is to restore the anatomical position of the talus within the ankle
 for a normal tibiotalar joint relationship.
 Methods: 73 patients who were admitted to our outpatient clinics between January
 2006 and October 2015, who were diagnosed with ankle fracture and underwent
 surgical treatment, were retrospectively evaluated and compared with the intact
 ankle.
 Results: Of the patients who had surgery; Bimalleol fracture in 34 (46.58%),
 trimalleol fracture in 8 (10.96%), lateral malleolar fracture in 14 (19.18%), medial
 malleolar fracture in 13 (17.81%), with posterior malleolar fracture in 1 ankle
 dislocation (1.37%) and 1 had posterior malleolar fracture with medial malleolus
 fracture (1.37%). According to the Lauge Hansen classification, the most common
 type of SER (Supination External Rotation) fracture (14 cases) (19.18%), followed
 by the second most common PER (Pronation External Rotation) fracture type (14
 cases) (19.18%). According to the Danis - Weber classification, Type C (21 cases)
 (52.50%) was the most common and Type B (14 cases) (35.00%) was the second
 most common. When the union time was analyzed according to the fracture type, no
 statistically significant difference was observed (p=0.064).
 Conclusions: If surgical treatment is applied in ankle fractures the length of the
 fibula should be ensured, rigid internal fixation should be made with the aim of
 anatomical reduction of the joint surface, and ankle movements should be started
 early.

New Therapy Option: Maisonneuve Fracture without Transsyndesmotic Fixation

Ankle fracture is one of the common injuries in orthopedic department, the Maisonneuve fracture is a specific type of ankle injury. This fracture is usually caused by rotational force. According to the Lauge -Hansen classification, it is a pronation and external rotation type injury, often resulting in inferior tibiofibular injury. Because it is extremely unstable, it is usually treated surgically. Operative treatment includes medial malleolus fixtion, reduction of the inferior tibiofibular joint and screw fixation. When the fibula fractured is without shortening or dislocation, it is still controversial if inferior tibiofibular joint needs fixation. The aim of this study is to introduce a new method-Maisonneuve without transsyndesmotic fixation and analysis the follow-up result.

New therapy option: Maisonneuve fracture without transsyndesmotic fixation

Ankle fracture is one of the common injuries in the orthopedic department, the Maisonneuve fracture is a specific type of ankle injury. This fracture is usually caused by rotational force. According to the Lauge -Hansen classification, it is a pronation and external rotation type injury, often resulting in inferior tibiofibular injury. Because it is extremely unstable, it is usually treated surgically. Operative treatment includes medial malleolus fixation, reduction of the inferior tibiofibular joint and screw fixation. When the fibula fractured is without shortening or dislocation, it is still controversial if the inferior tibiofibular joint needs fixation. This study aims to introduce a new method-Maisonneuve without transsyndesmotic fixation and analysis the follow-up result.

P109 Sherlock Holmes in Clinical Practice: The Deduction of the Pattern and Mechanism of Injury in Ankle Fractures Using Lauge-Hansen System

