Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study

Background: The goal of managing the comminuted fracture of lateral malleolus is to restore length, rotation and alignment which might be more challenging with extensive comminution around the area of the distal tip. The common osteosynthesis techniques such as the one-third tubular plate, tension band wiring, K-wires, screws, or intramedullary nail may be insufficient in cases with a comminuted lateral malleolus. The anatomical hook plate is an alternative implant in such cases. We present our results of the comminuted lateral malleolar fractures (Weber A, B), managed by open reduction and internal fixation (ORIF) with an anatomical hook plate of lateral malleolus (Konigsee Implant Company, Germany). Materials and Methods: We retrospectively reviewed 20 patients of comminuted fracture of distal lateral malleolus between 2008 and 2010. There were 12 males and 8 females, right side was involved in 18 patients and left in 2. The mean age was 51.9 years (range 18-75 years). The fractures were categorized by Denis-Weber classification type A (n=1), B1 (n=1), B2 (n=13) and B3 (n=5). Nineteen cases were of closed injury and one of open injury (Gustilo Anderson type II). These patients underwent ORIF with a lateral malleolus anatomical hook plate. Followup including radiographs and clinical examinations were performed. The American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were documented at followups. Results: The mean followup was 21.4 months (range 16-27 months). The average AOFAS score was 94.3 (range 78-100) points. A stable anatomic reduction and bony union were obtained in all the cases. The average time was 3.1 months (range 2.5-4 months). Four cases had complications like posttraumatic osteoarthritis, hardware impingement and superficial wound infection. Conclusion: A reasonably good stability can be obtained in distal most comminuted fractures of lateral malleolus with a lateral malleolus anatomical hook plate. We believe this method to be a reasonable treatment option for a distal lateral comminuted malleolar fracture when other common fixations are insufficient to fix the fragments.