scholarly journals Clinical Analysis of Posterolateral Approach for the Treatment of Posterior Malleolus Fracture with Cannulated Screw or Buttress Plate

2021 ◽  
Author(s):  
Yang Lei ◽  
liu zhiyuan ◽  
Yin Gang
Keyword(s):  
Internal Fixation ◽  
Pain Score ◽  
Cannulated Screw ◽  
Ankle Fractures ◽  
Posterolateral Approach ◽  
Aofas Score ◽  
Posterior Malleolus ◽  
The Mean ◽  
Buttress Plate

Abstract Background:Posterior malleolus (PM) fractures account for 7%-44% of all ankle fractures. however, the management of PM fractures remains controversial. Studies have shown that the posterolateral approach is one of the most commonly used surgical approaches. The aim of this study was to evaluate the clinical effect of the posterolateral approach with cannulated screw or buttress plate for the treatment of posterior malleolus fracture.Method:We retrospectively analyzed the clinical data of 66 patients with ankle fractures involving posterior malleolus from January 2016 to March 2018. All patients were treated with a posterolateral approach. Fixation of the posterior malleolus was made with anterior to posterior (AP) lag screws in 7 patients, posterior to anterior (PA) lag screws in 38 patients, buttress plates in 9 patients, and buttress plates combined with PA lag screws in 12 patients. We used the AOFAS ankle and posterior foot function scoring system, VAS pain score, and radiographic evaluations as the primary outcome measures. The mean follow-up was 10.8 ± 4.4 (range, 6-20) months.Results:Radiological evaluation showed that 64 patients (97.0%) achieved a good or excellent reduction and the primary bone union was achieved in all the 66 patients without internal fixation failure or occurrence of post-traumatic ankle arthritis. At the final follow-up, the mean AOFAS score of the patients was 92.39 ± 3.84, with an excellent/good rate of 100%. The VAS pain score was 6.62±1.03 before surgery, changed to 3.06 ± 0.72 one week after surgery, and 1.20 ± 0.92 at the final follow-up. There was no statistical difference in the AOFAS score (p=0.01) or VAS pain score (p=0.01) between the different internal fixation methods.Conclusion:The posterolateral approach using lag screws and/or buttress plates can achieve good clinical outcomes in the treatment of posterior malleolus fracture with reduced incidence of postoperative complications, fracture reduction failure, and ankle osteoarthritis.

scholarly journals Fixation of Posterior Malleolar Fractures with Posterior Plating Through a Posterolateral Approach

2021 ◽  
Vol 111 (2) ◽  
Author(s):  
Fırat Fidan ◽  
Abdulkadir Polat ◽  
Mehmet Ümit Çetin ◽  
Cengiz Kazdal ◽  
Umut Yavuz ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Visual Analog Scale Score ◽  
Ankle Fractures ◽  
Posterolateral Approach ◽  
Posterior Fixation ◽  
Analog Scale ◽  
Aofas Score ◽  
Posterior Malleolus ◽  
Loss Of Reduction ◽  
The Mean

Background We aimed to evaluate radiologic and clinical outcomes of ankle fractures involving posterior fragments that were fixed with a posterior plate by the posterolateral approach. Methods Sixty-five patients who were followed for at least 12 months and were older than 18 years were included. The posterior malleolus fractures were classified according to the Haraguchi classification system with computed tomography (CT). The posterior malleolus fragments were fixed with a plate through a posterolateral approach. Intra-articular step-off, reduction of the posterior malleolar fragment, and fibular position in the incisura were evaluated by early postoperative CT. American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale pain score were used for clinical assessment. Results The posterior malleolus fractures were classified as Haraguchi type 1 in 45 patients (69.2%), Haraguchi type 2 in 12 patients (18.5%), and Haraguchi type 3 in eight patients (12.3%). No patients showed signs of instability or loss of reduction on direct radiographs during follow-up. Postoperative CT showed no loss of reduction in the posterior malleolus and tibiofibular alignment. On evaluation, there was no intra-articular step-off (<1) in any of the patients. The mean AOFAS score was calculated to be 91.6. The mean visual analog scale score was 1.2. Conclusions We conclude that direct posterior fixation with the posterolateral approach can be a good option for ankle fractures involving posterior malleolar fragments.

