Treatment of the Posterior Malleolar Fracture Using Posterior Approach

Hyun Wook Chung; Dong Hwan Kim; Si Hoon Yoo; Jin Soo Suh

doi:10.12671/jkfs.2010.23.1.50

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Chung, Kim, Yoo, and Suh: Treatment of the Posterior Malleolar Fracture Using Posterior Approach

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2010; 23(1): 50-56.

Published online: 31 January 2010

DOI: https://doi.org/10.12671/jkfs.2010.23.1.50

Treatment of the Posterior Malleolar Fracture Using Posterior Approach

Hyun Wook Chung, M.D., Dong Hwan Kim, M.D., Si Hoon Yoo, M.D., Jin Soo Suh, M.D.

Department of Orthopedic Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea.

Address reprint requests to: Jin Soo Suh, M.D. Department of Orthopedic Surgery, Inje University College of Medicine, Ilsan Paik Hospital, 2240, Daehwa-dong, Ilsan-seo-gu, Goyang 411-706, Korea. Tel: 82-31-910-7968, Fax: 82-31-910-7967, sjs0506@paik.ac.kr

Received 7 June 2009 Revised 29 October 2009 Accepted 4 November 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

For fixation of the large posterior malleolar fracture fragment, indirect anterior fixation with cannulated screw has been widely used, but the anatomical reduction is not always obtained. The purpose of this article is to evaluate the clinical result of posterior malleolar fractures treated with anatomical reduction and internal fixation using posterior approach.

Materials and Methods

We have analyzed the 15 patients with posterior malleolar fractures, treated with posterior approach from August 2005 to August 2008. The mean follow up period was 17.6 months, We have reviewed the perioperative joint integrity, method of operation, postoperative care, bony union and complication. A clinical outcome was evaluated by AOFAS (American orthopedic foot and ankle society) scaling system and Olerud & Molander scoring system.

Results

Among 15 cases, posterolateral approach and posteromedial approach were chosen in 9 cases and 6 cases respectively. The radiologic unions were achieved at 12.4 (12~18) weeks. Mean AOFAS score was 90.3 (72~98), and Olerud & Molander score was "excellent" in 5 cases, "good" in 7 cases, "fair" in 1 case and "poor" in 2 cases. Postoperative complications in 2 cases revealed a posttraumatic arthritis and a scar band contracture respectively.

Conclusion

In posterior malleolar fracture of ankle joint, the integrity of joint has closely affected clinical outcomes. We suggest that a posterior approach for posterior malleolar fracture with especially incarcerated fragments and comminuted fractures, can be a useful method for anatomical reduction and stable fixation, and satisfactory clinical results.

Keywords: Ankle joint, Posterior malleolar fracture, Posterior approach

Figures and Tables

Fig. 1

Posterolateral approach to the posterior malleolar fracture. Intraoperative finding showing fixation of posterior malleolus using plate and screws.

Fig. 2

A schematic picture showing the posterolateral approach.

Fig. 3

(A) Preoperative CT image showing posterior malleolar fracture with displacement and incarcerated bony fragment.

(B) Postoperative lateral radiograph showing anatomical reduction of posterior malleolus.

Fig. 4

(A) Preoperative sagittal CT image showing posterior malleolar fracture with comminution.

(B) Postoperative lateral radiograph showing reduction and stabilization with plate and screws (C) 1 year follow-up sagittal CT image showing incongruity of joint.

(D) 2 year follow-up lateral radiograph with arthritic changes.

Table 1

Summary of cases

^*PM: Posteromedial, ^†PL: Posterolateral.

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