title: Open reduction and internal fixation of posterior malleolar fractures using the posterolateral approach.
abstract: OBJECTIVE
  Involvement of the posterior malleolus in fractures of the ankle probably adversely affects the functional outcome and may be associated with the development of post-traumatic osteoarthritis. Anatomical reduction is a predictor of a successful outcome. The purpose of this study was to describe the technique and short-term outcome of patients with trimalleolar fractures, who were treated surgically using a posterolateral approach in our hospital between 2010 and 2014.
  
  
  METHODS
  The study involved 52 patients. Their mean age was 49 years (22 to 79). There were 41 (79%) AO 44B-type and 11 (21%) 44C-type fractures. The mean size of the posterior fragment was 27% (10% to 52%) of the tibiotalar joint surface.
  
  
  RESULTS
  Reduction was anatomical in all patients with a residual step in the articular surface of ≤ 1 mm. In nine of the C-type fractures (82%), the syndesmosis was stable after fixation of the posterior fragment and a syndesmosis screw was not required. Apart from one superficial wound infection, there were no wound healing problems. At a mean radiological follow-up of 34 weeks (seven to 131), one patient with a 44C-type fracture had widening of the syndesmosis which required further surgery.
  
  
  CONCLUSIONS
  We conclude that the posterolateral surgical approach to the ankle gives adequate access to the posterior malleolus, allowing its anatomical reduction and stable fixation: it has few complications.
  
  
  CONCLUSIONS
  Fixation of the posterior malleolus in trimalleolar fractures can be easily done via the posterolateral approach whereby anatomical reduction and stable fixation can be reached due to adequate visualisation of the fracture. Cite this article: Bone Joint J 2016;98-B:812-17.
authors.affiliation: MC Haaglanden, locatie Westeinde, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Verhage
authors.affiliation: MC Haaglanden, locatie Westeinde, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Boot
authors.affiliation: Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
authors.forename: I B
authors.initials: IB
authors.lastname: Schipper
authors.affiliation: Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Hoogendoorn
mesh_terms: D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction / Q000379:methods*; D011183:Postoperative Complications; D055815:Young Adult
keywords: Ankle fracture; Operative fixation; Posterolateral approach; Trimalleolar fracture