Weber B형 회전 족관절 골절에서 비골 골절 고정 시 피질골 지연 나사와 해면골 위치 나사 사용에 따른 치료 결과 비교
Comparison of Outcomes Using Cortical Lag Screws Versus Cancellous Position Screws for Fibula Fixation in Weber Type B Rotational Ankle Fractures
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs. 84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion: For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.
Abstract
Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs. 84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion: For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.
참고문헌 (11)
- Vijimohan SJ, "An alternate technique of applying lag screw for fixation of distal fibula fracture : posterior to anterior interfragmentary compression screw", Foot Ankle Spec, 10, pp.555~559 (2017)[DOI]
- Thur CK, "Epidemiology of adult ankle fractures in Sweden between 1987 and 2004 : a population-based study of 91, 410 Swedish inpatients", Acta Orthop, 83, pp.276~281 (2012)[DOI]
- Juto H, "Epidemiology of adult ankle fractures : 1756 cases identified in Norrbotten County during 2009-2013 and classified according to AO", OTA, 2018, pp.19, 441~
- Aiyer AA, "Management of Isolated lateral malleolus fractures", J Am Acad Orthop Surg, 27, pp.50~59 (2019)[DOI]
- Kuzma AL, "Biomechanical evaluation of interfragmentary compression of lag screw versus positional screw at different angles of fixation", J Orthop Trauma, 33, pp.e183~e189 (2019)[DOI]
- Weber M, "Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures : the effect of plate and screw position", Foot Ankle Int, 26, pp.281~285 (2005)[DOI]
- Mehraban N, "Lateral locking plate fixation of simple weber B fibula fractures without a lag screw yields excellent radiographic results", Foot Ankle Spec, 17, pp.131~136 (2024)[DOI]
- Park YH, "Necessity of interfragmentary lag screws in precontoured lateral locking plate fixation for supination-external rotation lateral malleolar fractures", Foot Ankle Int, 41, pp.818~826 (2020)[DOI]
- Singla A, "Lag screw trajectory in supination-external rotation fractures : does the direction of the fibula lag screw have an effect?", Clin Orthop Surg, 13, pp.456~460 (2021)[DOI]
- Curtis R, "Fixation principles in metaphyseal bone--a patent based review", Osteoporos Int, 2, pp.S54~64 (2005)[DOI]
- Wang T, "Cancellous screws are biomechanically superior to cortical screws in metaphyseal bone", Orthopedics, 39, pp.e828~e832 (2016)[DOI]