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

Choi, Jun Young; Kim, Ji Hoon; Ko, Hyeong Tak; Suh, Jin Soo

doi:10.1053/j.jfas.2014.09.043

Cited by 52 publications

(54 citation statements)

References 16 publications

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“…It was reported that 83% of posterior malleolar fractures were fixed using anterior-to-posterior screws with indirect reduction technique. [8] Some authors believed that indirect reduction and percutaneous screw fixation were less traumatic, while posterolateral approach might increase the risk of posterior scarring, tendon impingement, and sural nerve injury [27, 28]. Provided that PITL was intact, the posterolateral fragment could be easily reduced using ligamentotaxis following anatomical reduction of the fibula [1].…”

Section: Discussionmentioning

confidence: 99%

“…In literature, very different results were reported considering the functional outcome of PMF following surgical reduction and fixation. Choi reported a mean AOFAS score of 90.6 following ORIF of PMF through a modified posterolateral approach [28]. Erdem achieved a mean AOFAS score of 94.1 of PMF following posterior-to-anterior lag screw fixation or buttress plate fixation through posterolateral approach [30].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis.MethodsPatients with a PMF involving over 25% of the articular surface were recruited and assigned to the direct reduction (DR) group or the indirect reduction (IR) group. Following reduction and fixation of the fracture, the quality of fracture reduction was evaluated in post-operative CT images. Clinical and radiological follow-ups were performed at 6 weeks, 3 months, 6 months, 12 months, and then at 6 month-intervals postoperatively. Functional outcome (AOFAS score), ankle range of motion, and Visual Analog Scale (VAS) were evaluated at the last follow-up. Statistical differences were compared between the DR and IR groups considering the patient demographics, quality of fracture reduction, AOFAS score, and VAS.ResultsTotally 116 patients were included, wherein 64 cases were assigned to the DR group and 52 cases were assigned to the IR group. The quality of fracture reduction was significant higher in the DR group (P = 0.038). In the patients who completed a minimum of 12 months’ follow-up, a median AOFAS score of 87 was recorded in the DR group, which was significantly higher than that recorded in the IR group (a median score of 80). The ankle range of motion was slightly better in the DR group, with the mean dorsiflexion restriction recorded to be 5.2° and 6.1° in the DR and IR group respectively (P = 0.331). Similar VAS score was observed in the two groups (P = 0.419).ConclusionsThe direct reduction technique through a posterolateral approach provide better quality of fracture reduction and functional outcome in the management of PMF over 25% of articular surface, as compared with the indirect reduction technique using ligamentotaxis.Trial registration NCT02801474 (retrospectively registered, June 2016, ClinicalTrails.gov).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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“…Choi et al . described the single oblique posterolateral approach that was more closed with fibula than others and found that it had the potential to decrease the incidence of sural nerve injury because of the smaller incision size [ 30 ]. The fracture was openly reduced and fixed through a combined operative approach (posterolateral and posteromedial) when Wang et al .…”

Section: Techniquementioning

confidence: 99%

“…Choi et al . reported the surgery was complicated by skin necrosis around the incision in 2 (4%) patients and sural nerve damage in 2 (4%) patients [ 30 ]. Huang et al .…”

Section: Complicationmentioning

confidence: 99%

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Operative Treatment of Posterior Malleolar Fractures

Duan¹,

Kadakia²

2017

TOORTHJ

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Fractures of the posterior malleolus can occur in conjunction with fibular and medial malleolar fractures or in isolation. The indications for fixation of the posterior malleolus remain controversial except for the fragment sizes. A number of different surgical approaches and techniques for internal fixation of posterior malleolar fractures have been reported. Newer techniques such as direct exposure and plating of the posterior malleolus are chosen more frequently than traditional techniques of indirect reduction and percutaneous screw fixation. These attributes help to minimize the occurrence of postoperative complications.

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