Abstract
Comparative clinical efficacy of nickel-titanium shape memory staples versus miniplate for Bartoníček-Rammelt type III and IV posterior malleolar fractures. A retrospective analysis of 47 consecutive patients treated between January 2022 and June 2024 documented operative time, intraoperative blood loss, fluoroscopy times, healing time, complications, postoperative fracture gap distance (mm), and articular surface step-off (mm) at the ankle joint. Ankle function was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the Manchester-Oxford Foot Questionnaire (MOXFQ), and range of motion measurements at 3, 6, 12, and 14 months. There were no statistically significant differences in baseline characteristics between the 2 groups. The shape-memory alloy group exhibited significantly shorter operative time [65.0 (60.0, 70.0)], less intraoperative blood loss [40.0 (30.0, 50.0)], and fewer intraoperative fluoroscopy instances [5.0 (4.0, 6.0)] than the miniplate group, with all differences showing statistical significance (P < .05). Postoperative imaging examinations revealed no significant differences in the fracture gap distance and articular surface step height of the ankle joint between the 2 groups. At 3 months, 6 months, and the final follow-up, there were no statistically significant differences in the AOFAS ankle-hindfoot scores and MOXFQ scores between the 2 groups of patients (P > .05). At the final follow-up, the AOFAS ankle-hindfoot scores and MOXFQ scores of all patients showed statistically significant differences compared to those at 3 and 6 months postoperatively (P < .05). At the final follow-up, there were no statistically significant differences in the range of motion for ankle dorsiflexion, plantarflexion, inversion, or eversion between the 2 patient groups (P > .05). Both nickel-titanium shape memory staples and miniplates achieved good clinical outcomes in the treatment of Bartoníček-Rammelt type III and IV posterior malleolar fractures. Both methods maintained satisfactory fracture reduction and resulted in favorable functional recovery of the ankle joint. However, the nickel-titanium shape memory staples offered advantages in shorter operative time, reduced intraoperative blood loss, and fewer intraoperative fluoroscopy exposures.