Percutaneous screw fixation of unstable ankle fractures in patients with poor soft tissues and significant co-morbidities.

INTRODUCTION: We describe a minimally invasive technique to stabilise unstable ankle fractures by inserting a 100mm screw up the fibula medullary canal along with percutaneous screw fixation of the medial malleolus if required. This technique is utilised in patients with poor soft tissues and significant co-morbidities where the fracture cannot be adequately controlled by a cast alone.

PATIENTS AND METHODS: Retrospective review of 23 patients the average age being 70 years (29-89) and 74% had significant co-morbidities. Postoperative radiographs were examined for adequacy of reduction using the method described by Mclenna and Ungersma. Patient based functional and health questionnaires were performed, reviewed and scored.

RESULTS: Six patients were lost during the follow-up period due to death caused by issues unrelated to the ankle fracture. There were no reported intraoperative complications, no postoperative wound infections and no non-unions. There was two complications one loss of fixation, and another required removal of the screw due to irritation. Radiographic reduction was good in 52%, fair in 44% and poor in 4%. Patient questionnaire results were 70 (20-100) for the Abbreviated Olerud and Molander score and the SF-12 physical component score was 42 and mental component was 44.

CONCLUSIONS: With appropriate patient selection percutaneous screw fixation is an excellent technique supplementing cast immobilisation of unstable ankle fractures with poor soft tissues.