IntroductionAnkle fractures are among the commonest fractures in adults and as population ages, the incidence is also increasing. It is crucial to ascertain the mechanism of injury of an ankle fracture as it determines the management plan. The diagnosis and management of ankle fractures are usually relatively straightforward but they are not always the case. Most patients are unable to recall the exact mechanism of injury due to the instantaneous nature of incident. We herein describe a case report of a patient who sustained an ankle fracture following a fall but was unable to recall the exact mechanisms of injury. This case report addresses the importance of recognising Maisonneuve fractures and how Lauge-Hansen Classification system might be useful in diagnosing and making management plans for ankle fractures.Case ReportA 30-year-old male self-presented to the Emergency Department in a wheelchair following a fall. He tripped down the last four steps of stairs the night before, sustaining a right ankle injury as a result. He has been unable to weight-bear since. Elevation and application of ice packs have showed limited effect. Patient was unable to recall the exact mechanism of injury. On examination, the right ankle was swollen and there were bruises around the medial malleolus. Upon palpation, he complained of bony tenderness around lateral and medial malleoli. No other injury was found and patient was neurovascularly intact. A referral was made to the Orthopaedics team and further orthopaedic examinations revealed tenderness and crepitus upon palpation over the proximal fibula. Full lower leg X-rays was ordered to look for possible proximal fibula fracture. A diagnosis of closed, Maisonneuve (Weber C)/trimalleolar fracture of the right ankle was made.A CT-scan of the right ankle was requested to determine the involvement of joint surface to aid surgical planning. Both CT-scan and ankle X-rays showed disrupted syndesmosis. Disrupted syndesmosis is most commonly associated with Weber C fractures as shown in this case. Since the fibular fracture is greater than 4.5cm away from the tibial plafond, syndesmosis fixation is required. In Maisonneuve fractures, syndesmotic screws can be used to achieve anatomical reduction and ankle stability. This patient was scheduled for an ORIF surgery.DiscussionsBased on the findings of medial and posterior malleoli fractures from the ankle X-rays, we can deduce that the patient has most likely sustained a complete Pronation-External Rotation (PER) injury. A Maisonneuve fracture was almost missed initially due to distracting injuries and not obtaining full lower leg X-rays. However, based on Lauge-Hansen Classification, we know that it is highly unlikely to have a posterior malleolus fracture (Stage 4) without any fibular fracture (Stage 3). Hence, a full-fibula X-ray was ordered to look for proximal fibula fracture and the X-rays revealed a spiral fracture at the proximal fibula (Maisonneuve fracture). The injury force was transmitted along the interosseous membrane and exited at the shaft of proximal fibula, causing a proximal fibular fracture. PER or injury sustained from an internally rotated leg on a planted foot may cause external rotation injury, resulting in a disruption of the ligaments. The syndesmosis, which provides primary support to the ankle, if disrupted, will disrupt the ankle mortise, displacing the fibula laterally, as demonstrated in this case.ConclusionAs demonstrated in this case, some fractures, like the Maisonneuve fracture, can easily be missed. Due to distracting injuries, the chief complain in most cases of Maisonneuve fracture is severe ankle pain instead of the fracture site at proximal fibula. These fractures, if not identified early, can lead to poor prognosis. It is important to consider Maisonneuve fracture in all ankle injuries. A delayed diagnosis can lead to post-traumatic arthritis and pain, leading to loss of function. This case report addresses the importance of recognising easily missed fractures and how Lauge- Hansen Classification system is useful in aiding the diagnosis and management of ankle fracture

Functional outcome of tension band wiring in transverse fracture of medial malleolus

Background and Objectives: Medial malleoli fracture is one of the common fractures in ankle joint mainly due to road traffic accident in which transverse fracture of medial malleolus accounts for significant morbidity and mortality. Tension band wiring (TBW) is an accepted modality of treatment which enables early mobilization of the patients than any other methods of treatment at present. TBW converts a tensile force into compressive force there by improves fracture healing, early mobilization and improved functional outcome of medial malleoli fracture of ankle joint.Materials and Methods: A longitudinal cohort study of transverse fracture of medial malleolus requiring surgical treatment, 20 patients were selected by convenient sampling technique and were operated by tension band wiring technique. In our study we use Lauge- Hansen classification pronation –abduction and pronation- eversion type, patients were evaluated for functional outcome by using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle – Hind foot scale. All data were analyzed using SPSS software v 20.0.Results: The result of our study shows the effectiveness of the procedure for medial malleolus where good to excellent results were obtained in 75% of cases, fair results were in 15% of cases and poor results in 10%.Conclusion: TBW is a simple, inexpensive technique and effective means of fixing medial malleolus fracture based on biomechanical principle with minimum complications. Long term complications of prolonged immobilization like joint stiffness, muscle wasting, pressure sores and osteoporosis are avoided. TBW for medial malleolus helps by achieving compression at fracture site, the fracture heals faster and helps in early rehabilitation.

