A Direct Approach to Trimalleolar Fractures.

When the major portion of a weight-bearing joint such as the ankle is fractured and displacement occurs, accurate reduction is essential if late osteoarthritic changes are to be avoided. In many trimalleolar fractures the posterior malleolar fragment is small and simple manipulative treatment and plaster fixation is satisfactory. If, however, the posterior malleolar fragment constitutes one-third or more of the weight-bearing surface, it is essential to obtain perfect reduction, for, without it, the remaining weight-bearing area articulating with the talus eventually becomes osteoarthritic. Most attempts at open reduction of such a fracture have been done through a posterior incision and the posterior malleolus has been manipulated into place and screwed without a view of the fracture line on the joint surface. Experience shows that by such an approach perfect reduction is rarely obtained.