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Safety of the modified posteromedial approach in complex ankle fractures: Comparative analysis versus posterolateral
Julieta Porta1, Ignacio Toledo1, Martín Mangupli1
1Sanatorio Allende. Ciudad de Córdoba, Argentina.
Introduction:
The aim of the study was to evaluate the safety of the modified posteromedial approach (MfPM) in the surgical management of complex ankle fractures in terms of local complications.
Methods:
Retrospective multicenter review of a series of malleolar fractures surgically treated by posterior ankle approaches between 2016 and 2022. Two approaches were used. In the MfPM group patients were placed in a prone position and the incision was made 1 cm medially to the Achilles tendon. In the posterolateral access (PL) group patients were placed in a prone or lateral decubitus position and the incision was made between the lateral malleolus and the Achilles tendon. Complications evaluated were divided into wound complications, infections, neuritis, vascular alterations and others.
Results:
81 ankle fractures with a posterior malleolar fragment treated by open reduction and internal fixation were identified. 20 cases were approached through the MfPM approach and 61 through the PL access. The mean follow up was 18.60 months (range 4-78 months). In the MfPM group the local complication rate was 10% (2/10 patients), both corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. In the PL group a complication rate of 8,19% (5/61 patients) was found, all of them corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. There were no significant differences between the two approaches regarding postoperative local complications (z score 0.249 - P: 0.803).
Conclusion:
The MfPM approach is safe and may become as readily used as the PL due to the low incidence of postoperative local complications, especially in fractures with a large fragment and posteromedial extension in which greater access to the posterior pilon can facilitate instrumentation for anatomic reduction and fixation.
Insights
The modified posteromedial (MfPM) approach for complex ankle fractures shows a low complication rate, similar to the posterolateral (PL) approach. This MfPM technique is safe for surgical management of posterior malleolar fractures.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Surgical Approaches
Background:
- Complex ankle fractures often involve posterior malleolar fragments requiring surgical intervention.
- Evaluating the safety of surgical approaches is crucial for patient outcomes.
- The modified posteromedial (MfPM) approach is a technique for managing these fractures.
Purpose of the Study:
- To assess the safety of the modified posteromedial (MfPM) approach for complex ankle fractures.
- To compare local complication rates between the MfPM and posterolateral (PL) approaches.
Main Methods:
- Retrospective multicenter review of malleolar fractures treated between 2016-2022.
- Comparison of MfPM (n=20) and PL (n=61) posterior ankle surgical approaches.
- Evaluation of wound complications, infections, neuritis, and vascular alterations.
Main Results:
- Both MfPM and PL approaches had low rates of minor, non-surgical wound complications (10% vs. 8.19%).
- No significant differences in local complication rates were observed between the MfPM and PL groups (P=0.803).
- No infections, neuritis, or vascular complications were reported for either approach.
Conclusions:
- The modified posteromedial (MfPM) approach demonstrates safety comparable to the posterolateral (PL) approach.
- MfPM may be widely adopted due to its low complication incidence.
- MfPM offers excellent access for fixation of complex posterior malleolar fractures.
