The 2-Window Posterolateral vs Single-Window Approach for Ankle Fracture Fixation

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Surgical Techniques

Background:

• The posterolateral approach to the ankle facilitates reduction and fixation of posterior and lateral malleoli.
• This technique can be performed using one or two surgical windows.
• Unstable rotational ankle fractures present challenges in surgical management.

Purpose of the Study:

• To compare the clinical outcomes of unstable rotational ankle fractures treated with the posterolateral approach using either one or two surgical windows.
• Specifically, to evaluate differences in wound complications and range of motion between the two techniques.

Main Methods:

• A retrospective cohort study reviewed 164 patients with bi- or trimalleolar ankle fractures.
• Patients were treated with either a single-window (n=108) or two-window (n=56) posterolateral approach.
• Outcomes including wound complications and range of motion were assessed at 3-month and 12-month follow-ups.

Main Results:

• The two-window group had significantly more early wound complications (32% vs. 12%) and more complications when treated later than one week post-injury (44% vs. 16%).
• No significant difference in surgical site infections or nerve complications was observed.
• Patients treated with the single-window approach demonstrated significantly better plantarflexion and dorsiflexion at 12 months.

Conclusions:

• The single-window posterolateral approach is associated with fewer wound complications compared to the two-window approach for unstable rotational ankle fractures.
• The single-window technique also leads to better postoperative ankle range of motion.
• This suggests the single-window approach may be preferable for managing these types of fractures.