Biomechanical comparison of three different methods used in the treatment of medial malleolar fractures

Among all fractures of the skeletal system, ankle fractures with a rate of %10, the most common type of fractures of the lower extremity after hip fractures. An important part of these fractures is isolated malleolar fracture. While stable and nondisplaced fractures can be treated conservatively, surgical treatment may be required for unstable fractures. The methods used in the surgical treatment of ankle fractures are changing over time. Although there are different opinions in terms of surgical timing, patients can be mobilized sooner with early surgery. One of the fractures of the ankle that may require surgical treatment is medial malleolus transverse fractures. Different fixation methods are available for this type of fracture. In this study, we aimed to biomechanically compare the medial malleolar plate, sled fixation system and malleolar screw methods in transverse fractures of the medial malleolus. The tibias of the cows obtained from the butcher was purified from soft tissues and 42 cow tibias were obtained. These tibias were cut 15 cm proximal to the tibial plafond and the proximal parts were excluded. Transverse fractures were formed in the medial malleolus of the bones included in the study and were divided into 3 groups, each consisting of 14 bones. The medial malleolar fractures formed in these 3 groups were fixed by using sled device, malleolar screw and medial malleolar plate. Afterwards, these samples were subjected to biomechanical analysis in the Engineering Laboratory of Fırat University by means of specially prepared apparatus for attaching the bones to the tensile and transverse force tester device. The data obtained from the device were converted to force-displacement curves and interpreted. When tensile force was applied, the medial malleolar plate method was resistant to higher forces than other methods in terms of 2 mm displacement force and catastrophic failure force, no difference was found between the medial malleolar plate method and sled device method in terms of stifness. The medial malleolar plate method was found to be more durable in tensile strength than malleolar screw method. The medial malleolar plate method with 2 mm displacement force was able to withstand higher forces in the transverse force groups compared to sled device and malleolar screw methods. In transverse forces, the medial malleolar plate method was found to be more durable than sled device and malleolar screw methods. In the transverse force group, no significant difference was found between the medial malleolar plate method and sled device method in terms of catastrophic failure forces. Keywords: Medial malleolus, medial malleolar plate, sled device, malleolar screw