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
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
* Introduction Increasing ankle fractures in the elderly Koval KJ et al, Ankle fracture in the elderly J orthop trauma. 2005 Kannus P et al, Stabilizing incidence of low trauma ankle fractures in elderly people. Bone 2008
* 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)
* 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
* 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. 2012 to July 2014 19 cases of 19 patients older than 65 years (mean 72yrs, 67-76 yrs) Mean Follow up period : 15 months (12 to 18 months) SER stage 4, PER stage >3 (by Lauge-Hansen Classification) Infrasyndesmotic fracture
* 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
* 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. 1984 * Median Bone Union period Statistics analysis (SPSS 19.0, p <0.05)
* Results 2 month 3 month 6 month 9 month 12 month P-value VAS (visual analog scale) 6.2 ± 0.9 4.8 ± 0.7 2.1 ± 0.8 1.8 ± 0.6 1.2 ± 0.8 P = 0.001 AOFAS ankle-hindfoot score 56.4 ± 3.1 78.5 ± 2.8 85.8 ± 3.5 89.5 ± 2.5 93 ± 1.5 P = 0.012 Olerud Molander Ankle score 15.5 ± 0.2 45.0 ± 0.5 68.4 ± 0.4 70.5± 0.5 75 ± 2.5 P = 0.001 7 6 5 4 3 2 1 0 VAS 2 Mo 3 Mo 6 Mo 9 Mo 12 Mo VAS VAS 100 90 80 70 60 50 40 30 20 10 0 2 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)
* 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
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