Augmented osteosynthesis of OTA 44-B fractures in older patients: a technique allowing early weightbearing.

OBJECTIVES: To determine the effectiveness of an augmented technique of osteosynthesis in allowing early weightbearing in older patients with OTA 44-B (Danis-Weber B) fractures. DESIGN: Case series. SETTING: University Level I trauma center. PATIENTS: Thirty-six patients, nonconsecutive, with OTA 44-B fractures. INTERVENTION: Augmented internal fixation using an intramedullary wire, lateral plate, and screw augmentation with polymethylmethacrylate. MAIN OUTCOME: Healed fracture with no loss of reduction. SECONDARY OUTCOMES: American Orthopaedic Foot and Ankle Society score; percentage of patients who returned to prefracture function. RESULTS: All patients began weightbearing as tolerated in a removable brace at a mean of 13.5 days postoperatively. Thirty patients were available for follow-up at a minimum of 12 months (range, 12-14 months). All fractures healed with no loss of reduction. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 84.9 (range, 74-100), and 90% of patients returned to prefracture function. There were two infections, one in a 74-year-old diabetic woman and the other in a 92-year-old woman with pre-existing arterial insufficiency and a small ulcer over the tip of the second toe. CONCLUSIONS: Augmented internal fixation consisting of intramedullary wire, lateral plate, and screw augmentation with polymethylmethacrylate may allow for very early weightbearing without risk of secondary loss of reduction or disruption of the ankle mortise in older patients with OTA 44-B (Danis-Weber B) malleolar fractures.