Unstable Fractures Osteosynthesis of Malleoli and Posterior Edge of the Tibia Using Posterolateral Surgical Approach

The malleoli fractures in combination with the fractures of posterior edge of the tibia are considered unstable injuries and present particular difficulties in surgical treatment. The aim of the study was to evaluate short-term and mid-term results of osteosynthesis on account of unstable fractures of malleoli and posterior edge of the tibia using posterolateral surgical approach. Materials and Methods. The analysis of short-term and mid-term results of the treatment of 29 patients with malleoli fractures types 44-B3 and 44-C1.3, C2.3 and C3.3 (according to the AO classification) with the involvement of the Volkman's posterior tibia fragment was performed in traumatology departments of three hospitals during the period from January 2019 to September 2020. In all 29 cases the fracture of the posterior edge of the tibia was classified as type 1 according to the classification of N. Haraguchi et al. All patients underwent osteosynthesis of the posterior edge of the tibia and the lateral malleolus via posterolateral surgical approach. Combined fracture of the medial malleolus was fixed via classical medial approach. 5 patients (17.2%) with continued instability of the distal tibiofibular syndesmosis underwent fixation with positional screw. Functional results, as well as the range of motions in the ankle joint were evaluated with the use of AOFAS and Neer scales 3, 6 and 12 months after surgery. Results. Statistically significant improvement in functional outcomes over time was noted when evaluated on the AOFAS scale (p<0.05) and on the Neer scale (p<0.01). 12 months after the surgery these points were 83.2 +/- 13.4 and 87.8 +/- 16.8 respectively. Complications were noted in 5 patients (17.24%). Deep periimplant infection was registered just in one case, another patient had marginal necrosis of the operative wound. Three patients had clinically significant post-traumatic deforming arthritis of the ankle joint. Conclusion. Posterolateral surgical approach has advantages when performing osteosynthesis in patients of the studied profile and enables anatomical reduction and stable fixation of fragments of the Volkman's posterior edge of the tibia, which provides the possibility of early mobilization of the ankle joint and has positive effect on the results of treatment.