The mean age was 47 years (range 20-82 years). Group I comprised 29 patients and Group II comprised 20 patients. Posterior malleolar fragment was fixed directly by screws alone or plate screw using a posterolateral ankle approach in Group II. Posterior malleolar fracture was left untreated in Group I. Preoperative computed tomography (CT) was also taken for planning of the surgery.įorty nine patients were retrospectively placed in one of the treatment groups. The remaining 49 patients operated by two authors (BT, OS) were included in the study.Īll patients had immediate prereduction radiographs of the ankle including anteroposterior and lateral views. Five patients were lost during followup and one patient was in pediatric age were excluded from the study. Nine patients with a fracture-dislocation injury were excluded from the study. This study compares the results after posterior malleolus and trans syndesmal fixation while considering the reduction quality, development of posttraumatic ankle osteoarthritis, and functional outcomes in trimalleolar ankle fractures.Ī retrospective review conducted between 20 identified 64 patients with posterior malleolar fracture, a component of trimalleolar fracture. 17 Only a few surgical methodologies concerning the ankle for open reduction and internal fixation of posterior malleolar fragments have been described, whereas a reasonable approach for different fracture patterns and the method of posterior malleolus fixation for trimalleolar fractures have not been addressed in the literature at all. In ankle fractures involving the posterior malleolus, the issue of which type of fractures require posterior malleolus fixation is still controversial, 13, 16 suggesting that a trans-syndesmotic fixation may be adequate instead of posterior malleolar fixation. 2 As the surgical treatment of posterior malleolus fracture requires approaches other than traditional medial or lateral incisions, orthopedic surgeons may have a tendency to neglect the posterior malleolus fractures or underestimate the size of the fragment. 15 When a posterior fragment is present, surgical technique fails more often in the anatomic reduction of the joint. Posterior malleolus fractures are frequently left unfixed because they are expected to be reduced spontaneously after open reduction of the lateral malleolus. 2, 5, 7, 8, 10, 11, 12, 13, 14 Surgical treatment with open reduction and internal fixation is the accepted method of treatment for medial and lateral malleolus fractures. Most authors recommend fixation when the fracture comprises >25% of the articular surface. The treatment of ankle fractures with the involvement of posterior malleolus remains a subject of debate. 2, 5, 6, 7, 8, 9 Due to the important biomechanical function of the posterior tibial margin in weight-bearing and ankle stability, the affected ankle is prone to degenerative ankle arthritis. Recent studies have demonstrated that functional outcomes are adversely affected in trimalleolar fractures in comparison to bimalleolar fractures of the lateral and medial malleolus. 4 Large posterior malleolar fracture fragments with posteromedial involvement occur along with the axial loading and posterior shearing forces to the ankle mortise. 3 The most common type of posterior malleolar fracture involves the posterior tubercle, resulting in an avulsion of the posterior inferior tibiofibular ligament (PITFL) following a rotational ankle injury. 1, 2 These types of fractures usually include the posterior tubercle of the distal tibia or posteromedial tibial plafond. Posterior malleolar fractures are observed in approximately 14%–44% of all ankle fractures.
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