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Bimall vs. Trimall Ankle fractures:Outcome Study

Orthopeadic Chief Resident at ThomasJefferson University Hospital and theRothman Institute Administrative and Academic Chief Resident 2010-2011 Interest :

Spine Surgery Medical Illustrations Medical education

Medical Leadership Emergent Leader Physician Enjoys Arts, Music, Martial Arts, Travel,Social Networking

C h di @ il

Chadi Tannoury, MD


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A Comparison of Outcomes of

Bimalleolar and Trimalleolar AnkleFracturesChadi Tannoury, M.D.

Thomas Jefferson University Hospital& The Rothman Institute

S.P.I.N.E. Meeting Lebanon June 2010


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Disclosure

* Disclosure of Financial Interest The author have not received nothing of value from or does not own stock (or stock options) in a commercial company or institution related directly or indirectly to the subjecof this topic.


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Bimalleolar and Trimalleolar AnkleFractures

Higher energy injuries among rotational ankle fracturesCompared to unimalleolarankle fractures

Greater residual painLonger lasting dysfunctionHigher risk of

posttraumatic arthritis


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Literature Review

Tri vs. Bimall Outcomes:More pain & dysfunction - Higher risk of arthritis

McDaniel et al CORR 1977

Similar pain & dysfunction - Higher risk of arthriBeris et al CORR 1997

Bony vs. Lig Bimall: Worse functional scores - Similar pain scores

Tejwani et al JBJS 2007


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Literature - Shortcomings

Inconsistent results (pain dysfunction)Limited comparisons regarding long-termoutcomes of bimalleolar to trimalleolar ankle

fracturesLimited comparisons regarding

Bony vs. ligamentous Bimall

Trimall w or w/o post large fragment


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Purpose

To retrospectively evaluate and comparoutcomes andcomplications of medium-term resultssurgical treatment ofbimalleolar and

trimalleolar anklefractures


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Treatment PeriodFebruary 2001 through January 2007

117 patients with closed ankle fractures & syndesmotic instab74 patients with bimalleolar fractures43 patients with trimalleolar fractures

All procedures performed by One surgeon


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Clinical Assessment

AmericanOrthopaedic Footand Ankle Society

(AOFAS) Ankle-Hindfoot system

Visual analog scale(VAS) for pain


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Results AssessmentSatisfaction

ExcellentGoodFairPoor

FailureRevisionNonunion


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Radiographic Assessment

Fracture union

Mortise congruency

Arthrosis


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Statistical analysis

Fisher exact test

Pearson Chi-Square test

P


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Preoperative DataBimalleolar Trimalleolar

Male: Female 38:36 19:24

Mean age 37.2 47.3

Age range 15 73 17 - 71

Right: Left 40:34 19:24No statistical difference between groups


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Follow-upMean follow-up in months

Bimalleolar 48.0 [22-87]

Trimalleolar 53.9 [21-92

Revision surgery Bimalleolar 0 of 74

Trimalleolar 0 of 43

No statistical difference between groups


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Results

BI-Malleolar Frx70 of 74 (94.6%) patientspresented for final follow-up

Union rate:100% by 12 weeks after surgery

Alignment: All acceptable

TRI-Malleolar Frx42 of 43 (97.7%) patientspresented for final follow-

Union rate100% by 12 weeks after surge

Alignment All acceptable


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Post-Op ResultsScores/Overall ***Bimall Trimall P value Significant di

Mean AOFAS 88.9 82.1 P=0.085 NOMean VAS 1.9 3.1 P=0.046 YES

P-T-Arthritis 1.4% (1/70) 4.8% (2/42) P=0.278 3.5 Fold inc

Bimall Frx Bony ***Lig P value Significant d

Mean AOFAS 82.6 90.5 P=0.129 NoMean VAS 2.9 1.7 P=0.131 No

Trimall Frx w ORIF - PM Small PM P value Significant diff

Mean AOFAS 77.7 83.5 P=0.50 No

Mean VAS 2.5 3.3 P=0.51 No


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Scores/Overall ***Bimall Trimall P value Significant diff

Mean AOFAS 88.9 82.1 P=0.085 NO

Mean VAS 1.9 3.1 P=0.046 YES


Bimall Frx Bony ***Lig P value Significant d

Mean AOFAS 82.6 90.5 P=0.129 No

Mean VAS 2.9 1.7 P=0.131 No



Mean VAS 2.5 3.3 P=0.51 No


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Scores/Overall ***Bimall Trimall P value Significant diff

Mean AOFAS 88.9 82.1 P=0.085 NO

Mean VAS 1.9 3.1 P=0.046 YES


Bimall Frx Bony ***Lig P value Significant dif

Mean AOFAS 82.6 90.5 P=0.129 NoMean VAS 2.9 1.7 P=0.131 No



Mean VAS 2.5 3.3 P=0.51 No


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Satisfaction

Bimalleolar Trimalleola

Excellent 40 (56.6%) 13 (30%

Good 14 (20.8%) 11 (26.7%

Fair 8 (11.3%) 11 (26.7

Poor 8 (11.3%) 7 (16.6P=0.044


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DiscussionPatients with bimalleolar ankle fractureshad:

Higher functional scores (P=0.085)Lower incidence of post-traumatic

arthritis (P=0.278)Higher rates of satisfaction(P=0.044)Lower pain scores (P=0.046)


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Conclusion

Surgical treatment of Bimalleolarankle fractures is more predictab

in alleviating symptoms andrestoring function than trimalleoankle fractures.


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The End Thank you.

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