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Early results of proximally inserted minimally invasive plate osteosynthesis for distal fibular fractures in unfavorable skin conditions: A case series

Zawam, Sherif Hamdy MSc; Shaheen, Ayman Abdelsamee MD; Elnahal, Walid A. MD; ElJeady, Ibrahim Taha MD

doi: 10.1097/BCO.0000000000000810
Innovations In Practice

Background: Operative fixation of fractures of the lateral malleolus may be complicated by skin complications and wound infection, especially in patients with an unfavorable skin condition or soft-tissue injury. The goal of this study was to assess a technique of minimally invasive, proximally inserted plate fixation for distal fibular fractures in unfavorable skin conditions, including superficial abrasions, blisters, and contusions.

Methods: This prospective case series study included 20 patients with syndesmotic and suprasyndesmotic fractures of the distal fibula, with unfavorable skin conditions, presenting to the emergency department of a major trauma center between May, 2015 and May, 2016. All patients were followed for an average of 1 yr (range, 6 mo-2 yr).

Results: All fractures united at an average of 9.4 wk (range, 8-12 wk). Functional assessment according to the American Orthopaedic Foot And Ankle Society Scoring system was 93.9 (range, 78-100). None of the cases was complicated by wound dehiscence or deep infection.

Conclusions: Minimally invasive, proximally inserted plate fixation is a viable and safe technique that can avoid an incision over the skin of the distal fibula in patients with unfavorable skin conditions.

Level of Evidence: Level IV.

Cairo University, Cairo, Egypt

Financial Disclosure: The authors report no conflicts of interest.

Correspondence to Sherif Hamdy Zawam, MSc, Assistant Lecturer, Faculty of Medicine, Cairo University, Cairo, Egypt Tel: +00201004103862; fax: +002-0223786608; e-mail:

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