[Posterolateral approach in trimalleolar ankle fractures: surgical technique]

Ankle fractures involving a posterior malleolar fragment are associated with worse clinical outcomes. The standard indication for its fixation is a displaced fragment that involves more than 25% of the distal articular tibia. The method of reduction and fixation of these fractures has not received much attention. The purpose of this paper is to describe the surgical technique and clinical results.

Over a 6 year period 10 patients with an ankle fracture involving more than 25% posterior malleolus were admitted for surgery, which was performed by the first author. Postoperative management and complications were recorded, reduction accuracy evaluated in the first postoperative radiograph, and functional outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) hind foot-ankle score and the modified Weber protocol. The surgical technique is described.

A total of 10 patients were included in the study; and the overall mean age was 53.8 (range: 19-82) years. With regard to complications, none of the 10 patients had any postoperative complication. No cases of reflex sympathetic dystrophy syndrome, superficial infection, iatrogenic lesion of the sural nerve or failure of internal fixation were recorded. One of them had screw and plate removal surgery. Clinical results were good; 9 patients regained their pre-injury activity level, with excellent or good results in both AOFAS and modified Weber protocol.

Given that posterior malleolus fractures are usually posterolateral, this approach allows perfect visualization of the fracture, articular anatomical reduction, and strong fixation. Clinical results obtained were at least equal to other case series published.