Uloga i značaj fiksacije zadnjeg maleolusa kod trimaleolarnih preloma

Introduction - ankle fractures are third when it comes to frequency, right after hip and wrist joint fractures. Posterior malleolus fractures are common, comprising 7% to 44% of all ankle fractures, and are very rare on their own; that is a Volkmann triangle fracture. Ankle is a supporting joint in the human body, and fractures generally occur within rotation of the body with different fixed foot positions. The posterior malleolus is a very important structure in distal tibiofibular joint. Material and methods - we retrospectively present a group of 21 patients who had a fracture of the ankle and were surgically treated at the Clinic for Orthopedics and Traumatology in Niš during the period from January 2013 to December 2015. The basic criterion for surgical treatment was the size of the fragment, > 25% from tibial joint surface and dislocation >2mm. We systemized all ankle fractures according to the Lauge Hansen system, which is based on the mechanism of injury. We evaluated treatment results according to the Olerud-Molander classification, followed by subjective and objective signs. We systemized posterior malleolus fractures into three types, according to the Haraguchi classification. Results - etiological causes of the fractures are: a fall at the same level - sport, skating in 11 (52.3%) patients, a fall from a height in 6 (28.6%) and traffic accident in 4 (21.1%) patients. According to the Lauge Hansen classification, there were 15 (71.4%) patients with a SER-type fracture, 4 (19%) of the PER type, and 2 (9.6%) of the PA type. End result of the treatment was excellent in 13 (61.9%) patients, good in 7 (33.4%) and poor in 1 (4.7%) patient. Post-traumatic arthritis (PTA) was assessed one year after the surgery and level 1 and 2 were present in 12 (57.1%) patients.

A CASE REPORT OF TRIMALLEOLAR FRACTURE TREATED WITH PLATING AND TENSION BAND WIRING

A case of trimalleolar fractures of left ankle has been described here. Fractures around the ankle joint mainly depend on the direction of forces during trauma ,position of the ankle and foot at the hour of injury. A 44 year-old man fell off a two wheeler on a road and sustained injury to his left ankle. X-ray radiographs were taken and patient was diagnosed to have left sided post traumatic closed trimalleolar fracture with lauge Hansen classification of supination external rotation without any distal neurovascular deficit. Patient underwent osteosyntheses and During the post-operative period there was no complications.

Surgical treatment of multifragmentary segmental femur shaft fractures with ORIF and bone graft versus MIPO: a prospective control-group study.

Aim Multifragmentary segmental femoral shaft fracture is a high energy injury frequently associated with life-threatening conditions. The aim of this study was to compare the use of bio metallic open reduction internal fixation (ORIF) (plate with allograft bone strut) with minimally invasive plate osteosynthesis (MIPO) fixation for the treatment of multi-segmental femoral shaft fracture in terms of outcomes, bone healing and complications. Methods Forty patients with segmental femoral shaft fractures were included and divided into two groups: 20 patients treated with ORIF+, 20 with MIPO. All fractures were classified according to AO (Arbeitsgemeinschaft für Osteosynthesefragen) and Winquist and Hansen Classification. Evaluation criteria were: duration of follow up and surgery, Non-Union Scoring System, Pain Visual Analogic Scale (VAS), objective quality of life and hip function, subjective quality of life and knee function, quality of life the Short Form-12 Survey Questionnaires (SF-12), bone healing and femoral alignment (radiographs), Radiographic Union Score for Hip (RUSH). Results Better results of ORIF in terms of complication rate, RUSH, VAS, regression between RUSH and VAS, average correlation clinical-radiographic results and patients' outcomes (Cohen k) were obtained, and similar results for the length of follow up, surgery duration, perioperative blood transfusion, wound healing. No statistical difference for Harris Hip Score (HHS), Knee Society Score (KSS), quality of life (SF-12). Conclusions The ORIF and bone strut allograft technique had better results compared to the MIPO technique with regards to complication rate, RUSH, VAS, regression between RUSH and VAS, and average correlation clinical-radiographic results and patients' outcomes (Cohen k) in the surgical treatment of multifragmentary segmental femoral shaft fractures.

