Method Kabelitz (Zurich / CH), Nina Kabelitz (Chur / CH), Herman Frima (Alkmaar / NL), Philipp F. Stillhard (Chur / CH), Christoph Sommer (Chur / CH), Christian Michelitsch (Chur / CH), Thomas S. Müller (Chur / CH)
Abstract text (incl. references and figure legends)
Introduction
Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value. Current computer-tomography (CT)-based fracture classifications led to an increase in fixation of the posterior malleolus. The aim of this study was to describe the functional outcome after a two-stage stabilisation with direct fixation of the posterior fragment in trimalleolar dislocation fractures.
Material Methods
In a retrospective study, all patients presenting with a trimalleolar dislocation fracture (AO/OTA 44B3), an available CT scan and a two-stage operative stabilisation of the posterior malleolus by a posterior approach were included. All fractures were treated with initial external fixator and delayed definitive stabilisation including a posterior approach for fixation of the posterior malleolus. Next to clinical and radiological follow-up, outcome measures (Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS), Activity of Daily Living (ADL), Hulsmans implant removal score) and complications were analysed.
Results
Between 2008 - 2019, a total of 1200 ankle fractures were treated. In a group of a total of 320 trimalleolar dislocation fractures, 39 patients fulfilled the inclusion criteria and were available for follow-up examinations. Mean follow-up was 49 months (standard deviation (SD) 29.7, range 16 - 148). The mean age was 60 years (SD 15.3, 17 - 84) with 69% female patients. The mean FAOS was 93/100 (SD 9.7, 57 - 100), NRS 2 (interquartile range (IQR) 0 - 3) and ADL 2 (IQR 1 - 2). 4 patients showed a postoperative infection, 6 re-operations had to be performed and implants were removed in 24 individuals.
Conclusion
A two-stage procedure of trimalleolar dislocation fractures with in direct reduction and fixation of the posterior tibial fragment through a posterior approach leads to good functional outcome scores with a low rate of complications.
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