Posterior Malleolar Open Reduction and Internal Fixation Through a Posterolateral Approach for Trimalleolar Fractures

JBJS Essential Surgical Techniques
J M Hoogendoorn

Abstract

Fixation of the posterior fragment in trimalleolar fractures remains a matter of debate. Recent studies have shown that a persistent step-off in the tibiotalar joint is the most important factor in the development of osteoarthritis and therefore the functional outcome. The disadvantages of the regularly performed indirect reduction by ligamentotaxis or percutaneous reduction followed by percutaneous screw fixation of the posterior fragment in an anterior-to-posterior direction are that an anatomical reduction is more difficult to achieve because of the interposition of soft tissue or loose osseous fragments, it is hard to assess reduction satisfactorily using an image intensifier, and fixation of small or comminuted fragments is technically difficult. Therefore, we favor an open, anatomical reduction of the posterior malleolar fragment using a posterolateral approach. The patient is prone for the operation. A longitudinal incision is made between the lateral border of the Achilles tendon and the posteromedial border of the fibula. The posterior aspect of the fibula is easily reached through the interval just lateral to the peroneal muscle. After debridement of the fracture, it can be reduced and is fixed with either (1) a buttr...Continue Reading

References

Feb 10, 2006·Clinical Orthopaedics and Related Research·Michael J GardnerDean G Lorich
Apr 10, 2009·Foot & Ankle International·Jens ForbergerAndreas Platz
Oct 3, 2009·Clinical Orthopaedics and Related Research·Anna N MillerDean G Lorich
Jul 11, 2012·International Orthopaedics·Hai-lin XuXin-bao Wu
Jun 26, 2014·Foot & Ankle International·Mehmet Nuri ErdemMehmet Aydogan
Feb 13, 2015·Foot & Ankle International·Cornelis Christiaan Drijfhout van HooffJochem Maarten Hoogendoorn

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Citations

Nov 16, 2018·Archives of Orthopaedic and Trauma Surgery·Samuel Marinus VerhageJochem Maarten Hoogendoorn
Nov 19, 2020·Foot & Ankle International·Kristian PilskogJonas Meling Fevang
Feb 20, 2021·Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews·Jeff S KimballJoey P Johnson
May 4, 2021·OTA International : the Open Access Journal of Orthopaedic Trauma·Naoki Haraguchi, Robert S Armiger

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