scholarly journals PO 18198 - Treatment of distal tibiofibular syndesmosis injury in ankle fractures with suture button

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 43S
Author(s):  
Guilherme Honda Saito ◽  
Marcelo Pires Prado ◽  
Alberto Abussamra Moreira Mendes ◽  
Danilo Ryuko Nishikawa ◽  
Beatriz Devito ◽  
...  
Keyword(s):  
Hardware Removal ◽  
Ankle Fractures ◽  
Tibiofibular Syndesmosis ◽  
Aofas Score ◽  
Patient Functioning ◽  
Suture Button ◽  
Distal Tibiofibular Syndesmosis ◽  
Tibiofibular Joint ◽  
The Mean

Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.

scholarly journals The Clinical, Radiologic Outcomes of Indirect Anteroposterior Screw Fixation for Posterior Malleolar Fracture in Rotational Ankle Fractures: Comparison with Syndesmosis Fixation

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0027
Author(s):  
Sunghyun Lee ◽  
Hoiyoung Kwon
Keyword(s):  
Functional Outcomes ◽  
Screw Fixation ◽  
Fragment Size ◽  
Fracture Repair ◽  
Ankle Fractures ◽  
Posterolateral Approach ◽  
Malleolar Fracture ◽  
Syndesmotic Screw ◽  
Posterior Malleolus

Category: Ankle Introduction/Purpose: The posterior malleolus is an important soft tissue attachment for the posterior inferior syndesmosis ligament. Recent studies suggested that direct fixation of a sizable posterior malleolar (PM) fracture through posterolateral approach would act to stabilize the syndesmosis and minimize or eliminate the need for trans-syndesmotic fixation. Indirect anteroposterior (AP) screw fixation was an alternative method, which represent relatively low complication. However, there were few studies to evaluate the stability of syndesmosis after indirect anteroposterior screw. The purpose of this study was to define the rate of syndesmotic instability after anteroposterior screw fixation and to compare to the clinical and anatomical outcomes with indirect reduction without fixation. Methods: We performed a retrospective review between 2009 and 2015 of consecutive patients who underwent surgery with sustained rotational ankle fractures including PM fractures. The exclusion criteria included age <18 years, diabetic neuropathy, tibial pilon fractures, previous ankle fracture repair and not available at minimum 1 year follow up. After the fibula and medial malleolar fracture fixation, the PM was fixed with an AP screw, leaving some of relatively smaller and indirect reduced PM fractures unfixed. Patients were sorted into 2 groups according to the presence (group F) or absence (group N) of AP screw fixation of PM. Then, both groups were divided according to the intraoperative necessity of syndesmotic fixation. The demographics, PM fragment size and syndesmosis widening comparing intact ankle on CT at 1 year postoperatively were recorded for each fracture. The functional outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Results: A total 126 patients met the study inclusion criteria and underwent analysis. Syndesmotic fixation was required in 17 of 78 (21.8%) and 24 of 88 (72.7%) in group F and N, respectively (p=0.012). Postoperative and follow-up FAOS scores were similar in the four subgroups. The tibiofibular distance on CT was greater in the patients without syndesmotic screw fixation in group F and N (p=0.036 and 0.021, respectively). Conclusion: Indirect AP screw fixation of the PM fracture in rotational ankle fractures might be support syndesmotic stability and, thus, lower the rate of syndesmotic fixation. Also, these patients have functional outcomes at least equivalent to outcomes for patients having syndesmotic screw fixation. However, in AP screw fixation group, syndesmosis widening was evaluated without syndesmosis fixation, which could be resulted in degenerative arthritis change. Therefore, our data demonstrate that indirect AP screw fixation of PM fracture alone could not restore syndesmotic stability perfectly.

