Minimally invasive fixation of posterior malleolus fracture: description of surgical technique and radiological results

Abstract

Introduction. Ankle fractures are one of the most common lower extremity injuries. Despite the high incidence of these fractures in the population, the best therapeutic approach has not been established yet. The treatment of posterior malleolus fractures is particularly controversial.Aim. Evaluation of percutaneous posterior-to-anterior fixation of posterior malleolus fracture (posterolateral fragment) in terms of safety of the method and accuracy of fracture reduction. A detailed description of the surgical technique was also presented.Materials and methods. A retrospective evaluation included 18 patients operated on due to complex ankle fractures between April 2023 and March 2024. All patients included in the study underwent percutaneous posterior-to-anterior fixation of posterior malleolus fracture. Patients were evaluated for neurovascular complications and postoperative CT scans were assessed to determine the accuracy of posterior malleolus reduction.Results. In 14 patients (77.8%), the fracture displacement was less than 1 mm; in 3 patients (16.7%), the displacement was 1-2 mm; and in one patient (5.5%), the displacement was >2 mm. No neurovascular complications were observed in any patient.Conclusions. Percutaneous posterior-to-anterior fixation of fractures of the posterolateral part of the posterior malleolus is a safe method and provides a high percentage of anatomical reduction.

Keywords

• ankle fractures
• posterior malleolus
• minimally invasive fixation
• percutaneous fixation
• computed tomography