title: "A to p" screw versus posterolateral plate for posterior malleolus fixation in trimalleolar ankle fractures.
abstract: OBJECTIVE
  To compare radiographic and clinical midterm outcomes of posterior malleolar fractures treated with posterior buttress plating versus anterior to posterior lag screw fixation.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Between January 2002 and December 2010, patients with posterior malleolar fractures were identified by Current Procedural Terminology code and their charts reviewed for eligibility.
  
  
  METHODS
  Posterior malleolar fixation using either anterior to posterior (AP) lag screws or posterior buttress plating.
  
  
  METHODS
  Demographic data, length of follow-up, range of motion, and postoperative Short Musculoskeletal Function Assessment (SMFA) scores were the main outcome measurements. Immediate postoperative radiographs for residual gap/step-off and final follow-up radiographs for the degree of arthritis that developed were evaluated.
  
  
  RESULTS
  Thirty-seven patients were eligible for the study, and 27 chose to participate. Sixteen patients underwent posterior buttress plating, and 11 underwent AP screw fixation with mean follow-up times of 54.9 and 32 months, respectively. Demographic data were similar between groups. The posterolateral plating group demonstrated superior postoperative SMFA scores compared with the AP screw group with statistically significant differences in the SMFA bother index (26.7 vs. 9.2, P = 0.03) and trends toward improvement in the mobility (28.3 vs. 12.9, P = 0.08) and functional indices (20.2 vs. 9.4, P = 0.08). There were no significant differences in the range of motion or the development of ankle arthritis over time.
  
  
  CONCLUSIONS
  Patients with trimalleolar ankle fractures in whom the posterior malleolus was treated with posterolateral buttress plating had superior clinical outcomes at follow-up compared with those treated with AP screws.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Regions Hospital, St Paul, MN; and †Department of Orthopaedic Surgery, Prevea Health St Mary's, Green Bay, WI.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: OʼConnor
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mueller
authors.forename: Thuan V
authors.initials: TV
authors.lastname: Ly
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Jacobson
authors.forename: Eric R
authors.initials: ER
authors.lastname: Nelson
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cole
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000175:diagnosis* / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013639:Tarsal Bones / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult