Work

Modified T-plate internal fixation in the treatment of medial malleolus fractures of the distal tibia in the elderly

Year: 2025

Type: article

Abstract: Objective This study aimed to compare the clinical efficacy of modified T-plate internal fixation vs. conventional cannulated lag screws in treating medial malleolus fractures of the distal tibia in elderly patients, with a focus on surgical outcomes, functional recovery, and complication profiles. Methods A prospective cohort analysis was conducted on a sample of 46 elderly patients (aged ≥ 60 years) with isolated medial malleolus fractures treated at a single orthopedic center between April 2020 and December 2022. Patients were allocated to either modified T-plate internal fixation (n = 23) or cannulated lag screw internal fixation (n = 23). The postoperative conditions, including operative time, blood loss, and complications, as well as the long-term rehabilitation outcomes, such as AOFAS ankle and hindfoot score at 3, 6, and 12 months, were systematically compared. Results The modified T-plate group exhibited significantly superior early functional recovery, with higher AOFAS ankle and hindfoot score at 3 months (63.5 ± 8.0 vs. 55.3 ± 13.3, P = 0.015) and 6 months (74.6 ± 8.9 vs. 67.8 ± 12.5, P = 0.041), though operative time was longer (85.6 ± 12.3 vs. 72.4 ± 10.8 min, P < 0.001). No significant differences were observed in intraoperative blood loss (120.5 ± 25.6 vs. 115.8 ± 22.4 ml, P = 0.511), overall complication rates (8.7% vs. 17.4%, P = 0.381), or long-term outcomes of AOFAS ankle and hindfoot score at 12 month (89.0 ± 8.7 vs. 87.9 ± 7.6, P = 0.628). Both groups demonstrated comparable safety profiles, with no severe complications during a mean 14.4-month follow-up. Conclusion Modified T-plate fixation has been shown to facilitate early functional rehabilitation in elderly patients with distal tibial medial malleolus fractures. Although this method requires marginally longer operative time, it offers equivalent long-term outcomes and safety to traditional lag screws internal fixation. Notably, it is particularly advantageous for osteoporotic patients, as it addresses the challenges posed by bone fragility and compromised healing capacity.

Source: Frontiers in Surgery

DOI: 10.3389/fsurg.2025.1581909

Authors: Xipeng Wang, Kun Nie, Jiangtao Liu, Cong Jiang

Institutions: Central Hospital of Wuhan, Huazhong University of Science and Technology

Language: English

Topic: Bone fractures and treatments

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801