No long-term effects of ultrasound therapy on bioabsorbable screw-fixed lateral malleolar fracture.

BACKGROUND AND AIMS: The present study was initiated to evaluate the long-term effects of low-intensity ultrasound therapy on bioabsorbable screw-fixed lateral malleolar fractures, which has not been studied earlier. PATIENTS AND METHODS: The study design was prospective, randomized, double-blinded, and placebo-controlled. Sixteen dislocated lateral malleolar fractures were fixed with one bioabsorbable self-reinforced poly-L-lactide screw. The patients used an ultrasound device 20 minutes daily for six weeks without knowing it was active (eight patients) or inactive (eight patients). The follow-up time was 18 months. The radiological bone morphology was assessed by multidetector computed tomography (MDCT) scans, the bone mineral density by dual-energy X-ray absorptiometry scans, and the clinical outcome by Olerud-Molander scoring and clinical examination of the ankle. RESULTS: The MDCT scans revealed that all fractures were fully healed, and no differences were observed in radiological bone morphology at the fracture site. The bone mineral density of the fractured lateral malleolus tended to increase slightly during the 18-month follow-up, the increase being symmetrical in both groups. No differences were observed in the clinical outcome or Olerud-Molander scores. CONCLUSIONS: The six-week low-intensity ultrasound therapy had no effect on radiological bone morphology, bone mineral density or clinical outcome in bioabsorbable screw-fixed lateral malleolar fractures 18 months after the injury.

Biodegradable screw fixation of the syndesmosis together with metallic osteosynthesis. Preliminary experience of 7 ankles.

BACKGROUND AND AIMS: In ankle fractures with separation of the tibiofibular mortise a metallic syndesmosis screw is generally used. As a rule, this transfixing screw is removed by a separate operation 6 to 8 weeks later. Usually the fracture fixation implants are removed by a second operation later on. In order to eliminate separate removal of the transfixing screw, we used a biodegradable syndesmosis screw in a pilot clinical study. PATIENTS AND METHODS: We treated seven consecutive patients with malleolar fractures and separation of the syndesmosis by an ordinary metallic plating and screw fixation of the fractures and biodegradable polyglycolic acid (PGA) screw transfixation of the syndesmosis. RESULTS AND CONCLUSIONS: All the patients ended up with an acceptable result and stable ankle mortise. One of the ankles, which was the only one fixed by two transfixing PGA screws instead of one screw, had transient sinus formation and intraosseal osteolysis. The final result was good also in this case. The ankle mortise can be fixed safely by biodegradable screws in connection with metallic osteosynthesis of malleolar fractures. Thus a separate removal of the transfixing material is possible to eliminate.