Posterior Malleolus Fractures in Trimalleolar Ankle Fractures: Malleolus versus Transyndesmal Fixation

Abstract

Background:In ankle fractures involving the posterior malleolus, the issue of which types of fractures require posterior malleolus fixation is still controversial. Recent studies have demonstrated that trimalleolar fractures adversely affect the functional outcomes in comparison to bimalleolar fractures of the lateral and medial malleolus. The purpose of this study was to assess the effects of posterior malleolus fixation on the functional and radiological outcomes.Materials and Methods:Reduction quality, development of posttraumatic ankle osteoarthritis, and functional outcomes in 49 consecutive trimalleolar ankle fractures were evaluated retrospectively in patients with and without posterior malleolus fixation. Group I consisted of 29 patients, in which posterior malleolar fracture was left untreated. Twenty patients in Group II, posterior malleolar fragment was fixed directly by screws alone or plate screw. Twenty-one of these 49 patients were male (43%). The mean age was 47 years (range 20-82 years).Results:The mean followup was 12 to 51 months with a mean of 15 months (range 12-51 months). Statistically significant differences were found between Group I and Group II in terms of ankle arthrosis. American Orthopaedic Foot and Ankle Society score was significantly lower in Group I compared to Groups II.Conclusions:These results demonstrate that posterior malleolar fracture fixation is closely related to successful radiological and functional outcomes after trimalleolar fractures. Transyndesmal screw fixation may not be needed in the cases where the posterior malleolar fracture fixated. For these reasons, we recommend that all posterior malleolar fractures have to be fixed regardless of size.

Comparison of the Efficacy of Posterior-Anterior Screws, Anterior-Posterior Screws and a Posterior-Anterior Plate in the Fixation of Posterior Malleolar Fractures with a Fragment Size of ≥15% and <15%

“…Jaskulka et al [30] performed a 5-7 year follow-up study of 142 patients with ankle fractures, and suggested that if fixation was not performed, long-term results were significantly poor, even in patients with a small marginal fragment of the lip of the tibia. Tosun et al [31] showed that the fixation of PMF is closely related to the successful radiological and functional outcomes of trimalleolar fracture. After PMF is fixed, transyndesmal screw fixation may not be required.…”

A Modified Posterolateral Approach for the Treatment of Posterior Malleolar Fracture

“…However, a lot of recent literature argue that surgical xation of small fragments of the posterior malleolus may have a better effect on the clinical effects [8,13,15]. And also, posterior malleolus xation relates to syndesmotic stability [14,[28][29][30]. Then it may allow an opportunity to avoid standard syndesmotic xation with screws, which bring about many complications [31].…”

Numerical Simulation of the Posterior Malleolus Fracture with the Finite Element Method

“…The incidence of the posterior malleolus fractures was reported to be 7% to 44% of all ankle fractures. These types of fractures classically include the Volkmann tubercle of the posteromedial tibial plafond [18,19]. Biomechanical studies suggest that the posterior malleolus serves as an important contributor to the stability of ankle joint, while the indication of surgical treatment remains controversial [20].…”