scholarly journals Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
Pablo Mococain ◽  
Pablo Wagner ◽  
Ruben Radkievich ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
X Rays ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Clear Space ◽  
Screw Breakage ◽  
The Mean

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

scholarly journals Fixation of posterior malleolus fractures through posterior access in the ankle

2018 ◽  
Vol 12 (3) ◽  
pp. 193-198
Author(s):  
Vitor Yoshiura Masuda ◽  
Vinicius Felipe Pereira ◽  
Daniel Soares Baumfeld ◽  
Caroline Marques Dos Santos Cavaleiro Cruel Neves ◽  
Caio Nery ◽  
...  
Keyword(s):  
Case Series ◽  
Score Function ◽  
Wound Complications ◽  
Joint Degeneration ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Posterior Malleolus ◽  
The Mean

Objective: The aim of this study is to present the preliminary results of posterior malleolus fixation in a case series by evaluating clinical and radiographic outcomes as well as possible complications related to this approach. Methods: This study involved a case series of 7 patients with posterior malleolus fractures, either isolated or associated with other tibiotarsal injuries, who were surgically treated and evaluated from January 2014 to December 2016 in one of the hospitals of our service. The patients were evaluated for consolidation, pain (Visual Analog Scale (VAS) score), function (American Foot and Ankle Society (AOFAS) score), surgical wound complications and joint degeneration in the postoperative period. Results: The mean follow-up was 66 weeks. All patients presented clinical and radiographic consolidation of the fractures by the sixth weekof the follow-up. The mean pain score according to the VAS was 1.5 and the mean AOFAS score was 92.5. At the end of follow-up, no clinical or radiographic evidence of joint degeneration was observed. Conclusion: Posterior access is a viable alternative that provides good results with few complications for the treatment of posterior malleolus fractures. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Treatment outcomes of buttress plating for posterior pilon fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Ming-Zhu Zhang ◽  
Guang-rong Yu
Keyword(s):  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Ct Scans ◽  
Posterolateral Approach ◽  
The Mean ◽  
Buttress Plate ◽  
Pilon Fractures

Category: Ankle Introduction/Purpose: The purpose of current study was to retrospectively analyze the clinical outcomes of buttress plate treatment of posterior pilon fractures. Methods: Between January 2005 and December 2016, 58 patients with posterior pilon fractures underwent buttress plate fixation. There were 32 males and 26 females and the mean age was 40.2years (range, 23 to 73 years). Preoperative radiographs, CT scans and three dimensional reconstructions were used to evaluate the fracture patterns. On the basis of the extension of the fracture lines presented on the CT scans, a posterolateral approach or a combination of both posterolateral and posteromedial approaches were used to reduce and fixate the posterior malleolar fragments. Clinical and radiographic examinations were used for postoperative follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Visual Analogue Scale (VAS) were used to evaluate the functional outcomes. Results: According to the CT scan images, the posterior pilon fractures were classified into 3 types. 51 patients were available for follow-up. The mean time of follow-up was 44.8 months. The mean AOFAS score was 84.3 points, and the mean VAS score was 1.6 points. One patient was found with ankle joint swelling and long term walking discomfort at 2-year follow-up. Other patients received favorable functional outcomes. No hardware failure occurred. Conclusion: The clinical outcomes of buttress plate treatment of posterior pilon fractures were satisfactory. Buttress plating availed the patients to return to earlier weight-bearing and functional exercises.

