title: Posterolateral approach for treatment of posterior malleolus fracture of the ankle.
abstract: Treatment of the posterior malleolus has been debated among orthopedic surgeons. Most orthopedic surgeons will fix the posterior malleolus if it is larger than 25% to 30% of the distal articular surface. The most common method of fixation of the posterior malleolus is by indirect reduction and anteroposterior screws. In the present study, we describe the technique and results of treatment of the posterior malleolus by direct reduction through the posterolateral approach to the ankle. The decision to fix the posterior malleolus was determined by its size and displacement. A total of 12 consecutive patients underwent the posterolateral approach to reduce the posterior malleolus, and these were fixed by posterior plate. Two patients were lost to follow-up in the early postoperative period (both after 2 months). No deep infection or wound dehiscence occurred. Ten patients had adequate (<2-mm displacement of the articular surface) radiologic reduction at the final follow-up visit. There were 2 cases of 2 mm or more of articular surface displacement at the final follow-up visit (1 patient had 2-mm displacement noted in the immediate postoperative period and 1 patient had adequate reduction in the beginning but was displaced with additional follow-up). The posterolateral approach to the ankle is a useful tool to treat certain cases of posterior malleolus fracture. It allows good visualization and stable fixation of the posterior malleolus.
authors.affiliation: Department of Orthopedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA. amr.abdelgawad@ttuhsc.edu
authors.forename: Amr A
authors.initials: AA
authors.lastname: Abdelgawad
authors.forename: Adel
authors.initials: A
authors.lastname: Kadous
authors.forename: Enes
authors.initials: E
authors.lastname: Kanlic
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D001860:Bone Plates; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult