Percutaneous anterior to posterior screw fixation via lateral malleolus incision window for Bartoníček-Rammelt type 4 posterior malleolus fractures.

INTRODUCTION

The presence of a posterior malleolar (PM) fragment has a negative prognostic impact in ankle fractures. Percutaneous anterior to posterior screw fixation has been advocated for the treatment of ankle fractures involving the posterior malleolus and satisfactory results were demonstrated in several studies. The aim of this retrospective study was to evaluate the clinical effect of percutaneous anterior to posterior screw fixation via lateral malleolus incision window approach (APSF-LMA) for the treatment of posterior malleolus fracture (PMF) and present outcomes of patients with type 4 of Bartoníček-Rammelt classification in comparison to using the dorsiflexion ankle anterior posterior screw fixation (APSF-DA) and posterior plate fixation through posterolateral approach (PPF-PLA).

METHODS

We retrospectively reviewed the clinical outcomes of 58 patients with ankle fractures involving Bartoníček-Rammelt type 4 PMF from January 2019 to December 2023. Comparisons were conducted between the groups regarding operative time, union time, the Olerud-Molander Ankle Score (OMAS), the EuroQol-5 Dimensions (EQ-5D), the American Orthopedic Foot and Ankle Society score (AOFAS), Kellgren-Lawrence (KL) osteoarthritis classification and clinical findings.

RESULTS

The demographic characteristics were comparable between the groups. Fewer operative time was performed in the APSF-LMA (79(75-84.5) mins) and APSF-DA (78(70-85) mins) groups than in the PPF-PLA group (105(98-112) mins; P < 0.0001). When compared with the other two approaches, the APSF-LMA approach was associated with higher AOFAS scores (P < 0.05) and lower grade of KL (P < 0.0001) at the last follow-up. No significant intergroup differences were detected in the incidence of complications (P > 0.999), OMAS scores (P = 0.921) and EQ-5D (P = 0.806). Radiological and clinical findings demonstrated that fixation of the distal fibula (P = 0.727), the time of bony union and postoperative angulation (P = 0.846) were similar between the groups.

CONCLUSIONS

The APSF-LMA approach can serve as a safe and effective option for posterior malleolus fractures, as it offers favorable outcomes in ankle operation time and ankle functional recovery in the early postoperative period and is equivalent to the other two approaches in terms of the incidence of complications, fracture healing and postoperative angulation for patients with posterior malleolus fractures.