Functional outcome of postero-lateral approach for fixation of posterior malleolus fracture in case of trimalleolar fractures of ankle: A study of 32 cases

Abstract

Introduction: Trimalleolar fracture fixation has undergone a sea change in the recent times. Posterior malleolus component used to be fixed by anteroposterior approach which has not been optimum as far as results are concerned. Posterolateral approach has been well described in literature but very few are using it. This study has tried to evaluate the results of this approach. Methods: Total 32 patients were included in this study. They underwent posterolateral approach and fixation of fibular fracture and posterior malleolus fracture in prone position . Medial malleolus fracture was fixed in supine position. Posterior malleolus was classified based on Haraguchi classification on CT scan. Final evaluation was done using Olerud and Molander scoring system. Results: All fractures united within three months duration. Excellent results were seen in 40.6%, Good in 43.8%, Fair in 9.4% and Poor in 6.2% cases. Most of the patients could return to pre-injury work levels by six months. Conclusion: Direct posterolateral approach allows fixation of fibula and anatomical restoration of ankle joint congruity and syndesmotic stability also, obviating the need of syndesmotic screw. Posterior malleolus fixation is essential in tri-malleolar fractures for good functional outcome.