SLR – October 2012 - Benjamin Cullen
Reference: Sushil Rangdal, Daljit Singh, Narendra Joshi, Ashwani Soni, Radheshyam Sament. Foot and Ankle Surgery. Sep;18(3):153-6. 2012
Scientific Literature Review
Reviewed by: Benjamin Cullen, DPM
Residency Program: Kaiser South Bay Consortium
Podiatric Relevance:
Bimalleolar ankle fractures are unstable injuries and require open reduction with internal fixation to prevent long-term sequalae. Traditional metal screws and plates function well, but may cause discomfort requiring removal during a subsequent operation. Bioabsorbable implants have been developed to avoid the need for additional surgery, but there are limited reports on outcomes with their use.
Methods:
This was a prospective study of a consecutive series of 19 patients with closed unilateral bimalleolar ankle fractures. All patients had ORIF using biodegradeable plates and screws performed under standard technique with a typical postoperative course of cast immobilization. Patients were followed for a minimum of 18 months and results were assessed based on the Olerud Molander ankle score as well as clinical and radiographic exam.
Results:
Three patients were lost to follow-up. Results were excellent in six patients, good in four and fair in six. The most common complaints were persistent stiffness, pain and swelling. No infections or loss of correction occurred within the study period. One patient (6.25 percent) required a second operation for debridement of granulomatous tissue at 16 weeks post-op.
Conclusions:
The incidence of hardware removal after bimalleolar ankle fracture surgery is not insignificant. It involves a second surgery with the associated increased cost and risk to the patient. Using biodegradeable implants in theory can avoid a subsequent surgery for removal, however they are dramatically more expensive than traditional metal fixation and may cause a foreign body reaction. It remains unclear whether absorbable implants for bimalleolar ankle fracture fixation offer substantial increased benefit relative to metal hardware.