A comparative study of the clinical results of two treatment methods for spiral fracture of the lower third of the tibia shaft combined with posterior malleolar fracture

Objective : To compare and analyze the clinical efficacy of spiral fracture of the lower third of the tibia shaft combined with a posterior malleolar fracture treated with a plate or hollow screws. Methods : Surgical treatment was carried out in 61 patients with a spiral fracture of the lower third of the tibia shaft combined with a posterior malleolar fracture. After the tibia fractures were fixed with a plate, the posterior malleolus fractures were repaired using either three hollow screws (hollow screw group, 34 cases) or a plate (plate group, 27 cases). The ankle and foot scoring system recommended by Baird-Jackson was used to evaluate the ankle postoperatively. Results: All 61 patients were followed-up; the follow-up period ranged from 6–36 months, with an average of 20.8 months. All fractures healed well, and no delayed unions or nonunions occurred. The function of the ankle joint according to the Baird-Jackson score system evaluation was as follows: in the hollow screw group, 18 were excellent, 10 were good, 5 were fair, and 1 was poor, with at least 82.4% experiencing good or excellent outcomes. In the plate group, 8 were excellent, 9 were good, 3 were fair, and 1 was poor, with 85.2% reporting excellent or good results. The difference in these two groups of Baird-Jackson scores with an excellent rate was not statistically significant (P =0.21>0.05). Conclusion : Spiral fractures of the distal third of the tibia are often accompanied by posterior malleolar fractures. Clinical treatment of the posterior malleolar fracture had no obvious impact on the clinical curative effect of hollow screw and L-type plates. Slight trauma was observed with hollow screw internal fixation, while internal plate fixation was more reliable. Keywords ： Spiral tibia fracture; Posterior malleolar fracture; Hollow screw; Plate; Internal Fixation