J Korean Fract Soc.  2011 Oct;24(4):328-334.

Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results

• Lee GC
• Lee JY
• Ha SH
• You JW
• Lee SH
• Sohn HM
• Nam KY
• Seo KH

Abstract

PURPOSE
To analyze the long term follow up results of treatment with posterolateral approach and to investigate its usefulness in the patients of trimalleolar fracture with posterior fragment which is above 25% of articular involvement.
MATERIALS AND METHODS
There were 34 cases of trimalleolar fracture in our hospital from May 2004 to April 2008. We investigated 20 patients who underwent operation with the posterolateral approach and over-2 years follow up cases. The mean follow up period was 34 (24~58) months. Preoperative posterior malleolar fragment involved above 25% of articular surface in all cases and displaced more than 2 mm in 11 cases. We analyzed the radiologic type of posterior malleolar fragments and evaluated the function and pain through AOFAS score and complications.
RESULTS
All cases showed primary union at mean 13.1 weeks. The complications are that partial ankylosis result of soft tissue contracture is seen in 2 cases (10%) and post-traumatic arthritis is seen in 1 cases (5%) and 17 cases (85%) of all patients are showed excellent AOFAS score.
CONCLUSION
The posterolateral approach is a valuable method because that it enables us to easily reduction and internal fixation of the posterior malleolus and lateral malleolus at one time and the results are satisfied for a long time follow up.

Keyword

Ankle joint; Trimalleolar fracture; Posterior malleolar fragment; Posterolateral approach

MeSH Terms

Ankle Joint
Ankylosis
Arthritis
Contracture
Follow-Up Studies
Humans

Figure

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  Fig. 1 Posterolateral approach. (A) Longitudinal skin incision is placed just medial to the posterior border of the fibula. (B) Retracting the peroneal tendons medially and fibular fracture is fixed with antiglide plate. (C) Posterior fragment is exposured between peroneal tendons and the flexor hallucis longus tendon, and is fixed with 4.0 cannulated screw after reduction.

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  Fig. 2 (A, B) Anteroposterior and lateral radiographs showing a displaced trimalleolar fracture. (C, D) Preoperative CT of the sagittal and axial view. It has posterolateral fragment. (E~G) There is postoperative radiograph.

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  Fig. 3 (A, B) Preoperative radiograph showing a displaced trimalleoar fracture. (C, D) 6 months later postoperative radiograph showing a Post-traumatic OA (grade 4). (E, F) Plate and screw is removed.

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