Prospective analysis of clinico-radiological outcome of direct internal fixation of posterior malleolus in trimalleolar ankle fractures through posterolateral approach in prone position

Vol 35 | Issue 1 | Jan-April 2020 | page: 12-16 | Ravi Garg, Rohit Nath, Tushar Chaurasia, Devendra Kumar


Authors: Ravi Garg [1], Rohit Nath [1], Tushar Chaurasia [1], Devendra Kumar [1]

¹Department of Orthopaedic Surgery, GSVM Medical College & LLR Hospital Kanpur, Uttarpradesh, India,

Address of Correspondence:
Dr. Rohit Nath,
GSVM Medical College & LLR Hospital Kanpur, Uttarpradesh, India.
E-mail: nath.ortho@gmail.com


Objectives: This prospective study has been done to evaluate the clinical and radiological outcome of open reduction and direct internal fixation of posterior malleolus in trimalleolar ankle fracture through posterolateral approach in prone position.

Methods: This study is a prospective study of 12 cases of trimalleolar ankle fracture with posterior malleolus fracture treated with open reduction and direct internal fixation technique through posterolateral approach, admitted in the department of orthopaedics, L.L.R. Hospital, Kanpur from June 2017 to June 2019. All cases of posterior malleolus fracture were directly fixed with antiglide/buttress plate in prone position. All patients were assessed using American Orthopedic Foot and Ankle Society (AOFAS) score clinically and post traumatic arthritic score radiologically. Ankle joint mobility was also compared with unaffected side.

Results: Mean follow-up period was 21 months (range: 18-24 months). There were 8 male patients and 4 female patients between 20 and 65 years of age (mean: 44 years). Average time to surgery was 7.5 days (4-21days). According to AOFAS assessment, result was excellent in 8 patients and good in 4 patients. When compared with uninjured side, there was no significant difference in plantar flexion of ankle (p=0.325) but there was significant difference in dorsiflexion of ankle joint (p<0.001).

Conclusion: Open reduction and direct internal fixation of small posterior malleolus provides satisfactory clinical and functional outcomes and facilitates rehabilitation by creating more stable construction. Posterolateral approach to ankle gives adequate access to the posterior malleolus allowing its anatomical reduction and stable fixation to maintain articular congruency without any step.

Keywords: Ankle fracture, Posterior malleolus, Trimalleolar fracture, Post traumatic arthritic score, AOFAS score.


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How to Cite this Article: Garg R, Nath R, Chaurasia T, Kumar D| Prospective analysis of clinicoradiological outcome of direct internal Fixation of posterior malleolus in
trimalleolar ankle fractures through posterolateral approach in prone position | Journal of Bone and Joint Diseases Jan-April 2020; 35(1):12- 16.


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