Does the posterior approach offer advantages in short-term in trimalleolar ankle fractures?

Authors

  • Mario Holgado-Fernandez Servicio de Cirugía Ortopédica y Traumatología del Hospital Universitario Marqués de Valdecilla, Santander, Cantábria, Spain. https://orcid.org/0000-0002-4642-404X
  • German Galindo-Juárez Servicio de Cirugía Ortopédica y Traumatología del Hospital Universitario Marqués de Valdecilla, Santander, Cantábria, Spain.
  • Pedro Muñiz-Zatón Servicio de Cirugía Ortopédica y Traumatología del Hospital Universitario Marqués de Valdecilla, Santander, Cantábria, Spain. https://orcid.org/0000-0002-5415-1723
  • Esther Laguna-Bercero Servicio de Cirugía Ortopédica y Traumatología del Hospital Universitario Marqués de Valdecilla, Santander, Cantábria, Spain. https://orcid.org/0000-0003-2319-9641
  • Guillermo Menéndez-Solana Servicio de Cirugía Ortopédica y Traumatología del Hospital Universitario Marqués de Valdecilla, Santander, Cantábria, Spain.
  • Elena Gallardo-Agromayor Servicio de Radiodiagnóstico del Hospital Universitario Marqués de Valdecilla, Santander, Cantábria, Spain.
  • Jesús Hernández-Elena Servicio de Cirugía Ortopédica y Traumatología del Hospital Universitario Marqués de Valdecilla, Santander, Cantábria, Spain.
  • María Isabel Pérez-Núñez Servicio de Cirugía Ortopédica y Traumatología del Hospital Universitario Marqués de Valdecilla, Santander, Cantábria, Spain. https://orcid.org/0000-0001-6423-260X

DOI:

https://doi.org/10.30795/jfootankle.2022.v16.1621

Keywords:

Ankle fractures, Fracture fixation, internal, Fracture reduction

Abstract

Objective: The aim of this study was to compare the early (nine months after surgery) synthesis of the posterior malleolus by direct posterior (P) approach versus the percutaneous anteroposterior (AP) screw in trimalleolar ankle fractures to analyze the early clinical status of the patient (eight months) by studying the American Orthopedic Foot And Ankle Society (AOFAS) scale to compare postsurgical clinical recovery between both approaches, the rate of hospital days in both groups, the quality of joint reduction by computed tomography (CT) study and the rate of most frequent complications (fibular tendinopathy and surgical wound). Methods: A retrospective comparative study was performed between 2016-2020, including 94 patients with trimalleolar ankle fracture type 44-A/B/C (27 percutaneous AP surgical treatment and 67 P approach). Both groups were compared by analyzing demographic variables, clinical-functional status, radiological variables, and complications. Statistical analysis was performed using SPSS-20, with a p-value of 0.05 as significance. Results: Demographically, both groups were comparable, not finding significant differences between them. An increase in the days of admission before surgery was observed in the P approach with a mean of 4 (p=0.001). No significant clinical differences were found in the AOFAS scale, with a mean of 85 in both groups. Regarding the radiological result, a better reduction was observed with P approach (good=57, fair=9, poor=0) compared to the AP approach (good=10, fair=7, poor=9) (p=0.001). As for the complications, no significant differences were observed for the surgical wound. However, a higher need for fibular plate removal could be observed with P approach (n=17) (p=0.046). Conclusions: Clinically, both groups observed no significant differences through the AOFAS scale. The posterolateral approach has a higher rate of hospital days before surgery. Radiologically, a better joint reduction is achieved by a direct approach to the posterior fragment. Level of Evidence III; Retrospective Comparative Study.

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Published

2022-08-31

How to Cite

Holgado-Fernandez, M., Galindo-Juárez, G. ., Muñiz-Zatón, P., Laguna-Bercero, E. . ., Menéndez-Solana, G. ., Gallardo-Agromayor, E. ., Hernández-Elena, J. . ., & Pérez-Núñez , M. I. . (2022). Does the posterior approach offer advantages in short-term in trimalleolar ankle fractures?. Journal of the Foot & Ankle, 16(2), 110–118. https://doi.org/10.30795/jfootankle.2022.v16.1621