Surgical management of malleolar fractures of ankle in adults

Background and Objectives: Ankle fractures represents 10% of all fractures making it a second most common fractures of lower limb after hip. Peak incidence of ankle fractures in younger men & older women have a bimodal distribution. Typically low energy injuries with majority occurring due to simple falls or Sports. Ankle joint is very congruous and any disturbance of the normal articular relationship may result in some progressive arthrosis of biomechanical dysfunction. Determining ankle stability for planning fracture management is very critical. Stable fractures can be managed conservatively but outcomes of unstable fractures are always better with surgical management. ORIF has shown clearly the superiority in literatures. Lateral malleoli without any deltoid ligament involvement can be treated conservatively with good results whereas lateral malleoli with deltoid ligament involvement leads to talar subluxation and arthritis hence needs to be fixed stably. The objectives is to study the functional outcomes and results of surgical management of malleolar fractures, and to know the complications of open reduction internal fixation of malleolar fractures. Methods: 30 patients with fresh malleolar fractures were taken into study. As soon as the patients were brought to emergency room a complete survey was done to rule out any significant injuries. Then radiographs were taken, both antero-posterior and lateral views of ankle joints. On admission history was elicited in relation to age, sex, occupation, address, mode of injury, past illnesses, associated medical aliments and was subjected to thorough clinical examination. Analgesics and below knee slabs were applied to alleviate the pain. Eventually fractures were classified according to Lauge Hansen’s classification system. Patients were operated as early as possible once they were fit for Surgery.Results: Out of 30 patients treated 23(76.6%) had good to excellent results, 4(13.3%) had fair & 3(10.0%) had poor results, our study showed that mean age of presentation was 37.87 years with male preponderance & involvement of dominant limb(right side), most common mode of injury was road traffic accident, analysis according to lauge Hansen classification were found to have supination external rotation injury in common, there were no intraoperative complications, But had poor outcomes due to the superficial skin infection which was treated appropriately. Interpretation and Conclusion: Mechanism of injury is necessary for accurate reduction & further management. Fibular length has to be maintained, Anatomical reduction is essential in all intra articular fractures like ankle joint, were weight bearing is essential. Open reduction and internal fixation Guarantees high standard of reduction besides eliminating the chances of loss of reduction. Chances of non- union of medial malleolus was reduced by preventing interposition of periosteum or any other soft tissue. Even after cast immobilization for 3-4 weeks the results are satisfactory due to the vigorous physiotherapy which was followed immediately after cast removal. Tension band principles was followed for osteoporotic & small fragment fractures.

Syndesmotic Fixation Utilizing a Novel Metal Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Category:AnkleIntroduction/Purpose:Syndesmotic disruption occurs in nearly 1 in 5 ankle fractures and requires anatomic reduction and internal stabilization to maximize functional outcomes. There is growing evidence to support retaining syndesmotic hardware from both a functional and economic standpoint. However, although broken screws are typically of little consequence, the location of screw breakage can be unpredictable and cause painful bony erosion and difficulty with extraction. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw with a more predictable break point and design features to allow for easier extraction.Methods:We performed a retrospective review of all consecutive patients who underwent syndesmotic fixation utilizing the novel syndesmotic screw over a one year period. Demographic data were obtained such as age, gender, fracture classification and relevant comorbidities. Screw specific data were obtained such as number of screws utilized and length. Screw loosening or breakage was documented. Postoperative radiographs were reviewed and tibiofibular overlap, tibiofibular clear space and medial clear space were measured.Results:18 patients met inclusion criteria. Mean length of clinical follow-up was 4.67 months (range 0.5 to 8.5 months). Per the Lauge Hansen classification, 14 injuries were supination external rotation type, two were pronation abduction and two pronation external rotation type. Three screws (12.5%) fractured at the break point with no screws fracturing at a different location. 21 screws did not fracture with 10 (42%) of the screws demonstrated to be loose. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow up of the cohort. No screws required removal during the study period. There were no other complications of any type (Table 1).Conclusion:Early reporting of outcomes is essential to maximize both safety and value in healthcare technology innovation. This study provides the first clinical data on a novel alternative to traditional screws and suture button devices for fixation of syndesmotic injuries. At short-term follow up, there were no complications and the novel screw provided adequate fixation to allow healing and prevent diastasis. While initial results are favorable, longer term follow-up is required to determine whether this novel implant can reduce rates of symptomatic hardware requiring removal, which could ultimately make them more cost- effective than suture-button fixation.