scholarly journals Timing of Open Reduction and Internal Fixation of Ankle Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Direk Tantigate ◽  
J. Turner Vosseller ◽  
Justin Greisberg ◽  
Benjamin Ascherman ◽  
Christina Freibott ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Demographic Variables ◽  
Ankle Fractures ◽  
Significant Difference ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) for stabilization in an effort to ultimately prevent post-traumatic arthritis. It is not uncommon for operative treatment to be performed as an outpatient in the ambulatory surgery setting several days to a couple weeks after the injury to facilitate things from a scheduling perspective. It is unclear what effect this delay has on functional outcome. The purpose of this study is to assess the impact of delayed operative treatment by comparing the functional outcomes for groups of patients based on the amount of time between the injury and surgery. Methods: A retrospective chart review of 122 ankle fracture patients who were surgically treated by ORIF over a three year period was performed. All ankle fracture patients older than 18 years with a minimum of 24 months of follow-up were included. A total of 61 patients were included for this study. Three patients were excluded; 2 patients had an open injury and 1 patient presented with a delayed union. Demographic data, comorbidities, injury characteristics, duration from injury to surgery, operative time, length of postoperative stay, complications and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow-up visit. Comparison of demographic variables and the subcategory of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) was performed between patient underwent ORIF less than 14 days after injury and 14 days or greater. Results: A total of 58 patients were included in this study. Thirty-six patients (62.1%) were female. The mean age of patients was 48.14 ± 16.84 years (19-84 years). The mean follow-up time was 41.48 ± 12.25 months (24-76 months). The duration between injury and operative fixation in the two groups was 7 ± 3 days (<14 days) and 18 ± 3 days (>14 days), respectively. There was no statistically significant difference in demographic variables, comorbidities, injury characteristics, or length of operation. Each subcategory of FAOS demonstrated no statistically significant difference between these two groups. (Table 1) Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS. Conclusion: Open reduction and internal fixation of ankle fracture more than 14 days does not significantly diminish functional outcome according to FAOS. Delay of ORIF for ankle fractures does not play a significant role in the long-term functional outcome.

scholarly journals Treatment Outcomes of Buttress Plating for Posterior Pilon Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Guang-Rong Yu ◽  
Mingzhu Zhang
Keyword(s):  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Ct Scans ◽  
Posterolateral Approach ◽  
The Mean ◽  
Buttress Plate ◽  
Pilon Fractures

Category: Ankle Introduction/Purpose: The purpose of current study was to retrospectively analyze the clinical outcomes of buttress plate treatment of posterior pilon fractures Methods: Between January 2005 and December 2009, 16 patients with posterior pilon fractures underwent buttress plate fixation. There were 11 males and 5 females and the mean age was 37.6 years (range, 23 to 62 years). Preoperative radiographs, CT scans and three dimensional reconstructions were used to evaluate the fracture patterns. On the basis of the extension of the fracture lines presented on the CT scans, a posterolateral approach or a combination of both posterolateral and posteromedial approaches were used to reduce and fixate the posterior malleolar fragments. Clinical and radiographic examinations were used for postoperative follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Visual Analogue Scale (VAS) were used to evaluate the functional outcomes. Results: According to the CT scan images, the posterior pilon fractures were classified into 3 types. 14 patients were available for follow-up. The mean time of follow-up was 37.6 months (range, 16 to 52 months). The mean AOFAS score was 86.4 points (range, 70 to 98 points), and the mean VAS score was 1.4 points (range, 0 to 3 points). One patient was found with ankle joint swelling and long term walking discomfort at 2-year follow-up. Other patients received favorable functional outcomes. No hardware failure occurred. Conclusion: The clinical outcomes of buttress plate treatment of posterior pilon fractures were satisfactory. Buttress plating availed the patients to return to earlier weight-bearing and functional exercises.

scholarly journals PO 18133 - Internal fixation of displaced intra-articular fractures of the hallux through a dorsomedial approach

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. S27
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Fernando Aires Duarte ◽  
Augusto César Monteiro ◽  
Bruno Rodrigues de Miranda ◽  
Guilherme Honda Saito ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Range Of Motion ◽  
Clinical Evaluation ◽  
Interphalangeal Joint ◽  
Rigid Fixation ◽  
Aofas Score ◽  
Articular Fractures ◽  
The Mean

