Efficacy of Hook-Type Locking Plate and Cancellous Screw in the Treatment of Displaced Medial Malleolar Fractures in Elderly Patients

CATEGORY: Trauma; Ankle INTRODUCTION/PURPOSE: We aimed to compare the midterm radiologic and clinical results between hook-type LCP and conventional malleolar screws for elderly medial malleolar fractures. We hypothesized that elderly patients treated with the hook- type locking compression plate (LCP) would have better fracture healing and clinical outcomes than those treated with cancellous lag screws, with fewer postoperative complications. METHODS: In total, 258 patients treated with a hook-type locking plate (hook LCP group: 121 patients) or partially threaded cancellous lag screws (screw group: 137 patients) over 65 years of age with at least 36 months' follow-up were included in this retrospective study. Radiographic assessments included the union rate and interval to fracture union. Clinical assessment was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Olerud and Molander score (OMAS), visual analog scale (VAS) pain score, and postoperative complications. RESULTS: The comminuted fracture rate was higher in the hook LCP group than in the screw group (p < .001). The interval to fracture union was significantly shorter in the LCP group than in the screw group (10.2 +- 7.0 vs. 12.3 +- 6.7, p =.015). There were no significant differences between the two groups regarding AOFAS, OMAS, and VAS pain scores at the final follow- up. There was a trend toward a lower rate of complications, including revision procedures, in the hook LCP group than in the screw group (19.9% vs. 28.5%, p =.107 and 6.6% vs. 13.9%, p =.074). The overall cost in the hook LCP group was 5.8% lower than that of the screw group despite the higher cost of the hook-type LCP. CONCLUSION: Hook-type LCP may be an alternative option for treating medial malleolar fractures with comminution in elderly patients.