Trimalleolar fractures of the ankle. An end result study

Fifty-one trimalleolar ankle fractures in 50 patients were evaluated subjectively, objectively, and roentgenographically at an average of 42 months following injury. Anatomic reduction of the posterior marginal fragment was achieved in 6 of 7 ankles treated by open reduction and internal fixation of the fragment. Anatomic reduction of the posterior marginal fragment was achieved in three of 44 ankles treated by closed reduction and in none of the eight with large fragments. End results rated as fair or poor occurred more frequently among those patients with large posterior lip fragments and those with residual subluxation of the talus. The incidence of moderate or marked post-traumatic arthritis was greatly increased in those patients with residual subluxation of the talus. Post-traumatic arthritis was present in 11 of 12 patients with moderate or severe pain and in 11 of 17 with moderate or marked restriction of motion. Failure to reduce a posterior lip fracture involving less than 25 per cent of the tibial articular surface did not affect the overall end result significantly. In ankles with a posterior marginal fragment involving 25 per cent or more of the articular surface, open treatment was associated with better subjective, objective, and roentgenographic end results than closed treatment.