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Posterolateral fixation of posterior malleolar fractures: Reduction quality and mid-term outcomes in complex ankle injuries.
СтатьяНазвание и аннотация: Перевод в очереди
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Saran J S R G, S M Ajoy, P Rahul, Singh Inderjit, Galagali Dev Anand, Isaac Natasha Varghese
Аннотация
BACKGROUND: Tri- and quadri-malleolar ankle fractures with posterior malleolar (PM) involvement are highly unstable injuries. This study evaluated radiological reduction quality and mid-term functional outcomes following standardized posterolateral PM fixation.
METHODS: This ambispective Level III cohort study included 45 adults with traumatic tri- or quadri-malleolar ankle fractures treated with posterolateral PM open reduction and internal fixation at a single tertiary center. Primary outcomes were PM articular step-off reduction and functional scores (OMAS, FFI, VAS pain, Modified Coughlin Score) assessed at 6 weeks, 6 months and 24 months, with minimal clinically important difference (MCID) analysis for OMAS.
RESULTS: Mean preoperative step-off on sagittal CT was 2.57 ± 0.55 mm, improving to 0.69 ± 0.29 mm postoperatively (73% correction, p < 0.001). Anatomical reduction (<1 mm) was achieved in 87% of cases. Functional outcomes improved progressively: OMAS increased from 42.6 ± 8.9 at 6 weeks to 88.7 ± 6.2 at 24 months (p < 0.001), with 89% achieving MCID (≥15 points). FFI decreased from 68.3 ± 12.1-12.8 ± 6.7 (p < 0.001) and VAS pain from 6.8 ± 1.3-0.9 ± 0.8 (p < 0.001). At final follow-up, 91% achieved excellent Modified Coughlin Scores.
CONCLUSION: Posterolateral fixation of posterior malleolar fractures achieved anatomical reduction and excellent mid-term functional outcomes. Longitudinal improvements exceeded MCID thresholds, supporting morphology-guided surgical strategies in complex ankle injuries.
METHODS: This ambispective Level III cohort study included 45 adults with traumatic tri- or quadri-malleolar ankle fractures treated with posterolateral PM open reduction and internal fixation at a single tertiary center. Primary outcomes were PM articular step-off reduction and functional scores (OMAS, FFI, VAS pain, Modified Coughlin Score) assessed at 6 weeks, 6 months and 24 months, with minimal clinically important difference (MCID) analysis for OMAS.
RESULTS: Mean preoperative step-off on sagittal CT was 2.57 ± 0.55 mm, improving to 0.69 ± 0.29 mm postoperatively (73% correction, p < 0.001). Anatomical reduction (<1 mm) was achieved in 87% of cases. Functional outcomes improved progressively: OMAS increased from 42.6 ± 8.9 at 6 weeks to 88.7 ± 6.2 at 24 months (p < 0.001), with 89% achieving MCID (≥15 points). FFI decreased from 68.3 ± 12.1-12.8 ± 6.7 (p < 0.001) and VAS pain from 6.8 ± 1.3-0.9 ± 0.8 (p < 0.001). At final follow-up, 91% achieved excellent Modified Coughlin Scores.
CONCLUSION: Posterolateral fixation of posterior malleolar fractures achieved anatomical reduction and excellent mid-term functional outcomes. Longitudinal improvements exceeded MCID thresholds, supporting morphology-guided surgical strategies in complex ankle injuries.