| ObjectiveThe distal fibular anatomic locking plate is a commonly used internal fixa tion device for the therapy of external ankle fractures in clinical practice,and the fibular locking intramedullary nail is a neoteric alternative that has characte ristic advantages in the management of external ankle fractures in the elderly.Aim of this study was to compare the results of internal fixation of the anato mical locking plate versus the closed locking intramedullary nail for the treatm ent of external ankle fractures in the elderly and provide reference for the dia gnosis and treatment of lateral malleolus fracture in the elderly.MethodsThis was a retrospective study.From October 2018 to February 2020,35 patients admitted to the emergency surgery department of the First Affiliated Hospital of Zhengzhou University were treated with anatomical locking plate(Group A)and 15 with intramedullary nail(Group B).These patients were diagnosed as Danis-WeberB and Danis-WeberC type lateral malleolus fractures and were all older than 60 years.The AOFAS ankle score was obtained and fracture healing time,sphere of motion,postoperative complication rate,and other data were recorded.Statistical software was used for data analysis.ResultsThe primary outcomes were as follows:(1)There was no significant diff erences in the aspect of baseline data(P>0.05).(2)Group B was significantly lower than group A in the aspect of incision length,intraoperative blood loss and fracture healing time(P<0.05).There was significant shorter operation ti me in Group B(45.45±6.64min)than in Group A(47.46±10.10min).(3)The AOFAS score of ankle-hindfoot function,dorsal extension and plantar flexion r ange of motion in group B were better than those in group A.The excellent r ate of ankle joint function was 80%for group B and 75%for group A.But t he differences were not statistically significant(P>0.05).(4)In the aspect of c omplications,there were 3 cases of incision complications in group A,includin g two cases of incision redness and swelling and one case of partial epidermal necrosis and scab,while no incision complications occurred in group B.Five patients complained of skin pain around the internal fixation in group A and o ne patient developed peroneus longus tendonitis in group B.Internal fixation 1 oosening occurred in 1 patient in both groups.There was one case of dorsal f oot numbness in group A while no case in group B.The comparison of comp lications was statistically significant(P<0.05).(5)In terms of reduction,the ex cellent rate of reduction was 80%for group A and 77.3%for group B.The d ifference was not statistically significant(P>0.05).ConclusionBoth the distal fibula anatomical locking plate and the fibula interlocking intramedullary nail can effectively fix the elderly Danis-Weber B and C lateral malleolus fractures.The distal fibula anatomical locking plate is suitable for most lateral malleolus fractures,but there is a high risk of incision complications and internal fixation discomfort after surgery.In contrast,we prefer fibular intramedullary nail fixation.The fibular intramedullary nail can be placed in a minimally invasive manner,which has little damage to the periosteum and soft tissues,promotes fracture healing,and has fewer postoperative complications,and the local soft tissue conditions are poor and complicated.It is especially suitable for elderly patients with basic diseases such as diabetes,but this technique cannot be applied to severe comminuted fractures. |
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