Approaches for surgical treatment of posterior malleolar fracture

Abstract

Objective To compare the approaches for surgical treatment of posterior malleolar fracture in terms of their effect on the fracture prognosis.Methods We analyzed retrospectively the 69 patients with posterior malleolar fracture who had been treated by surgery from July 2000 to June 2013.They were 24 males and 45 females,14 to 80 years of age (average,46.2 years).By AO classification,there were 8 cases of type 44A,49 cases of type 44B and 12 cases of type 44C.American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were compared between the 27 patients with ≥25％ fragments which were fixated from the anterior to the posterior and the 15 ones with ≥25％ fragments which were fixated from the posterior to the anterior,as well as between the 15 patients with ＜ 25％ fragments which were fixated from the anterior to the posterior and the 12 ones with ＜ 25％ fragments which were fixated from the posterior to the anterior.Results This cohort obtained follow-up from 12 to 126 months (average,52.0 months).When the fragments ≥25％,there was no significant difference in AOFAS or VAS score between those fixated from the anterior to the posterior (94.4 ± 5.0 and 0.2 ± 0.4 respectively) and those fixated from the posterior to the anterior (94.1 ±7.0 and 0.4 ±0.8 respectively) (P ＞ 0.05).When the fragments ＜ 25％,those fixated from the anterior to the posterior had a significantly lower AOFAS score (93.2 ± 5.4) than those fixated from the posterior to the anterior (98.3 ± 3.9) (P =0.009),but there was no significant difference in VAS score between the 2 groups (0.1 ± 0.4 versus 0) (P =0.058).Conclusions In the treatment of posterior malleolar fracture with a ≥ 25％ fragment,as the operative approaches may exert little impact on the fracture prognosis,the approach from anterior to posterior may be a priority choice due to its simplicity and smaller incision.When a posterior malleolar fragment is less than 25％,it may be better to choose the approach from posterior to anterior. Key words: Ankle; Fractures, bone; Prognosis; Approach for surgical treatment