Effect of buttress plate in Herscovici type D vertical medial malleolar fractures and peripheral fractures: a retrospective comparative cohort study

BACKGROUND: The purpose of current retrospective study was to review the surgical methods and to evaluate the clinical efficacy of supporting plate for the treatment of vertical medial malleolus fractures on the basis of stable fixation of ipsilateral fibula. METHODS: This retrospective study included a total of 191 patients with vertical medial malleolus fractures. Patients enrolled were divided into simple vertical medial malleolus fractures and complex types of fractures. General demographic information and surgical information, including age, sex, surgical procedure and postoperative complications, were collected. The functional prognosis of patients was evaluated by American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) and Visual Analog Scale (VAS). RESULT: Among patients with simple vertical fractures, the respective incidence of internal fixation failure in screw group, buttress plate group, and screw combined buttress plate fixation group (combined fixation group) was 10/61 (16.4%),1/54 (7.4%) and 1 (1.9%), and the difference was statistically significant (P = 0.024). The incidence of abnormal fracture growth and healing in screw group, buttress plate group and combined fixation group was, respectively, 13/61 (21.3%), 6/54 (12.5%) and 2 (3.85%), with statistically significant difference (P = 0.019). In the patients with complex types of fractures, after 2 years of postoperative follow-up, the AOFAS score and VAS score of the following subgroups had good results: 91.18 ± 6.05 and 2.18 ± 1.08 in patients with joint surface collapse, and 92.50 ± 4.80 and 2.50 ± 1.29 in patients with tibial fractures, with 100% excellent and good rate. CONCLUSION: For simple and complex vertical medial malleolus fractures, buttress plate showed excellent fixation. Despite poor wound healing and extensive soft tissue dissection with this approach, buttress plate may provide a novel insight into medial malleolar fractures, especially for extremely unstable medial malleolar fractures.