J Korean Fract Soc.  2009 Jan;22(1):19-23. 10.12671/jkfs.2009.22.1.19.

The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique

• Lee JS
• Lee HJ
• Yoo JH
• Kim HC

• KMID: 2183883
• DOI: http://doi.org/10.12671/jkfs.2009.22.1.19

Abstract

PURPOSE
To evaluate the usefullness of the percutaneous reduction technique with K-wire that could reduce the displaced posterolateral fracture fragment which persisted even after an anatomical reduction of the lateral malleolar fracture.
MATERIALS AND METHODS
From January 2004 to December 2006, we reviewed 72 patients who underwent surgical treatment for their trimalleolar fractures. We estimated the clinical and radiological results of 5 cases treated by percutaneous reduction technique with K-wire when more than the distal tibial articular step-off was left after reduction of the lateral malleolar fracture. The method of reduction starts with temporary fixation of lateral malleolar fracture followed by checking ankle radiographic image to confirm the accuracy of reduction. In case of incomplete reduction of the posterior fragment, a K-wire is inserted into the posterior fragment and pushed downward to the ankle joint level, and then lag screws were inserted.
RESULTS
The average articular involvement by the posterolateral fracture fragment was 30.2%. The average step-off after reduction of the lateral malleolar fracture was 3.7 mm. At the final follow up, step-off was less than 2 mm in all cases. In clinical results by Baird and Jackson score, 3 out of 5 cases were excellent, other 2 were good.
CONCLUSION
Percutaneous reduction technique for posterolateral fragment using the K-wire is relatively easy. This technique may be useful when the posterolateral fragment is large (more the 25% of articular surface) and not severely comminuted.

Keyword

Percutaneous reduction; Trimalleolar fracture; Posterior malleolar fracture

MeSH Terms

Animals
Ankle
Ankle Joint
Follow-Up Studies
Humans

Figure

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  Fig. 1 CT image shows large non-comminuted posterior malleolar fragment.

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  Fig. 2 Percutaneous K-wire location is confirmed by C-arm image. Post-reduction image (A) is taken by C-arm image intensifier and the schematic image is shown (B).

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  Fig. 3 Additional K-wire is inserted to maintain the reduction status.

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  Fig. 4 A guide wire is inserted from anteromedial to posterior direction under the C-arm monitoring.

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  Fig. 5 This photo shows completion of definite fixation. The medial malleolar fracture was reduced by non absorbable suture.

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