Middle-sized posterior malleolus fractures: Fixed versus non-fixed - A prospective randomized study

Area of Science:

• Orthopedic surgery
• Traumatology
• Radiology

Background:

• Ankle fractures involving the posterior malleolus are common.
• The optimal management strategy for posterior malleolus fractures remains debated.
• Fixation aims to restore articular congruity and improve outcomes.

Purpose of the Study:

• To evaluate the impact of posterior malleolus fixation on functional and radiological outcomes in ankle fractures.
• To determine if fixation of the posterior malleolus leads to improved patient outcomes.
• To test the hypothesis that fixation is associated with better radiological and functional results.

Main Methods:

• A prospective randomized controlled study included 40 patients with ankle fractures and middle-sized posterior fragments (10-25%).
• Group 1: No fixation of the posterior fragment. Group 2: Posterior malleolus fixation.
• Patients were assessed functionally and radiologically at a minimum of 2-year follow-up.

Main Results:

• No significant differences in functional or radiological outcomes were detected between the groups.
• Articular step-off > 1 mm was more frequent in the non-fixated group (p=0.04).
• Patients with articular step-off had significantly worse functional outcomes (p<0.05).

Conclusions:

• Posterior malleolus fixation did not yield significant improvements in short-to-mid-term functional or radiological outcomes.
• Fixation indirectly improved functional outcomes by reducing the incidence of articular step-off > 1 mm.
• Articular step-off > 1 mm is a negative prognostic factor for functional outcomes in ankle fractures.