Retrospective cohort study of operatively treated ankle fractures involving the posterior malleolus.


Department of Trauma and Orthopaedics, Torbay and South Devon NHS Foundation Trust, Torbay Hospital, Torquay, TQ2 7AA, UK. Electronic address: [Email]


BACKGROUND : Direct fixation of the posterior malleolus through a posterolateral approach is increasing in popularity. However, data is limited, and no studies have stratified results by posterior malleolus size.
METHODS : A retrospective cohort study of patients with posterior malleolus (PM) fractures undergoing internal fixation over an 18-month period was conducted. Radiographic and patient reported outcomes measures (PROMs) were assessed. 75 patients were included, and 31 returned Manchester-Oxford Foot and Ankle (MOXFQ), EQ-5D-3 L, 5-point Likert satisfaction questionnaires. Mean age was 56.2 years, 68% were female, mean ASA was 1.72, 6.7% were diabetic, and average surgical time was 75.7 min (±40.9).
RESULTS : Overall, the MOXFQ summary score was 26.9 (±25.8), with the pain domain showing the most severe score 32.4 (±24.0). The EQ-5D VAS index was 0.75 (±0.24). Larger PM size was associated with more anatomical reduction (58.8%, n = 20 of <10% vs. 90.9%, n = 10 of >30%) and larger sized fragments were more likely to be fixed posteriorly. Best PROMs were observed in PM fragments <10%, and the worst in fragments 10-20%. A tendency towards more secondary surgery was observed with posterior subluxation 21.9% (n = 7) vs. 7.0% (n = 3) (p = 0.06).
CONCLUSIONS : Patients with fragments >10% have an intra-articular injury. We recommend direct anatomic reduction and rigid internal fixation.
METHODS : Level III, retrospective comparative study.


Ankle,Fracture,Internal fixation,Posterior malleolus,