2021 ISAKOS Biennial Congress ePoster
Treatment of trimalleolar fractures: Is osteosynthesis needed in posterior malleolar fractures measuring less than 25% of the joint surface?
Hugo Marques Ribeiro, MD, Lisboa PORTUGAL
António Mendes Serrano, MD, Lisboa PORTUGAL
João Silva, MD, Lisboa PORTUGAL
Raquel Teixeira, Dra., Lisboa PORTUGAL
Isabel Rosa, Dra., Lisboa PORTUGAL
Hospital São Francisco Xavier, Lisboa, PORTUGAL
FDA Status Not Applicable
Summary
This is the first study to evaluate the clinical outcomes after trimalleolar ankle fractures osteosynthesis with a posterior malleolus fracture involving < 25% of the articular surface.
ePosters will be available shortly before Congress
Abstract
Background
Most authors agree that posterior malleolus fragments worsen patient clinical outcomes. There are continuing debates as to whether small PMFs ( < 25% of joint surface affected) should be anatomically reduced and fixed. In the past, internal fixation of tibial posterior malleolus fragments was performed in cases wherein > 25% of the articular surface was involved for only 2 reasons: smaller fragments did not alter joint biomechanics and step defects < 2 mm did not affect the functional results. However, many studies have confirmed the role of the posterior malleolus as an important contributor to the alignment and stability of the ankle mortise and syndesmosis.
Objectives: This study aimed to evaluate the clinical outcomes after trimalleolar ankle fractures with a posterior malleolus fracture involving < 25% of the articular surface.
Study Design & Methods: Retrospective comparative study. Patients with trimalleolar ankle fracture who underwent surgery between January 2011 and January 2018 were identified within the department´s fracture database. General demographics, treatment details and fracture specific details (CT-scans) were assessed. Patients were grouped per the posterior malleolus fragment treatment: osteosynthesis (group 1) and non-osteosynthesis (group 2).
Results
64 patients, 58.6 ±17.8 years (range: 23–75), 68.8% female were eligible and follow up time was 43.1 ±22.2 (range 24–96) months. The mean size of the posterior malleolus fragment was 14.7 ±5.3% (range: 5–24). Posterior malleolus fragment treatment distribution: osteosynthesis (group 1) 31.2% and non- osteosynthesis (group 2) 68.8%. Group 1 showed significantly better clinical outcomes (p < 0.05), AOOS (93.9 ±5.79 (range: 73–99), AOFAS (91.5 ±6.22(range: 72–100) and VAS (0.8 ±1.22 (range: 0–5) compared to Group 2, AOOS (84.25 ±8.34 (range: 63–100); AOFAS (84.75 ±8.05 (range: 58–100) and VAS (1.7 ±1.38 (range: 0–6). The EQ-5D score was better in group 1 (1.08 ±0.27 (range: 1–2.2) compared to group 2 (1.27 ±0.27 (range: 1–2.4) but with no statistical significance ( p > 0.15).
Conclusions
Posterior malleolus fragments ( < 25% of the articular surface) have significantly better clinical outcomes following osteosynthesis.