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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. OUTCOME MEASURES: 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.

Original publication

DOI

10.1097/bot.0b013e318214bf1b

Type

Journal article

Journal

Journal of orthopaedic trauma

Publication Date

12/2011

Volume

25

Pages

742 - 747

Addresses

Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland.

Keywords

Humans, Ankle Injuries, Polymethacrylic Acids, Early Ambulation, Fracture Fixation, Intramedullary, Prospective Studies, Orthopedic Fixation Devices, Recovery of Function, Osseointegration, Fracture Healing, Osteogenesis, Weight-Bearing, Aged, Aged, 80 and over, Hospitals, Teaching, Trauma Centers, Female, Male, Fractures, Bone