The clinical outcome of fixation of posterior malleolus fragment in trimalleolar ankle fracture
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251789Keywords:
AOFAS score, Complications, Functional recovery, Posterior malleolus, Surgical fixation, Trimalleolar fractureAbstract
Background: Trimalleolar ankle fractures are complex injuries that often require surgery. Posterior malleolus fixation is important to restore ankle stability and function. The aim of this study was to evaluate the clinical outcomes associated with posterior malleolus fixation in patients with ankle fractures in the malleolus ankle fracture.
Methods: From 2018 to 2024, clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, range of motion measurements, and radiographic evaluations. Complications and functional recovery were carefully recorded to analyze the effectiveness of posterior malleolus fixation in trimalleolus ankle fractures.
Results: All 100 patients were included in the study. The mean AOFAS score at final follow-up was 85, indicating a significant improvement compared with the preoperative score. Radiographic analysis showed satisfactory alignment and integration of the posterior malleolus fragments in 92% of cases. Complications included minor infections and delayed wound healing in a few cases; however, overall, most patients achieved good results, demonstrating improved ankle stability and functional recovery.
Conclusions: Posterior malleolus fixation in trimalleolar ankle fractures is associated with satisfactory clinical outcomes, increased stability and recovery from work. These findings support the importance of managing the malleolus during surgery for trimalleolus fractures. Further prospective studies are needed to validate these results and improve surgical techniques.
Metrics
References
Sun L, Qin S, Pan Z, Sun L, Xing W. Homeopathic Ankle Dislocation for Treatment of Unstable Trimalleolar Fractures Involving Posterior Die-Punch Fragment: A Retrospective Cohort Study. Orthop Surg. 2024;16(5):1230-8. DOI: https://doi.org/10.1111/os.14047
Yang L, Yin G, Zhu J, Liu H, Zhao X, Xue L, et al. Posterolateral approach for posterior malleolus fixation in ankle fractures: functional and radiological outcome based on Bartonicek classification. Arch Orthop Trauma Surg. 2023;143(7):4099-109. DOI: https://doi.org/10.1007/s00402-022-04620-0
Kalem M, Şahin E, Songür M, Keser S, Kinik H. Comparison of three posterior malleolar fixation methods in trimalleolar ankle fractures. Acta Orthop Belg. 2018;84(2):203-12.
Yu G, Dong Y, Cui Y, Yang Z, Fu X, Li D, et al. Direct or indirect reduction internal fixation for posterior ankle fractures: A systematic review and meta-analysis. J Foot Ankle Surg. 2025;64(3):456-65. DOI: https://doi.org/10.1053/j.jfas.2025.03.014
Karaca S, Enercan M, Özdemir G, Kahraman S, Çobanoğlu M, Küçükkaya M. Importance of fixation of posterior malleolus fracture in trimalleolar fractures: A retrospective study. Ulus Travma Acil Cerrahi Derg. 2016;22(6):553-8. DOI: https://doi.org/10.5505/tjtes.2016.44844
Martin KD, Tripp CT, Huh J. Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures. Foot Ankle Int. 2021;42(2):157-65. DOI: https://doi.org/10.1177/1071100720955149
Behery OA, Narayanan R, Konda SR, Tejwani NC, Egol KA. Posterior Malleolar Fixation Reduces the Incidence of Trans-Syndesmotic Fixation in Rotational Ankle Fracture Repair. Iowa Orthop J. 2021;41(1):121-5.
Verhage SM, Krijnen P, Schipper IB, Hoogendoorn JM. Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures. Arch Orthop Trauma Surg. 2019;139(3):323-9. DOI: https://doi.org/10.1007/s00402-018-3056-0
Patel S, Baburaj V, Sharma S, Mason LW, Dhillon MS. Influence of posterior malleolar fragment morphology on the outcomes of trimalleolar fractures: A systematic review and meta-analysis. Foot Ankle Surg. 2022;28(8):1337-44. DOI: https://doi.org/10.1016/j.fas.2022.06.012
Batar S, Şişman A. Comparison of anteroposterior and posteroanterior screw fixation techniques for posterior malleolar fractures: a retrospective and clinical study. Ulus Travma Acil Cerrahi Derg. 2023;29(12):1376-81. DOI: https://doi.org/10.14744/tjtes.2023.66204
Pina G, Fonseca F, Vaz A, Carvalho A, Borralho N. Unstable malleolar ankle fractures: evaluation of prognostic factors and sports return. Arch Orthop Trauma Surg. 2021;141(1):99-104. DOI: https://doi.org/10.1007/s00402-020-03650-w
Park JS, Porter DA, Sferra JJ, Cooper MT. Postoperative Weight Bearing and Rehabilitation After Foot and Ankle Surgery. Foot Ankle Spec. 2020;13(4):330-4. DOI: https://doi.org/10.1177/1938640020938912
Hoelsbrekken SE, Kaul-Jensen K, Mørch T, Vika H, Clementsen T, Paulsrud Ø, et al. Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial. J Orthop Trauma. 2013;27(11):633-7. DOI: https://doi.org/10.1097/BOT.0b013e31828e1bb7
Choi JY, Oh HK, Di Mento L, Hur JW, Suh JS. Operative strategy for tri-malleolar ankle fractures with posteromedial plafond involvement: a review of sixty six cases. Int Orthop. 2022;46(11):2637-48. DOI: https://doi.org/10.1007/s00264-022-05554-3
Downloads
Published
How to Cite
Issue
Section
