Comparison of the Efficacy of Posterior-Anterior Screws, Anterior-Posterior Screws and a Posterior-Anterior Plate in the Fixation of Posterior Malleolar Fractures with a Fragment Size of ≥15% and <15%

Background To investigate the efficacy of posterior-anterior (PA), anterior-posterior (AP) screws and a PA plate in the fixation of posterior malleolar fractures (PMFs) with a fragment size of ≥ 15% and < 15%.MethodsThis is a retrospective study of the clinical data of 243 patients with unilateral ankle fractures involving the posterior malleolus. All patients were divided into two groups based on their fragment size, ≥ 15% (n = 136) and < 15% (n = 107). PA screws, AP screws and a posterior plate were used for fixation of PMF in the two groups. All patients were followed up at 1, 3, 6, and 12 months after surgery and thereafter at 6-month intervals. The primary outcomes were AOFAS and ROM, which were recorded at the final follow-up.Results The average follow-up time for all patients was 18.9 months and all fractures healed. There was no significant difference between the PA plate fixation, PA screw, and AP screw fixations in terms of AOFAS scores or ankle ROM in the fragment size of ≥ 15% group (P > 0.05). In the fragment size of < 15% group, there were statistically significant differences in the AOFAS scores and ankle ROM between the PA plate fixation and PA, AP screw fixation (P < 0.05); while no significant difference was observed between PA and AP screw fixation.Conclusion For PMFs with fragment size ≥ 15%, there was no significant difference in the outcomes between the three fixation methods. For PMF with fragmentation < 15%, the PA and AP screws both provided good fixation.