Role and importance of posterior malleolus fixation in trimaleolar fractures

Introduction - ankle fractures are third when it comes to frequency, right after hip and wrist joint fractures. Posterior malleolus fractures are common, comprising 7% to 44% of all ankle fractures, and are very rare on their own; that is a Volkmann triangle fracture. Ankle is a supporting joint in the human body, and fractures generally occur within rotation of the body with different fixed foot positions. The posterior malleolus is a very important structure in distal tibiofibular joint. Material and methods - we retrospectively present a group of 21 patients who had a fracture of the ankle and were surgically treated at the Clinic for Orthopedics and Traumatology in Niš during the period from January 2013 to December 2015. The basic criterion for surgical treatment was the size of the fragment, > 25% from tibial joint surface and dislocation >2mm. We systemized all ankle fractures according to the Lauge Hansen system, which is based on the mechanism of injury. We evaluated treatment results according to the Olerud-Molander classification, followed by subjective and objective signs. We systemized posterior malleolus fractures into three types, according to the Haraguchi classification. Results - etiological causes of the fractures are: a fall at the same level - sport, skating in 11 (52.3%) patients, a fall from a height in 6 (28.6%) and traffic accident in 4 (21.1%) patients. According to the Lauge Hansen classification, there were 15 (71.4%) patients with a SER-type fracture, 4 (19%) of the PER type, and 2 (9.6%) of the PA type. End result of the treatment was excellent in 13 (61.9%) patients, good in 7 (33.4%) and poor in 1 (4.7%) patient. Post-traumatic arthritis (PTA) was assessed one year after the surgery and level 1 and 2 were present in 12 (57.1%) patients.