A better approach yields a better result: comparison of two different surgical procedures for bi- and trimalleolar fractures with posterior fragments

Bimalleolar and trimalleolar fractures are common orthopedic injuries. There are different techniques of fixation and various surgical approaches. We compared our method of fixation, especially fractures with posterior fragments, with the traditional method. From January to June 2008, 73 cases of ankle fracture were treated in our trauma center. All cases were bimalleolar or trimalleolar fractures, and required open reduction and internal fixation. The posterolateral approach was used for both lateral and posterior malleolar fixation. All patients were followed up, and computed tomography was used to evaluate alignment of posterior fragments. In all patients, function was compared with that in previous cases treated with traditional approaches. All fractures healed without failure of hardware. There was no complication of traumatic osteoarthritis on follow-up. The presented approach leads to better ankle function than with the traditional procedure. The difference is significant (P < 0.05), according to an ankle scoring system (Baird RA, Jackson ST. JBJS, 1987, 69A: 1347). The posterolateral approach provided better exposure of posterior malleolar fragments and achieved better functional results. Our method of fixation conforms to biological theory. This surgical approach with its anatomical advantage can treat both lateral and posterior malleolar fractures through the same incision, and should become the preferred method of treatment.