title: Importance of fixation of posterior malleolus fracture in trimalleolar fractures: A retrospective study.
abstract: BACKGROUND
  The aim of this retrospective study was to evaluate treatment effect and importance of posterior malleolus (PM) fixation in surgically treated trimalleolar fractures.
  
  
  METHODS
  A total of 57 cases of ankle joint fracture involving PM and treated with open reduction and internal fixation technique between 2004 and 2011 were evaluated. PM fixation was performed with cannulated screws in 46 cases, and in 11 cases, PM plate was used. All patients were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score, American Academy of Orthopedic Surgeons (AAOS) foot and ankle questionnaire, and Visual Analog Score (VAS) pain scale. Ankle joint mobility was also compared with unaffected side.
  
  
  RESULTS
  Mean follow-up period was 44.6 months (range: 24-108 months). There were 36 female patients and 21 male patients between 23 and 85 years of age (mean: 55.9 years). Average time to surgery was 1.1 day (range: 1-3 days). According to AOFAS assessment, result was excellent in 21 patients and good in 26 patients. AAOS score was 92.4 (range: 32-100). Mean VAS score when resting was 1.1, and mean score was 1.3 when walking (range: 0-10). When compared with uninjured side, there was no significant difference in plantar flexion of ankle (p=0.325) but there was significant difference in dorsiflexion of ankle joint (p<0.001).
  
  
  CONCLUSIONS
  Anatomical reduction and rigid internal fixation of PM provide satisfactory clinical and functional outcomes even in elderly patients where bone quality may make adequate fixation difficult. Fixation of even small PM fragments can facilitate rehabilitation by creating more stable construction.
authors.forename: Sinan
authors.initials: S
authors.lastname: Karaca
authors.affiliation: Department of Orthopedics and Traumatology, İstanbul Florence Nightingale Hospital, İstanbul-Turkey. mdsnn@hotmail.com.
authors.forename: Meriç
authors.initials: M
authors.lastname: Enercan
authors.forename: Güzelali
authors.initials: G
authors.lastname: Özdemir
authors.forename: Sinan
authors.initials: S
authors.lastname: Kahraman
authors.forename: Mutlu
authors.initials: M
authors.lastname: Çobanoğlu
authors.forename: Metin
authors.initials: M
authors.lastname: Küçükkaya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D017063:Outcome Assessment, Health Care; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult