title: Posterior fracture dislocation of the ankle: technique and clinical experience using a posteromedial surgical approach.
abstract: OBJECTIVE
  The purpose of this study is to revisit the posteromedial surgical approach to the ankle and report the clinical outcomes of this technique in a cohort of 17 patients.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Seventeen patients between 1990 and 2006 were treated using a posteromedial surgical approach to the ankle. Thirteen presented with a posterior ankle fracture dislocation and 4 with an ankle fracture without dislocation producing a large posterior malleolar fragment. There were 6 males and 11 females, from 23 to 80 years of age (mean 45.2 years).
  
  
  METHODS
  All but 2 patients underwent open reduction and internal fixation of the posterior malleolar fracture using a single posteromedial approach. A combined surgical approach (posteromedial and posterolateral) to the ankle was used in 2 cases.
  
  
  METHODS
  The Foot and Ankle Outcomes Questionnaire was used to evaluate postoperative ankle pain, function, stiffness and swelling, and giving way. Posttraumatic osteoarthritis was assessed using an adapted 4-point radiographic grading system.
  
  
  RESULTS
  Follow-up data on 12 patients were obtained at a mean interval of 9.4 years. There were no wound complications. The average global foot and ankle score was 87 points (range 69-100). The degree of arthrosis was grades 0 in 3 ankles, I in 1 ankle, II in 5 ankles, and III in 3 ankles.
  
  
  CONCLUSIONS
  The posteromedial approach offers an effective technique for fracture reduction and buttress plate fixation of large posterior malleolar fragments. Good short- and mid-term clinical results should be expected.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, The University of Saskatchewan, Saskatoon, Saskatchewan, Canada. ajb157@mail.usask.ca
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Bois
authors.forename: William
authors.initials: W
authors.lastname: Dust
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050724:Fractures, Cartilage / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome