Retrospective cohort study of operatively treated ankle fractures involving the posterior malleolus. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: McHale, Stephen; Williams, Mark; Ball, Thomas
• Is Part Of: Foot and ankle surgery. Volume 26:Issue 2(2020)
• Page Start: 138
• Page End: 145
• Publication Date: 2020-02
• Subjects: Posterior malleolus -- Ankle -- Fracture -- Internal fixation; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Ankle -- surgery -- Periodicals; Foot -- surgery -- Periodicals; Ankle -- Surgery; Foot -- Surgery; Periodicals; Electronic journals; 617.58
• DOI: 10.1016/j.fas.2019.01.003
• Languages: English
• ISSNs: 1268-7731

Abstract

Highlights: Direct posterior fixation improves reduction of posterior malleolus fractures. Posterior malleolus fractures <10% do not require direct fixation. Posterior subluxation is a prognostically poor sign. Direct fixation is recommended for posterior malleolus fractures >10%. Abstract: Background: Direct fixation of the posterior malleolus through a posterolateral approach is increasing in popularity. However, data is limited, and no studies have stratified results by posterior malleolus size. Methods: A retrospective cohort study of patients with posterior malleolus (PM) fractures undergoing internal fixation over an 18-month period was conducted. Radiographic and patient reported outcomes measures (PROMs) were assessed. 75 patients were included, and 31 returned Manchester-Oxford Foot and Ankle (MOXFQ), EQ-5D-3 L, 5-point Likert satisfaction questionnaires. Mean age was 56.2 years, 68% were female, mean ASA was 1.72, 6.7% were diabetic, and average surgical time was 75.7 min (±40.9). Results: Overall, the MOXFQ summary score was 26.9 (±25.8), with the pain domain showing the most severe score 32.4 (±24.0). The EQ-5D VAS index was 0.75 (±0.24). Larger PM size was associated with more anatomical reduction (58.8%, n = 20 of <10% vs. 90.9%, n = 10 of >30%) and larger sized fragments were more likely to be fixed posteriorly. Best PROMs were observed in PM fragments <10%, and the worst in fragments 10-20%. A tendency towards more secondary surgery was observed with posterior subluxation 21.9% (n = 7) vs. 7.0% (n = 3) (p = 0.06). Conclusions: Patients with fragments >10% have an intra-articular injury. We recommend direct anatomic reduction and rigid internal fixation. Level of evidence: Level III, retrospective comparative study.