Posterior and traditional approaches had similar outcomes in posterior malleolus fractures
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Patients with ankle fractures involving the posterior malleolus treated with a posterior approach had similar outcomes to those treated with a traditional approach, according to published results.
Researchers categorized patients with ankle fractures involving posterior malleolus fragments into groups based on whether they were treated with a posterior approach or a traditional approach and performed a one-to-one matching of patients from each group based on the size of the posterior malleolus fragments. Researchers reviewed patient charts and performed outcome evaluations clinically, radiographically and by patient-reported outcome measures, including the self-reported foot and ankle score, RAND-36, VAS for pain and VAS for satisfaction.
Among 43 matched patients in each group, results showed both groups had a median posterior malleolus fragment size of 17%, as well as similar results in terms of patient-reported outcome measures. Researchers found 98% of patients in the posterior approach group and 16% of patients in the traditional approach group underwent fixation of the posterior malleolus fragments. Researchers noted 56% of patients in the posterior approach group had temporary external fixation vs. 12% in the traditional approach group. Results showed patients in the posterior approach group less frequently had syndesmotic fixation and had less mechanical irritation and hardware removal. However, researchers found patients in the posterior approach group had more noninfectious skin problems vs. the traditional approach group. The posterior approach group also had a longer median time from injury to definitive surgery and median length of stay, according to results.
“Although the need for syndesmotic fixation was reduced with the change to a posterior approach, patients waited longer until definitive surgery, had longer length of stay, more frequently developed severe posttraumatic osteoarthritis and more frequently reported noninfectious skin problems,” the authors wrote. “Although limitations apply, these results challenge the view that all posterior malleolus fractures need fixation.”
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