Journal of Musculoskeletal Trauma

Modified Tension Band Wiring using Cortical Screw for Medial Malleolar Fractures: Ho Rim Choi, Hyun Woo Doh, Byoung Heum Kim, Kyou Hyeun Kim, Jong Seok Park, Joon Min Song; J Korean Fract Soc 2004;17(4):319-322. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.319

Abstract PDF: PURPOSE
To evaluate the clinical results of modified tension band wire technique using cortical screw for treatment of displaced medial malleolar fractures of the ankle.
MATERIALS AND METHODS
From January 2001 to January 2003, 24 patients were treated by modified tension band wiring using cortical screw for medial malleolar fracture. The follow-up period was 12~35 months (average 18 months). There were 13 males and 11 females, and the mean age was 46 years. Fractures were classified by Lauge-Hansen's classification. The results were analyzed by Meyer and Kumler's criteria.
RESULTS
There were 13 cases (54%) of excellent, 9 cases (38%) of good, and one case of fair because of limitation of motion of the ankle joint and one case of poor which showed post-traumatic arthritis of the ankle.
CONCLUSION
Modified tension band wire technique using cortical screw can be an effective operative method for the treatment of displaced medial malleolar fractures of the ankle.

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Modified Tension Band Wiring using Cortical Screw for Displaced Medial Malleolar Fractures: Jong Oh Kim, Sang Hun Ko; J Korean Soc Fract 2002;15(4):459-464. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.459

Abstract PDF: PURPOSE
To evaluate the clinical results of minimal incision and modified tension band wiring using 3.5mm cortical screw in the treatment of ankle fracture including displaced medial malleolar fractures MATERIALS AND METHODS: From March 1997 to May 2001, 77 patients were treated by modified tension band wiring using minimal incision about 4cm for medial malleolar fracture.
RESULTS
According to Lauge-Hansen classification, there were 47 supination-external rotation type fractures (61%), 14 supination -adduction type fractures (18.2%), 10 pronation-external rotation type(12.9%), 6 pronation-abduction type fracture(7.8%). The average time to union was 12.5weeks. In the functional outcome (according to Meyer and Kumler), 71 patients(92%) showed excellent results.
CONCLUSION
We concluded that modified tension band wiring using cortical screw proved effective fixation method in the treatment of the displaced medial malleolar fracture. The merits of this procedure are minimal incision about 4cm and preservation of blood supply on suprafracture area due to not injuried periosteum, stable fixation and early range of motion of joint, simple procedure and reduced surgical time.

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PROPER SCREW LENGTH FOR FIXATION OF THE MEDIAL MALLEOLAR FRACTURE OF ANKLE: Dong Bae Shin, Soo Hong Han, Seung Soo Jeon; J Korean Soc Fract 2000;13(3):522-528. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.522

Abstract PDF: PURPOSE
There is rare report about screw length in ankle fracture in spite of the anatomical characteristic that distal densest area can give enough purchase of screw threads for fixation of medial malleolar fragment. Purpose of the current study is to evaluate the results of screw fixation and to estimate proper screw length in medial malleolar fracture.
MATERIALS AND METHODS
Authors retrospectively reviewed 136 cases of medial malleolar fracture which had been performed from Janurary 1985 to December 1997. The patients were divided into 3 groups according to screw length ; under 34mm screw length (9 cases), between 35mm and 45mm (76 cases), over 46mm (50 cases). Each group was evaluated bone union time, clinical outcomes and radiological results by Meyer and Kumler.
RESULTS
Good and excellent results were achieved 121 cases (89%) on clinical result and 125 cases (91.9%) on radiological result by Meyer criteria. There were no statistical differences between three group, but the 35mm-45mm screw length group showed slightly faster union tendency.
CONCLUSION
In the treatment of medial malleolar fracture, around 40mm length screw is sufficient for fixation and it doesn,t need to use the screw over 45mm length for more rigid fixation.

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HERBERT SCREW FIXATION FOR NON-COMMINUTED CLOSED MEDIAL MALLEOLAR FRACTURE: Dong Man Park, Yong Jin Kim, Jea Won Chang, Jin Cheul Park; J Korean Soc Fract 1999;12(3):638-644. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.638

Abstract PDF: It is known that the Salter-Harris type I and II fractures of the distal tibial epiphysis usually Non-comminuted closed displaced medial malleolar fracture has been treated by open reduction and internal fixation. Since fracture fragment of medial malleolar is usually thiner and smaller than that of lateral malleolar, it is more difficult to fix firmly than that of lateral malleolar. In the treatment of medial malleolar fracture, although various fixation methods in the treatment of medial malleolar fracture have been reported, several complications have been reported. And then authors have been tried to find fixation methods and firm fixation material for medial malleolar fracture to minimize complications. The purpose of this paper is to compare operation time, duration of bone union, the presence of complication, and results by Meyer and Kumler criteria between Herbert and malleolar screw and to introduce percutaneous Herbert screw fixation technique. Since March 1996, forty-four patients had undergone surgical intervention for medial malleolar fractures. Twenty-three Herbert screw and twenty-one malleolar screws were used. The results were as follows; The operation time was shorter in Herbert screw fixation group. There were no complications such as pain and tenderness due to hardware protrusion and metal lossening in Herbert screw fixation group. We come to the coonclusion that the Herbert screw fixation method was a little better than the malleolar screw fixation method according to comparison by Meyer and Kumler ctireria. We concluded that Herbert screw fixation was a better method for non-comminuted closed displaced medial malleolar fracture to obtain early union and to prevent postoperative complications.

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Percutaneous Fixation in Medial Malleolar Fracture: Phil Hyun Chung, Chung Soo Hwang, Suk Kang, Ki Se Nam, Ho Kyun Bae; J Korean Soc Fract 1999;12(2):314-320. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.314

Abstract PDF: Fracture of the ankle is one of the most common fractures. Usually medial malleolar fractures, when non-displaced or minimally displaced, have been treated by closed reduction and cast immobilization for long period, so stiffness and osteoporosis of ankle were frequently inevitable. We investigated the result of percutaneous pinning or screw fixation and early mobilization in the treatment of medial malleolar fracture of the ankle. With clinical and radiological data, authors analysed 17 patients(17 ankles) who were treated with closed reduction and percutaneous pinning or screw fixation between August 1991 and May 1997. and following results were obtained. One case of pin site infection was noted and no nonunion or loss of fixation was identified and average duration of bone union was 12 weeks. According to Burwell's protocol, the good result are 16 cases, the fair is 1 case and the poor result is not observed. From the viewpoint of rehabilitation, authors consider percutaneuos pinning is an excellent plan of treatment of medial malleolar fractures, when non-displaced or minimally displaced.

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Tension Band Wiring with Anchoring Screw in Medial Malleolar Fracture: Young Won Rho, Taik Keun Ahn, Jong Oh Kim, Taik Seon Kim, Jai Ik Shim; J Korean Soc Fract 1990;3(2):247-251. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.247

Abstract PDF: Since development of sports and leisure, ankle fracture occurs frequently. The goal of treatment of ankle fracture is anatomic restoration of ankle joint. With introduction of tension band wiring technique by A-O group, this technique was used popularly. The authors reported 15 cases of medial malleolar fracture in which patients were treated by tension band wiring with anchoring of screw instead of primary osseous tunnel, from September 1987 to August 1989. The advantage of modified tension band wiring technique is shortening of operative time and simplicity of technique.

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