Trans-Syndesmotic Versus Posterior Malleolar Fixation Techniques for Trimalleolar Ankle Fractures: A Comparative Study | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 43, Volume 97, Issue 1, October 2024, Page 3716-3720 PDF (231.37 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2024.387347 | ||||
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| Abstract | ||||
| Background: Extra-articular distal tibial fractures, often referred to as posterior malleolar fractures, have been a focus of ankle injury management. While direct syndesmotic fixation is considered the gold standard, the effectiveness of internal fixation and reduction of posterior malleolar fractures in improving syndesmotic reduction remains unclear. Objective: This study aims to compare the outcomes of two approaches: transsyndesmotic screw fixation without posterior malleolus fixation versus direct internal fixation of posterior malleolar fractures, regardless of fragment size, in managing trimalleolar ankle fractures. Patients and Methods: This randomized, prospective study included 30 participants with recent trimalleolar fractures, treated at Shebin El-Kom Teaching Hospital between December 2019 and June 2021. Participants were divided into two groups: Group A (n = 15) received transsyndesmotic screw fixation without direct fixation of posterior malleolar fragments, and Group B (n = 15) underwent direct fixation of the posterior malleolar fracture using screws or plates. Follow-up continued for six months post-operation. Results: Group A achieved shorter times to complete union and full ambulation compared to Group B (P < 0.001 and P = 0.002, respectively). While VAS pain scores were comparable between groups, Group B demonstrated better AOFAS scores (P = 0.016). Some cases in Group A required additional syndesmotic fixation, highlighting challenges in achieving optimal outcomes without posterior malleolar fixation. Conclusions: Direct fixation of posterior malleolar fractures provided better functional outcomes, as reflected by higher AOFAS scores, supporting the approach of fixing all posterior malleolar fractures except avulsion fractures, regardless of fragment size. | ||||
| Keywords | ||||
| Posterior Malleolar Fixation; Trans-Syndesmotic; Trimalleolar Ankle Fractures | ||||
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