Abstract: Introduction: Posterior malleolar fractures are observed in approximately 7%-44% of all ankle fractures. Due to the important biomechanical function of the posterior tibial margin in weight-bearing and ankle stability, the affected ankle is prone to degenerative ankle arthritis. In ankle fractures involving the posterior malleolus, the issue of which type of fractures require posterior malleolus fixation is still controversial, suggesting that a trans-syndesmotic fixation may be adequate instead of posterior malleolar fixation.
Objective: This study compares the anterior to posterior screw versus posterolateral plate for posterior malleous fixation in trimalleolar ankle fractures.
Material and Methods: This study was conducted in patients with trimalleolar ankle fracture admitted in a tertiary level health care centre.It is a Prospective, randomized comparative study. Patients were randomized into two groups by using computerized random no. table and subsequent pt. was allocated in alternative groups /In group A fixed with anterior to posterior screw was done by an identified orthopedic surgeon. In group open reduction internal fixation with posterolateral plate fixation. Patients were examined for clinical and radiological, union, bone strength, weight bearing, deformity and range of motion at 2wks, 6wks, till 6 months.
Results: Forty six patients were evaluated in this study and were divided in two groups accordingly. Group A = Anterior to posterior leg screw and Group B = Postero-lateral Plate. Evidence of union in X-ray seen after 18.80±1.92 weeks of operation in group-A and 20.16±2.01 weeks in group-B. In terms of functional result, 28.00% patients were excellent, 58.00% patients were good and 14.00% patients were poor in group-A. 40.00% patients treatment results were excellent, 50.00% patients treatment results were good and 10.00% patients treatment results were poor in group-B.
Conclusion: These results demonstrate that posterior malleolar fracture fixation is closely related to successful radiological and functional outcomes after trimalleolar fractures. Transyndesmal screw fixation may not be needed in the cases where the posterior malleolar fracture fixated. For these reasons, we recommend that all posterior malleolar fractures have to be fixed regardless of size.
