Role of Fixation of Posterior Malleolus in Trimalleolar Fractures (44-B3), When & How to fix
Sudhir Shankar Babhulkar1* , Sushrut Babhulkar2 and Amol Yashwantrao Patil3
1Sushrut Institute of Medical Sciences, Nagpur, India
*Corresponding Author: Prof. Dr. Sudhir Shankar Babhulkar, Sushrut Institute of Medical Sciences, Nagpur, India.
Received: March 16, 2022 Published: March 28, 2022
Abstract
Purpose: Planning the fixation modality and approach for the posterior malleolus fracture with trimalleolar fracture (44 -B3).
Design: Prospective study
Setting: Level II academic trauma centre
Methods: 48 patients with trimalleolar 44-B3 fractures from 01/01/2010 to 31/12/2017 were studied. Preoperative CT scan use to divide them in Group I-Posterolateral & Group II-posteromedial fragments of posterior malleolus. Postoperative x-rays done to check instability, residual articular displacement and malposition. Final radiological union was assessed and correlated with functional outcome. In Group I (38 cases) fixation was performed by posterolateral approach and medial incision for medial malleolus. In Group II (10 cases) surgical fixation was performed by extended modified posteromedial approach and lateral approach for fibula fixation.
Results: Subjective assessment was done for pain, range of movements, ability to bear the weight and activities of daily living according to Olerud and Molander score system. The x-rays done at each follow up. Medial clear space was maintained in most but in 4 patients, it was increased by more than 0.2 mm. Reduction of posterior malleolar fragments was anatomical in 44 patients. Follow-up period was 2 years with an average score of 70.
Conclusion: Posterolateral pattern is common in trimalleolar fracture 44-B3. Two different surgical approaches were taken to stabilize malleolar fractures. With the average follow up of two years. Most patients had good to excellent results with a very little rate of complications.
Level of Evidence: Therapeutic Level II.
Keywords: Trimalleolar fracture (44-B3), Posterolateral & Posteromedial, approach, Posterior malleolus
Citation: Babhulkar SS, Babhulkar S, Patil AY. “Role of Fixation of Posterior Malleolus in Trimalleolar Fractures (44-B3), When & How to fix”. SVOA Orthopaedics 2:2 (2022) Pages 39-49.