title: Comparison of Posteromedial Versus Posterolateral Approach for Posterior Malleolus Fixation in Trimalleolar Ankle Fractures.
abstract: OBJECTIVE
  To compare clinical and radiographic outcomes of posterior malleolar fractures (PMF) treated with lag screws from anterior to posterior versus posterior to anterior approach.
  
  
  METHODS
  We retrospectively analyzed 48 patients with trimalleolar fractures who underwent open reduction and internal fixation (ORIF) with either posteromedial (PM) or posterolateral (PL) approaches between January 2012 and December 2014. Fixation of the posterior malleolus was made with anteroposterior screws in 20 patients using the PM approach and posteroanterior screws in 28 patients using the PL approach. The American Orthopedic Foot and Ankle Society (AOFAS) scores and range of motion (ROM) of the ankle were used as the main outcome measurements, and results were evaluated at the 6-month, 12-month and final follow-up. Postoperative radiographs and computed tomography scans were used to evaluate the residual gap/step-off. The degree of arthritis was evaluated on final follow-up using Bargon criteria. Other complications were also recorded to compare the clinical outcomes of the two approaches.
  
  
  RESULTS
  The mean duration of follow-up regardless of the approaches was 21.1 months (range, 15-54 months). None of the patients developed delayed union or nonunion. Functional bone healing was obtained in all patients at 10.7 weeks (range, 8-16 weeks). The mean AOFAS scores of the PM group at the postoperative 6-mouth, 12-month, and final follow-up were 91.4 (range, 82-100), 92.5 (range, 84-100), and 92.9 (range, 86-100), respectively. In the PL group, the mean AOFAS scores were 89.9 (range, 72-100), 91.4 (range, 77-100), and 91.9 (range, 77-100), respectively. At the final follow-up, the median loss of range of motion (ROM) for dorsiflexion and plantaflexion were 0°(0°, 5°) and 0°(0°, 0°), respectively, in both groups. There were no significant differences between the two approaches in AOFAS scores and ROM of the ankle in each period postoperatively (P > 0.05). Two patients in the PL group and 1 in the PM group developed Bargon grade 2 or 3 arthritis. We detected a 2-mm and 3-mm step-off in 1 patient in the PM and PL groups, respectively.
  
  
  CONCLUSIONS
  Satisfactory results were obtained by using the two approaches for fixation of posterior malleolus, and the approaches have similar clinical and radiographic outcomes. Surgeons should choose the appropriate approach based on their experience.
authors.affiliation: Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Zhong
authors.affiliation: Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, China.
authors.forename: Jia-Guo
authors.initials: JG
authors.lastname: Zhao
authors.affiliation: Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Jin-Feng
authors.initials: JF
authors.lastname: Xie
authors.affiliation: Spine Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, China.
authors.forename: Ying-Hua
authors.initials: YH
authors.lastname: Wu
authors.affiliation: Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, China.
authors.forename: Xian-Tie
authors.initials: XT
authors.lastname: Zeng
mesh_terms: D000293:Adolescent; D000328:Adult; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Posterior malleolar fractures; Posterolateral approach; Posteromedial approach; Trimalleolar fractures