Clinical Outcome Of Fixation Of Posterior Malleolus Fragment In Trimalleolar Ankle Fracture

Abstract

Background: Trimalleolar ankle fractures, involving the lateral, medial, and posterior malleoli, are complex injuries that significantly impact joint stability and long-term function. Fixation of the posterior malleolus fragment has emerged as an important consideration in optimizing surgical outcomes. Aim of the study: To evaluate the clinical and functional outcomes of posterior malleolus fixation in patients with trimalleolar ankle fractures. Methods: This retrospective observational study included 85 patients with radiographically confirmed trimalleolar fractures who underwent posterior malleolus fixation using either posterior-to-anterior screws or plate fixation. Functional recovery was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at preoperative and postoperative intervals (6 weeks, 3 months, 6 months, and 12 months). Complications were also documented. Result: The mean age of the study population was 43.2 ± 11.5 years, with 60% males. Posterior-to-anterior screw fixation was used in 70% of cases, and plate fixation in 30%. At 12 months, the mean AOFAS score improved from 42.6 ± 8.3 preoperatively to 85.2 ± 7.4 (p < 0.001). Complication rates were low, with infection (9.4%) and joint stiffness (8.2%) being the most common. Radiographic assessment revealed satisfactory alignment in the majority of cases, particularly with combined fixation techniques. Conclusion: Fixation of the posterior malleolus fragment in trimalleolar ankle fractures results in significant functional improvement and high rates of satisfactory alignment, with low complication rates. These findings support the importance of posterior fragment fixation in restoring joint stability and improving clinical outcomes.