Extra-Periosteal Plate Fixation of Ankle Fractures

AbstractBackground: Open reduction and internal fixation with plate and screws is the standard operative treatment for displaced or unstable malleolar fractures, as it allows for a stable mechanical environment for healing. However, extensive surgical dissection can lead to devitalization of the fracture fragments and their soft tissue attachments, resulting in delayed union, non-union, and infection. Hence, a balance is necessary between anatomic reduction and soft tissue devitalization.Aim of Study: Was to evaluate the results of extra-periosteal plate fixation in ankle fractures.Patients and Methods: This study was done on 21 patients with closed ankle fractures who were admitted to Department of Orthopaedics, Tanta University Hospitals. The distribution of patients was according to age, sex, side, mode of trauma, lauge hansen classification type of fracture, medical history, smoking, time lag and associated injuries. Fixation was done by extra-periosteal plating technique. Clinical evaluation was according to Baird and Jackson scoring system. Results: There were significant statistical correlation between the time of union and mode of trauma, associated injuries, associated medical condition and Time lag.Conclusion: Extra-periosteal plating of ankle fractures is an effective method of stabilization that leads to predictable union of the fibular fracture. The results of this procedure are at least as good as those of other techniques of open reduction and internal fixation of the ankle.

Досвід оперативного лікування собак при зміщеннях міжхребцевих дисків

Досвід оперативного лікування собак при зміщеннях міжхребцевих дисків

Supination external rotation ankle fractures: A simpler pattern with better outcomes.

Background:Rotational injuries are the most common and usually classified as per the Lauge Hansen classification; with the most common subgroup being the supination external rotation (SER) mechanism. Isolated fractures of the distal fibula (SE2) without associated ligamentous injury are usually treated with a splint or brace and the patient may be allowed to weight bear as tolerated. This study reports the functional outcomes following a stable, low energy, rotational ankle fracture supination external rotation (SER2) when compared to unstable SER4 fractures treated operatively.Materials and Methods:64 patients who were diagnosed and treated nonoperatively for a stable SER2 ankle fracture were followed prospectively. In the comparison group, 93 operatively treated fibular fractures were extracted from a prospectively collected database and evaluated comparison. Baseline characteristics obtained by trained interviewers at the time of injury included: Patient demographics, short form-36, short musculoskeletal functional assessment (SMFA) and American Orthopedic Foot and Ankle Society (AOFAS) questionnaires. Patients were followed at 3, 6 and 12 months postsurgery. Additional information obtained at each followup point included any complications or evidence on fracture healing. Data were analyzed by the Student's t-test and theFisher's Exact Test to compare demographic and functional outcomes between the two cohorts. P < 0.05 was considered to be significant.Results:The average of patients’ age in the stable fracture cohort was 43 versus 45 in the SER4 group. Nearly 64% of the patient population was female when compared with 37% in the operative group. In the SER2 by 6 months all patients had returned to baseline functional status. There were 18 delayed unions (all healed by 6 months). Based on the functional outcome scores all patients had returned to preoperative level. In comparison, SE4 patients had less functional recovery at 3 and 6 months (P < 0.05) based on the SMFA scores and at 3, 6 and 12 months based on the AOFAS (P < 0.001) scores. There was no difference in pain levels between the two groups at all time points. There were three nonunions in the SE4 group and six delayed unions.Conclusions:An SER2 ankle fracture is a relatively benign injury with functional limitations resolving by 3 months while the need for surgical fixation in SER ankle fractures appears to affect lower extremity function to a greater degree for a longer time period. Patients should be counseled as to these expected outcomes.

