Complications Following Treatment of Supination External Rotation Ankle Fractures Through the Posterolateral Approach

Abstract

The posterolateral approach to the ankle was a valuable approach for SER ankle fractures. This series demonstrated many key aspects of this approach including access to the apex of the fibula fracture for posterior antiglide plating, access to the posterior malleolus for fixation, access to the posterior inferior tibiofibular ligament for repair, minimal major wound complications, good functional outcomes, and minimal need for reoperation.

Single Oblique Posterolateral Approach for Open Reduction and Internal Fixation of Posterior Malleolar Fractures With an Associated Lateral Malleolar Fracture

“…No deep infections requiring surgical intervention developed. We believe the postoperative wound complication prevalence was lower in our study than in the study by Little et al (20). Also, the incisions used on our study were more oblique, which required a lower tensile force to the skin and allowed more flexible operative visualization anteroposteriorly, in addition to a remarkably shorter incision length.…”

“…5). Little et al (20) reported that 9.8% of patients developed skin edge necrosis and 3.8% required surgery to eradicate an infection after a posterolateral approach was used in 112 patients with a supination-external rotation type ankle fracture. In our study, 2 patients (4%) developed some degree of skin edge necrosis but healed with local wound care.…”

Anatomic Fixation of Supination External Rotation Type IV Equivalent Ankle Fractures

“…Patients in each group underwent open reduction internal fixation through the posterolateral approach as previously described. 4 Patients were positioned prone, and the interval between the peroneals and flexor hallucis longus were used for fibular fixation. Synthes (Paoli, PA) 2.4-mm or 2.7-mm reconstruction plates were placed in an antiglide fashion on the posterior aspect of the fibula after initial reduction.…”

“…[1][2][3][4][5][6][7] Historically, fixation strategies have been directed at the restoration of the bony anatomy while ignoring the impact of anatomic repair of the associated ligamentous injuries. Deltoid or posterior inferior tibiofibular ligament (PITFL) repair has been considered superfluous after lateral malleolus fixation and transsyndesmotic screw placement when indicated in supination external rotation type IV equivalent (SER IV E) injuries.…”

The epidemiology of reoperations for orthopaedic trauma

“…Little et al reported reoperation rates of 12.5% following ORIF of supination external rotation injuries of the ankle in 112 patients, with 7% undergoing removal of symptomatic metalwork, 1.8% requiring removal for infections and 0.9% requiring plastic surgery for wound complications. 11 This need for reoperations was considered by Little et al to be minimal. However, we feel the relatively high number of reoperations observed in the present study highlights the importance of respecting an injury that has a broad spectrum of difficulty and technical requirements.…”