The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons · 2025
Does patient position matter? Lateral-to-supine positioning offers surgical and clinical advantages in Trimalleolar ankle fracture fixation.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Kurk Muhammed Bilal, Albayrak Kutalmis, Pehlivanoglu Gokhan, Acidemir Ugur, Ezici Atakan, Dirvar Ferdi
Аннотация
BACKGROUND: Intraoperative patient positioning for trimalleolar ankle fracture fixation may affect surgical exposure, reduction quality, operative time, and complication rates.
PURPOSE: To compare the clinical, radiographic, and functional outcomes of trimalleolar ankle fracture fixation performed in the lateral-to-supine, prone-to-supine, and prone positions.
METHODS: Eighty-six patients who underwent open reduction and internal fixation for trimalleolar ankle fractures between 2018 and 2023 were retrospectively reviewed, with a minimum follow-up of 12 months. Patients were categorized according to intraoperative positioning: lateral-to-supine (n = 23), prone-to-supine (n = 28), and prone (n = 35). All procedures were performed by a single experienced orthopedic trauma surgeon using the same fixation system and standardized postoperative protocol. Demographic and perioperative variables, including age, sex, body mass index, smoking status, time to surgery, tourniquet and operative times, and number of fluoroscopic images, were recorded. Radiographic assessments included fibular shortening, medial and posterior step-off, medial clear space, and talar tilt. Complications such as infection, wound problems, implant irritation retained intraosseous hardware, sensory nerve injury, intra-articular screw penetration, nonunion, and reoperation were evaluated. Functional outcomes were assessed using the visual analog scale (VAS) for pain, ankle range of motion, and the American Orthopaedic Foot & Ankle Society (AOFAS) score.
RESULTS: Baseline characteristics, including age, BMI, smoking status, and injury laterality, were comparable among groups (all p > 0.05). The prone group required more fluoroscopy (p < 0.001), while the prone-to-supine group had the longest operative time (p < 0.001) and highest infection rate (p = 0.03). The prone group showed greater medial malleolar step-off ≥2 mm and screw joint penetration, resulting in higher revision rates (p = 0.03, 0.04). Postoperative pain scores were lowest in the lateral-to-supine group (p = 0.03).
CONCLUSION: The lateral-to-supine position provides safe, efficient, and reproducible access for trimalleolar ankle fracture fixation, with fewer complications, lower pain, and better radiographic alignment than prone and prone-to-supine positioning.
PURPOSE: To compare the clinical, radiographic, and functional outcomes of trimalleolar ankle fracture fixation performed in the lateral-to-supine, prone-to-supine, and prone positions.
METHODS: Eighty-six patients who underwent open reduction and internal fixation for trimalleolar ankle fractures between 2018 and 2023 were retrospectively reviewed, with a minimum follow-up of 12 months. Patients were categorized according to intraoperative positioning: lateral-to-supine (n = 23), prone-to-supine (n = 28), and prone (n = 35). All procedures were performed by a single experienced orthopedic trauma surgeon using the same fixation system and standardized postoperative protocol. Demographic and perioperative variables, including age, sex, body mass index, smoking status, time to surgery, tourniquet and operative times, and number of fluoroscopic images, were recorded. Radiographic assessments included fibular shortening, medial and posterior step-off, medial clear space, and talar tilt. Complications such as infection, wound problems, implant irritation retained intraosseous hardware, sensory nerve injury, intra-articular screw penetration, nonunion, and reoperation were evaluated. Functional outcomes were assessed using the visual analog scale (VAS) for pain, ankle range of motion, and the American Orthopaedic Foot & Ankle Society (AOFAS) score.
RESULTS: Baseline characteristics, including age, BMI, smoking status, and injury laterality, were comparable among groups (all p > 0.05). The prone group required more fluoroscopy (p < 0.001), while the prone-to-supine group had the longest operative time (p < 0.001) and highest infection rate (p = 0.03). The prone group showed greater medial malleolar step-off ≥2 mm and screw joint penetration, resulting in higher revision rates (p = 0.03, 0.04). Postoperative pain scores were lowest in the lateral-to-supine group (p = 0.03).
CONCLUSION: The lateral-to-supine position provides safe, efficient, and reproducible access for trimalleolar ankle fracture fixation, with fewer complications, lower pain, and better radiographic alignment than prone and prone-to-supine positioning.