Comparative Study of Management of Closed Comminuted Femoral Shaft Fractures with Closed Interlocking Intramedullary Nail and Open Reduction and Dynamic Compression Bridge Plating

Fracture shaft of the femur are life-threatening injuries and can cause severe permanent disability. Nowadays die interlocking nailing is regarded as the operative technique of choice for fracture shaft of femur. However, the advantages and disadvantages have rarely been compared with plate osteosynthesis. This is prospective study to compare the two methods of treatments in terms of time to union, hospital slay (including readmission), wound infection, shortening of limb, delayed union, malunion, joint stiffness and implant failure. 54 patients, age (16 to 66) years, were treated by DCP (22), and interlocking nail (24). Eight patients were lost to follow up. The study was conducted in Services Hospital, Department of Orthopaedics and Ittefaq Hospital, Lahore, Pakistan from June 1996 to Dec 1997. Written consent was taken regarding the type of surgery to be performed. Open fractures of Gustilo Grade n or in, femoral shaft fractures associated with other fractures of the same femur, fractures in immature skeleton and segmental fracture were excluded. Winquist and Hansen classification was used to classify fracture comminution. Patients were alternately allocated. In the plating group, primary bone grafting was done in all cases. Time to union in nailing group was 16.43t2.48 weeks and in plating 19.88±3.46 weeks, p-value&lt;0.05. Mean hospital stay in nailing group was 12.8±2.75 day and plating group 21.1±2.73 days, p&gt;0.05. There were 2 deep infections in the plating group and none in nailing group. There was no shortening of limb in die plating group but 2 patients in the nailing group had shortening of 2 cms. Delayed union occurred in 2 patients in nailing group but 5 in plating group. One patient in the nailing group had external rotation of at least 10 degrees and none in plating group. Two patients in the nailing group had knee stiffness and 6 patients in me plating group. One patient in the nailing group had a broken interlocking screw 2 patients in the plating group had bent plates. Closed interlocking intramedullary nailing as a method of treating closed communited femoral shaft fracture is better than plating in terms of rate of postoperative complication including infection.Key Words: Comminuted fractures shaft of femur, static interlocking nailing and bridge plating.

The ANK Device: A New Approach in the Treatment of the Fractures of the Lateral Malleoulus Associated with the Rupture of the Syndesmosis

The ANK device was developed for the treatment of fractures of the lateral malleolus occurring with rupture of the syndesmosis. While it provides the anatomic reduction of the fracture and the syndesmosis, it allows the physiologic movements of the fibula. It is not used for comminuted fractures of the lateral malleolus and in cases where fibular medullary canal is narrow. We included forty-nine patients who had the ANK device applied and at least 2 years follow-up. The mean follow-up was 41 months (range 24-124). The fractures were evaluated according to the Lauge-Hansen classification; 25 cases were evaluated as supination-external rotation, 11 cases were pronation-abduction, and 13 cases were pronation-external rotation type fractures. There were also 46 fractures of the medial malleolus and three ruptures of the deltoid ligament. Twenty-nine (59,2%) patients were evaluated as excellent, 12 (24,5%) as good, 5 (10.2%) as fair and 3 (6.1%) as poor. Arthrosis was observed in 3 (6.1%) of the patients.

閉鎖性髄内釘法による大腿骨骨折の治療 Ｋｕｅｎｔｓｃｈｅｒ釘とＥｎｄｅｒ釘の比較

Twenty-two femoral shaft fractures in 22 patients were treated by intramedullary nailing, 14 patients were operated with Küntscher nail and 8 patients were with Ender nails. According to the winquest and Hansen classification, these fractures were classified in Type II or in Type III. The period when full-weight bearing was permitted was earlier in patients who was operated with Küntscher nail than in Ender nails.However, the time of bone union in cases operated with Ender nails was the same as in cases with Küntscher nails. The cases which showed radio-lucent zone at the distal points of Küntscher nails were shorter in period of bone union than others without radio-lucent zone. These results suggested that elastic fixation was better than rigid fixation in operative teratment for femoral shaft fractures by closed intramedullary nailing.