Modified 3D-Controlled Inside-Out Compression Screw Fixation Technique in Posterior Malleolar Fractures: A Narrative...

Area of Science:

• Orthopedic Surgery
• Traumatology
• Ankle Biomechanics

Background:

• Posterior malleolus fractures significantly impact ankle stability and functional outcomes in complex injuries.
• Posterolateral rim fragments are crucial as they involve the posterior syndesmotic complex.

Purpose of the Study:

• To describe a modified minimally invasive inside-out fixation technique for Bartoníček type 2 posterior malleolar fractures.
• To evaluate the efficacy of this technique in restoring syndesmotic integrity and ankle stability.

Main Methods:

• A modified minimally invasive inside-out fixation using a posterior-to-anterior headless compression screw.
• Intraoperative three-dimensional imaging for precise anatomical reduction.
• Fixation of medial malleolus and distal fibula with standard orthopedic implants.

Main Results:

• Successful anatomical reduction and stable fixation of the posterior malleolar fragment.
• Restoration of the fibular incisura, posterior tibiotalar stability, and syndesmotic integrity.
• Demonstrated feasibility in a geriatric patient with a trimalleolar fracture.

Conclusions:

• The described technique offers biomechanical advantages of direct fixation with minimal soft-tissue disruption.
• This approach provides a stable and reliable construct for complex ankle fractures, particularly in geriatric or soft-tissue compromised patients.