To compare radiographic and clinical midterm outcomes of posterior malleolar fractures treated with anterior to posterior lag screw versus posterior buttress plating ﬁxation.
Patients: Between June 2017 and June 2021, patients with posterior malleolar fractures were identiﬁed by the Current Procedural Terminology code and their charts were reviewed for eligibility.
Intervention: Posterior malleolar ﬁxation using either anterior to posterior (AP) lag screws or posterior buttress plating.
Main Outcome Measurements: 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: 37 patients were eligible for the study, and 27 choose to participate. 16 patients underwent posterior buttress plating, and 11 underwent AP screw ﬁxation with mean follow-up times of 26 and 20 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.