Incidence of early complications in the posterolateral approach to posterior malleolus fractures

Abstract

Introduction: To ascertain the incidence of early complications in the posterolateral approach to open reduction and internal fixation of posterior malleolar fractures and identify possible risk factors related to occurrence of these complications. Methods: Retrospective study carried out in three tertiary hospitals. Patients who underwent open reduction and internal fixation of posterior malleolus fractures via the posterolateral route were divided into two groups: with versus without delayed postoperative healing. To assess risk and protective factors for the outcome of delayed healing, we evaluated the time between trauma and surgery, whether the patient had a fracture-dislocation of the ankle, and whether external fixation was performed before surgery. We also evaluated whether improvement in operative technique led to a reduction in complication rates. Results: A total of 43 individuals who underwent surgical correction of posterior malleolus fractures via the posterolateral route between 2013 and 2018 were included. Of these, 19 (44.2%) had skin complications that led to delayed healing. Skin complications occurred more frequently at the beginning of the learning curve of the surgeons involved; the incidence up to the year 2016 was 56.3%, decreasing significantly to 37% from 2017 onward. Conclusion: Patients who undergo open reduction and internal fixation of posterior malleolus fractures via the posterolateral route at the beginning of the learning curve are a greater risk of developing skin complications, demonstrating the importance of this approach being restricted to more experienced surgeons. Level of Evidence III; Prognostic Studies; Retrospective Study.

The 2-Window Posterolateral vs Single-Window Approach for Ankle Fracture Fixation

“…A recent study by Tavares et al also explored wound complications among posterior malleolus fractures surgically treated in the posterolateral approach through a single window. 7 Their wound complication rate of 44.2% is higher than our findings and that of Little et al 7,16 In surgically treated geriatric ankle fractures, Aigner et al 1 had wound complications in just 9.7% of cases, making our 12.0% finding relatively high despite being younger with an average age of 49.3 years.…”

“…Still, the high rate found by Tavares implies that the single-window approach is also susceptible to similar issues. 7…”

Complications following surgical treatment of posterior malleolar fractures: an analysis of 300 cases

“…The treatment of ankle fractures involving the PM has undergone considerable changes over the past decade [4][5][6][7][8][9][10][11][12][13]. The aim of our study was to identify risk factors for complications following surgical treatment in a sizeable number of patients.…”

“…On the other hand, Pinho-Tavares et al [ 13 ] reported 44% (19/43) delayed wound healing with the posterolateral approach and referred to a considerable learning curve. Mertens et al [ 12 ] saw a hallux flexion deficit in 30% and sural nerve lesions in even 38% of 50 patients treated via a posterolateral approach.…”

“…With an individualized approach to the fracture morphology as assessed with preoperative computed tomography (CT) scanning, the historically poor outcomes of trimalleolar ankle fractures could be improved substantially [7][8][9][10]. However, although the indications to surgery and techniques of reduction and fixation have been refined, there is still controversy with respect to the individual approach and concerns have been raised about possible complications with the increased use of posterior approaches [11][12][13]. Several studies have demonstrated that complications have a negative impact on outcome of ankle fracture treatment [12,[14][15][16].…”