Polish orthopedics and traumatology · 2012
Minimally invasive osteosynthesis of ankle fractures.
СтатьяНазвание и аннотация: Перевод в очереди
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Szczęsny Grzegorz, Janowicz Jakub
Аннотация
BACKGROUND: In this publication, we present a technique for internal ankle fracture fixation through minimally invasive surgical access.
MATERIAL/METHOD: Observations were carried out in a group of 17 patients (9 men and 8 women) treated due to closed injuries. Fractures were reduced under fluoroscopic guidance and stabilized percutaneously with 2 or 3 Kirschner wires (lateral malleole), 1-2 malleolar screws (medial malleole) and cortical screws (syndesmosis). If displaced or involving articular surfaces, posterior tibia was reduced and stabilized with cortical screws.
RESULTS: We compared the results from our group with those obtained in a group of 17 patients (13 men and 4 women) operated on using traditional technique. In all cases, satisfactory stabilizations with forthcoming healing process were achieved, but in 2 cases widening of approach to medial malleole was required to remove interposing soft tissues. The operation time of procedures performed via minimal approach was shorter (50.1±23.4 min vs. 77.8±12.0 min; p=0.002), as well as duration of hospital stay (7.8±3.6 days vs. 10.5±5.5 days, NS), but required longer exposition to fluoroscopy (271.2±137.8 vs. 96.1±103.7 sec.; p=0.0002).
CONCLUSIONS: Minimally invasive technique is an alternative to traditional method. It allows for proper stabilization with minimal soft tissue traumatization, and thus could be recommended for patients with coexisting massive injuries affecting soft tissues and for those who, do not agree to open reductions for cosmetic reasons. It allows for reduction of operation time and hospital stay. Nevertheless, it involves higher exposition to fluoroscopy and, in some cases, widening of surgical approach.
MATERIAL/METHOD: Observations were carried out in a group of 17 patients (9 men and 8 women) treated due to closed injuries. Fractures were reduced under fluoroscopic guidance and stabilized percutaneously with 2 or 3 Kirschner wires (lateral malleole), 1-2 malleolar screws (medial malleole) and cortical screws (syndesmosis). If displaced or involving articular surfaces, posterior tibia was reduced and stabilized with cortical screws.
RESULTS: We compared the results from our group with those obtained in a group of 17 patients (13 men and 4 women) operated on using traditional technique. In all cases, satisfactory stabilizations with forthcoming healing process were achieved, but in 2 cases widening of approach to medial malleole was required to remove interposing soft tissues. The operation time of procedures performed via minimal approach was shorter (50.1±23.4 min vs. 77.8±12.0 min; p=0.002), as well as duration of hospital stay (7.8±3.6 days vs. 10.5±5.5 days, NS), but required longer exposition to fluoroscopy (271.2±137.8 vs. 96.1±103.7 sec.; p=0.0002).
CONCLUSIONS: Minimally invasive technique is an alternative to traditional method. It allows for proper stabilization with minimal soft tissue traumatization, and thus could be recommended for patients with coexisting massive injuries affecting soft tissues and for those who, do not agree to open reductions for cosmetic reasons. It allows for reduction of operation time and hospital stay. Nevertheless, it involves higher exposition to fluoroscopy and, in some cases, widening of surgical approach.