Clinical Impact of Posterior Malleolus Fixation in Trimalleolar Ankle Fracture – A Retrospective Study

Aims and Objectives: The aim of our study is to evaluate the clinical, functional and radiological outcomes of the patients with the trimalleolar fracture that had posterior malleolus fixation.

Study Design: Level 4, retrospective study.

Place and Duration of the Study: Dept. of Orthopaedics, Smt. NHL Medical College, Ahmedabad, Gujarat, India. Between Jan 2014 to Dec 2017.

Materials and Methods: A retrospective study was performed on 30 adult patients who sustained a trimalleolar ankle fracture in our hospital. Patients were selected according to inclusion and exclusion criteria and posterior malleolus was fixed using different modalities in those patients having joint incongruency or instability even after fixation of lateral malleolus fracture. Clinical, radiological and functional outcomes were evaluated using Olerud and Molander score of ankle fractures.

Results: Total 30 patients with a mean age of 48.03 years and mean follow-up of 16 months were operated for trimalleolar fracture. Posterior malleolus fixation was done with buttress plate in 8 patients and with cannulated cancellous screw in 22 patients. Out of 30 patients, according to Olerud and Molander score 14 patients showed an excellent result, 10 patients showed good results, 4 patients fair results and 2 patients showed poor results.

Conclusions: The anatomic reduction of the posterior malleolus is essential for maintaining the tibiotalar alignment and joint congruency, that is achieved by stable fixation of the posterior malleolus fragment regardless of size to improve post-operative function and quality of life.