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Lateral Trans-malleolar Approach for Posterior Malleolar Fractures of the Ankle for Articular and Syndesmosis Reduction: A Retrospective Study

Author(s): Masanori Taki, Kosuke Suzuki, Naohiro Hio, Atsushi Hasegawa

Background

The lateral transmalleolar approach (LTA), a surgical approach for posterior malleolar fractures (PMFs), provides direct visualization of the articular surface of the posterior malleolus, though temporarily disrupting the syndesmosis. It is still unclear whether this fibrous joint can be effectively reconstructed afterward to prevent complications. We report the clinical results and computed tomography (CT) findings for articular and syndesmosis reduction status after surgery with LTA for PMF.

Methods

Sixteen patients who underwent PMF reduction with LTA with a follow-up of at least 1 year were evaluated retrospectively. Per the AO Foundation/Orthopaedic Trauma Association classification, the fracture type was 44B in 13 patients and 44C in three patients. The Haraguchi classifications of PMF were type 1 in six cases and type 2 in 10 cases. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score, post-surgical complications, and reduction status of PMF and syndesmosis on CT were investigated.

Results

The mean AOFAS score was 93.0 ± 5.2 points. Post-operative complications were observed in one case of superficial infection and one case of delayed fibular union. The articular step-off seen on CT improved significantly after surgery (5.9 ± 2.9 mm preoperatively vs. 0.6 ± 0.8 mm post-operatively). Syndesmosis malreduction was seen in three cases, including two high fibular fractures and one comminuted fibular fracture with osteoporosis.

Conclusions

The LTA provided favorable clinical results and effective reduction of intra-articular PMFs. However, surgeons should be aware of the possibility of syndesmosis malreduction in cases of high fibular fractures or comminuted fibular fractures.

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