Open reduction in pilon variant posterior malleolar fractures: Radiological and clinical evaluation

Area of Science:

• Orthopedic Surgery
• Radiology
• Trauma Management

Background:

• Pilon variant posterior malleolar (PVPM) fractures disrupt ankle joint congruency and cause instability.
• These fractures are frequently underestimated and undertreated, leading to poor outcomes.

Purpose of the Study:

• To evaluate surgical treatment outcomes for PVPM fractures.
• To determine the role of computed tomography (CT) in diagnosing and managing these injuries.

Main Methods:

• Retrospective analysis of 67 trimalleolar ankle fractures, including 14 PVPM cases.
• Patients underwent open reduction; postoperative CT assessed joint reconstruction.
• Outcomes were measured using American Academy of Orthopaedic Surgeons (AAOS) and Osteoarthritis (OA) scores.

Main Results:

• PVPM fractures constituted 20.1% of trimalleolar fractures studied.
• Anatomic reconstruction was confirmed by postoperative CT in 11 patients.
• Mean AAOS scores were 85.6 (Type 1) and 81.1 (Type 2); mean OA scores were 1.0 and 1.1, respectively. Osteochondral impaction differed significantly between types (P<0.05).

Conclusions:

• Computed tomography (CT) is crucial for accurate diagnosis and surgical management of PVPM fractures.
• Posteromedial and posterolateral approaches facilitate direct exposure and joint surface reconstruction.