PURPOSE To evaluate the accuracy of reduction and stability of fixation according to different methods of internal fixation for the Danis-Weber classification type B fractures of the distal fibula.
MATERIAL AND METHODS: Seventy-three cases with follow up of average 13 months were divided into three groups: plate fixation(Group I, 36), more than two lag screws fixation (Group II, 13) and multiple K wires fixation with less than one lag screw(Group III, 24). We measured the bimalleolar angle and axial displacement of the fracture ends for radiographic evaluation, and used the Meyer's classification for clinical evaluation. RESULTS There was significant difference of postoperative fibular shortening between group I(0.44mm) and III(0.17mm) on the anteroposterior view(p=0.003), but no difference of it on the lateral view. The changes of bimalleolar angle and the increment of fibular shortening showed no significant difference among three groups. CONCLUSION Multiple K wires fixation combined with less than one lag screw for Danis-Weber type B fractures of distal fibula demonstrated that it provides accurate reduction and stable internal fixation.
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Posterior Plating in Distal Fibular Fracture Choong-Hyeok Choi, Young-A Cho, Jae-Hoon Kim, Il-Hoon Sung Journal of the Korean Fracture Society.2007; 20(2): 161. CrossRef
Lauge-Hansens classification system and Webers classification system are the two most commonly used systems in ankle fractures. both are based on causative mechanism but both have some deficiencies. Authors intended to decide which is easily applicable in clinical practice and shwich provides more information about treatement, especially that of diastasis.
So we analysed 143 cases of ankle fractures in Seoul National University Hospital, Kang-nam General Hospital and Namseoul Hospital from January 1983 to December 1988.
The results obtained are as follows.
1. Webers type A fractures correspond not only supination-adduction but also to pronation-abduction and pronation-dorsiflexion. Type B fractures correspond most closely to supination-external rotation and possibly to pronation abduction and pronation external rotation. Type C fractures show the nearest equivalence to pronation-external rotation and occasionally correspond to supination-external roation or pronation-abduction.
2. Diastasis was noted in 16 cases(28%) of type B and in 18 cases(74%) of type C and this lower incidence was seemed to be due to neglect of diastasis at physical examination or during operation.
3. It seemed to be more reasonable to fix the diastasis with tibiofibular fixation screw especially in type C.
4. Webers simpler classification system, which can explain the hidden ligamentous injury such as diastasis, was more easily applicable in daily use than Lauge-Hansen classification.