Title : Outcomes of open reduction and internal fixation versus conservative management in posterior malleolus ankle fractures: a retrospective comparative study
Abstract:
Background: The posterior malleolus may be referred to as Volkmann’s triangle or the posterior tibial plafond and approximately 50% of ankle fractures may have involvement of this area. Posterior malleolus ankle fractures (PMFs) may be associated with unfavourable long-term outcomes for patients involving pain, stiffness and post-traumatic osteoarthritis of the ankle. The optimal treatment approach for ankle fractures involving the posterior malleolus (PM) continues to be a controversial topic in orthopaedic surgery.
Aims: This study aims to compare outcomes of healing, complications and return to pre-morbid mobility in open reduction, internal fixation versus conservative management in posterior malleolus ankle fractures.
Materials and methods: A single-centre retrospective comparative study was conducted on 166 patients with posterior malleolus ankle fractures using non-probability, consecutive sampling. Inclusion criteria entailed, complete digital records of patients between the ages of 16 and 60 with an acute, unilateral, closed fracture. Exclusion criteria entailed, patients with incomplete records, pre-existing ankle joint disease, Parkinson's disease, poliomyelitis, tumour, immunodeficiency, blood disease, posterior Pilon fractures and multiple or bilateral fractures. Study duration was one year from December 2021 to December 2022. De-identified data such as age, gender, management approach, surgical approach, Haraguchi fracture type, non-weight bearing duration, follow-up time and healing outcome was extracted from records. Statistical analysis for comparison between conservative and open reduction and internal fixation management was conducted with a chi-square test. Haraguchi fracture type, non-weight bearing duration and follow-up time were significant factors in determining conservative or surgical management for posterior malleolus ankle fractures.
Results: The mean age of patients was 43.93±15.72 years. The majority of patients (72.29%) were managed with open reduction and internal fixation in an ambulatory trauma and orthopaedic surgery list using a posterolateral surgical approach (39.76%) and plate fixation (45.78%). The overall most common identified Haraguchi fracture type was type I (39.76%). Plain film x-ray follow-up outcomes showed that the majority of patients healed with return to pre-morbid mobility in surgical and conservative management groups (92.17%). Healing outcomes were superior in the open reduction group with 91.67% achieving pre-morbid mobility compared to 76.09% in the conservative group. Non-union was more frequent in the conservative group (17.39% vs 4.17%). These differences were statistically significant with a p-value of 0.01. The conservative group had a significantly higher proportion (p-value 0.002) of patients with a four-week non-weight bearing duration. The open reduction and internal fixation group had significantly higher proportion of patients with a 6-week non-weight bearing duration (p-value 0.002).
Conclusion: The open reduction and internal fixation group resulted in superior healing outcomes with higher return to pre-morbid mobility compared to conservative management, which was statistically significant. Non-union incidence was higher in the conservative group. Pain frequency was similar in both groups.
What will audience learn from your presentation?
- Optimal treatment of posterior malleolar ankle fractures is a controversial topic in orthopaedic surgery
- Posterior malleolar fractures may be classified according to Haraguchi et al.
- Traditionally, unstable fractures are treated with open, reduction and internal fixation
- Open, reduction and internal fixation may result in superior healing outcomes with an earlier return to function
