J Korean Orthop Assoc.  2009 Aug;44(4):422-428.

Treatment of the Posterior Malleolar Fragment of Trimalleolar Fracture Using Posterolateral Approach: Preliminary Report

• Lee JY
• Ha SH
• Noh KH
• Lee SJ

Abstract

PURPOSE
We wanted to evaluate the effectiveness of posterolateral approach for open reduction and internal fixation of posterior malleolar fragment with trimalleolar fracture of ankle joint. MATERIALS AND METHODS: There were 27 cases of trimalleolar fracture in our hospital from Jan. 2005 to Dec. 2007. We investigated 10 patients who underwent operation with the posterolateral approach. The mean follow up period was 20 (6-36) months. Preoperative posterior malleolar fragment involved above 25% of articular surface in 10 cases and displaced more than 2 mm in 4 cases. We analyzed the radiologic type of posterior malleolar fragments and complications, and evaluated the AOFAS score. RESULTS: All cases showed primary union mean 11.8 (8-14) weeks. The complication focal skin necrosis in one case and all patients showed excellent AOFAS score. CONCLUSION: The posterolateral approach may be a useful for open reduction and internal fixation of posterior malleolar fragment with trimalleolar fracture, especially simultaneous management of lateral malleolar fracture.

Keyword

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

MeSH Terms

Ankle Joint
Follow-Up Studies
Humans
Necrosis
Skin

Figure

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  Fig. 1 Posterolateral approach. (A) The longitudinal incision is placed just medial to the posterior border of the fibula. (B) Retracting the peroneal tendons medially gives access to the posterior aspect of the lateral malleolus. (C) View of the posterior fragment in the interval between the peroneal tendons and the flexor hallucis longus. (D) Posterior fragment was reduced and fixed with 1 or 2 of 4.0 mm cannulated screw.

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  Fig. 2 Transverse computed tomographic scan at the level of the tibial plafond showing posterolateral fragment of the posterior malleolus. We measured the area of the posterior malleolar fragment and the remaining cross-sectional area of the tibia.

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  Fig. 3 (A, B) Preoperative anteroposterior and lateral radiograph of the left ankle of a sixty-four-year-old man who vehicle accident, revealing an supination-external rotation injury and Weber B trimalleolar fracture with posterior malleolar fragment of 32% joint surface involved. He has a osteoporosis of T-score -3.8. (C, D) There is postoperative radiograph. (E, F) Radiograph made three months postoperatively, showing complete bony union.

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  Fig. 4 (A, B) Preoperative anteroposterior and lateral radiograph of the left ankle of a sixty-one-year-old man who slip down, revealing an supination-external rotation injury and Weber B trimalleolar fracture with posterior malleolar fragment of 25% joint surface involved. (C, D) Preoperative CT of the sagittal and axial view. It has posterolateral fragment. (E) There is postoperative radiograph. (F, G) Radiograph made six months postoperatively showing complete bone union. (H, I) Normal ankle joint motion of twelve months postoperatively.

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