Introduction: Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation. The aim of this study is to present the results of the surgical treatment of displaced interphalangeal joint (IPJ) fractures of the hallux using a dorsomedial approach. It is our understanding that this approach minimizes injury to the soft tissue envelope without the need to detach or create a tenotomy of the extensor hallucis longus tendon (EHL), allowing rigid fixation and early weight bearing and range of motion. Methods: A retrospective case series was performed of 5 patients with displaced IPJ fractures of the hallux treated with the dorsomedial approach from July 2013 to October 2017. Two patients were male and three female, with a mean age of 37,4 years and a mean follow-up of 36 months. The surgical indication for open reduction and internal fixation through a dorsomedial approach of the IPJ was displaced (>2 mm) bicondylar fractures of the proximal phalanx of the hallux. The incision was performed along the medial border of the EHL tendon without the need to detach or create a tenotomy of this tendon. In the postoperative period, follow-up included clinical evaluation and radiographic exams. All patients were assessed by visual analog scale (VAS) scores for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: All patients presented bone consolidation and returned to their previous activities without limitations. At the final follow-up, the mean VAS score was 0, and the mean AOFAS score was 92,6. Clinical evaluation revealed preservation of approximately 50% of the range of motion of the IPJ compared with the contralateral side. Conclusion: We concluded that a dorsomedial approach should be considered in the surgical management of displaced intra-articular fractures of the hallux. It preserves soft tissue and most of the IPJ motion, preventing postoperative joint pain and stiffness.

scholarly journals A lean bioabsorbable magnesium-zinc-calcium alloy ZX00 used for operative treatment of medial malleolus fractures

2020 ◽  
Vol 9 (8) ◽  
pp. 477-483
Author(s):  
Patrick Holweg ◽  
Valentin Herber ◽  
Martin Ornig ◽  
Gloria Hohenberger ◽  
Nicolas Donohue ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Clinical Investigation ◽  
Blood Analysis ◽  
Ankle Fractures ◽  
Fracture Reduction ◽  
Medial Malleolus ◽  
Aofas Score ◽  
Talocrural Joint ◽  
The Mean

Aims This study is a prospective, non-randomized trial for the treatment of fractures of the medial malleolus using lean, bioabsorbable, rare-earth element (REE)-free, magnesium (Mg)-based biodegradable screws in the adult skeleton. Methods A total of 20 patients with isolated, bimalleolar, or trimalleolar ankle fractures were recruited between July 2018 and October 2019. Fracture reduction was achieved through bioabsorbable Mg-based screws composed of pure Mg alloyed with zinc (Zn) and calcium (Ca) ( Mg-Zn0.45-Ca0.45, in wt.%; ZX00). Visual analogue scale (VAS) and the presence of complications (adverse events) during follow-up (12 weeks) were used to evaluate the clinical outcomes. The functional outcomes were analyzed through the range of motion (ROM) of the ankle joint and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Fracture reduction and gas formation were assessed using several plane radiographs. Results The follow-up was performed after at least 12 weeks. The mean difference in ROM of the talocrural joint between the treated and the non-treated sites decreased from 39° (SD 12°) after two weeks to 8° (SD 11°) after 12 weeks (p ≤ 0.05). After 12 weeks, the mean AOFAS score was 92.5 points (SD 4.1). Blood analysis revealed that Mg and Ca were within a physiologically normal range. All ankle fractures were reduced and stabilized sufficiently by two Mg screws. A complete consolidation of all fractures was achieved. No loosening or breakage of screws was observed. Conclusion This first prospective clinical investigation of fracture reduction and fixation using lean, bioabsorbable, REE-free ZX00 screws showed excellent clinical and functional outcomes. Cite this article: Bone Joint Res 2020;9(8):477–483.

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