Posterolateral approach to the displaced posterior malleolus: functional outcome and local morbidity

Forberger, Jens; Sabandal, Philipp V; Dietrich, Michael; Gralla, Jan; Lattmann, Thomas; Platz, Andreas (2009). Posterolateral approach to the displaced posterior malleolus: functional outcome and local morbidity. Foot & ankle international, 30(4), pp. 309-14. Thousand Oaks, Calif.: Sage 10.3113/FAI.2009.0309

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BACKGROUND: Stable anatomical reconstruction of the joint surface in ankle fractures is essential to successful recovery. However, the functional outcome of fractures involving the posterior tibial plafond is often poor. We describe the morbidity and functional outcome for plate fixation of the displaced posterior malleolus using a posterolateral approach. MATERIALS AND METHODS: The posterolateral approach was used for osteosynthesis of the posterior malleolus in 45 consecutive patients (median age 54 years) with AO/Muller-classification type 44-A3 (n = 1), 44-B3 (n = 35), 44-C1 (n = 7), and 44-C2 (n = 2) ankle fractures. Thirty-three of the patients suffered complete fracture dislocation. Functional outcome at followup was measured using the modified Weber protocol and the standardized AAOS foot and ankle questionnaire. Radiological evaluation employed standardized anterior-posterior and lateral views. RESULTS: The fragment comprised a median of 24% (range, 10% to 48%) of the articular surface. Postoperative soft tissue problems were encountered in five patients (11%), one of whom required revision surgery. Two patients (4%) developed Stage I complex regional pain syndrome. Clinical and radiological followup at 25 months disclosed no secondary displacement of the fixed fragment. The median foot and ankle score was 93 (range, 58 to 100), shoe comfort score was 77 (range, 0 to 100). A median score of 7 (range, 5 to 16) was documented using the modified Weber protocol. CONCLUSION: The posterolateral approach allowed good exposure and stable fixation of a displaced posterior malleolar fragment with few local complications. The anatomical repositioning and stable fixation led to good functional and subjective outcome.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
UniBE Contributor:	Gralla, Jan
ISSN:	1071-1007
ISBN:	19356354
Publisher:	Sage
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 15:08
Last Modified:	05 Dec 2022 14:21
Publisher DOI:	10.3113/FAI.2009.0309
PubMed ID:	19356354
Web of Science ID:	000264741500005
URI:	https://boris.unibe.ch/id/eprint/30145 (FactScience: 185461)