The Result of the treatment in osteoporotic ankle fractures with small fragment using claw plate in elderly

Transcription

1 The Result of the treatment in osteoporotic ankle fractures with small fragment using claw plate in elderly Jun-Beom Kim M.D, Byeong-Seop Park M.D, Chi-Hun, Ahn M.D Foot and Ankle Clinics, Department of Orthopedics Sun General Hospital, Daejeon, Republic of Korea

2 Disclosure NO CONFLICT TO DISCLOSE The Result of the treatment in osteoporotic ankle fractures Jun-Beom Kim M.D, Byeong-Seop Park M.D, Chi-Hun, Ahn M.D Our disclosures are in the Final AOFAS Mobile App. We have no potential conflicts with this presentation

3 * Introduction Increasing ankle fractures in the elderly Koval KJ et al, Ankle fracture in the elderly J orthop trauma Kannus P et al, Stabilizing incidence of low trauma ankle fractures in elderly people. Bone 2008

4 * Current treatments Variable methods to fix and maintain, unstable fracture c small fragment Screw (cannulated or malleolar) fixation Modified Tension band wiring Fixation with Kirschner wire * Limitations in Elderly Pull out (implant) Loss of reduction (not firm fixation)

5 * Our Claw Plate (Modified spring plate) 1/3 tubular locking plate Cut the hole at distal portion and sharpen by bone file Bend the distal sharpen end C shape

6 * Purpose To evaluate the clinical results of Claw plate for unstable ankle fracture with small fragment to get stable fixation and avoid iatrogenic injury by fixation methods * Materials From Jan to July cases of 19 patients older than 65 years (mean 72yrs, yrs) Mean Follow up period : 15 months (12 to 18 months) SER stage 4, PER stage >3 (by Lauge-Hansen Classification) Infrasyndesmotic fracture

7 * Operative Procedure Hooking distal spike portion at joint Insert spike into distal fragment striking by mallet Compression (cortical) screw (tension force compression force) Additional locking screw Cortical screw 1

8 * Methods Evaluation of Clinical results (at 2, 3, 6, 9, 12 months) * Visual Analog Scale * AOFAS ankle-hindfoot score * Olerud Molander Ankle score Evaluation of Radiological results C. Olerud, H. Molander. Arch Orthop Trauma Surg * Median Bone Union period Statistics analysis (SPSS 19.0, p <0.05)

9 * Results 2 month 3 month 6 month 9 month 12 month P-value VAS (visual analog scale) 6.2 ± ± ± ± ± 0.8 P = AOFAS ankle-hindfoot score 56.4 ± ± ± ± ± 1.5 P = Olerud Molander Ankle score 15.5 ± ± ± ± ± 2.5 P = VAS 2 Mo 3 Mo 6 Mo 9 Mo 12 Mo VAS VAS Mo 3 Mo 6 Mo 9 Mo 12 Mo OMAS AOFAS # Median Bone union time (month) : 4.7 ± 0.7 No Complications (such as skin problem, metal failure, etc)

10 * Limitations Mismatch between plate shape and malleolar shape Small size Short term follow up No consideration of factors affecting healing ( e.g smoking, obesity, diabetes ) No comparison study * Conclusion All cases were healed without complications and took satisfied clinical results, statistically In elderly, Claw plate is the alternative and useful method to fix and maintain in osteoporotic ankle fractures with small fragment

11 * References 1.Koval KJ, Lurie J, Zhou W, et al. Ankle fractures in the elderly: what you get depends on where you live and who you see. J Orthop Trauma 2005;19: Kannus P, Palvanen M, Niemi S, et al. Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during and projections for the future. Bone 2002;31: Kannus P, Palvanen M, Niemi S, et al. Stabilizing incidence of low-trauma ankle fractures in elderly people Finnish statistics in and prediction for the future. Bone 2008;43: Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosisrelated fractures in the United States, J Bone Miner Res 2007;22: Hasselman CT, Vogt MT, Stone KL, et al. Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Joint SurgAm2003;85: Seeley DG, Kelsey J, Jergas M, et al. Predictors of ankle and foot fractures in older women. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 1996;11: Pritchard JM, Giangregorio LM, Ioannidis G, et al. Ankle fractures do not predict osteoporotic fractures in women with or without diabetes. Osteoporos Int 2012;23: Valtola A, Honkanen R, Kro ger H, et al. Lifestyle and other factors predict ankle fractures in perimenopausal women: a population-based prospective cohort study. Bone 2002;30: Greenfield DM, Eastell R. Risk factors for ankle fracture. Osteoporos Int 2001;12: Daly PJ, Fitzgerald RH, Melton LJ, et al. Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand 1987;58: De Vries MR, Van der EM, Schepers T et al. Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures. Arch Orthop Trauma Surg ;132(2): Gul A, Batra S, Mehmood S, Gillham N. Immediate unprotected weight-bearing of operatively treated ankle fractures. Acta Orthop Belg. 2007;73(3): Xu HL, Liu LM, Li X et al. Multicenter follow-up study of ankle fracture surgery. Chin Med J (Engl). 2012;125(4): Nilsson G, Jonsson K, Ekdahl C, Eneroth M. Outcome and quality of life after surgically treated ankle fractures in patients 65 years or older. BMC Musculoskelet Disord. 2007;8:127.

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