Open reduction internal fixation (ORIF) for supination-external rotation type IV ankle fractures via anterolateral and posterolateral approaches

Abstract Background: The present study aimed to analyze and compare the efficacy of the anterolateral and posterolateral approaches for surgical treatment of supination-external rotation type IV ankle fractures.Methods: This retrospective study enrolled 60 patients (60 feet) with supination-external rotation type IV ankle fractures, including 30 patients (30 feet) treated via the anterolateral approach and 30 patients (30 feet) treated via the posterolateral approach. Postoperative clinical efficacy was compared between the groups based on operation time, intraoperative blood loss, postoperative complications, fracture healing time, visual analog scale (VAS) scores, Short Form-36 Health Survey (SF-36) scores, and American Orthopedic Foot and Ankle Society (AOFAS) scores. Comparisons between the two groups were performed using independent-samples t-tests and analyses of variance. Intra-group differences were compared using paired t-tests, and the Chi-square test was used to compare categorical variables.Results: All 60 included patients completed follow-up ranging from 12 to 18 months (mean duration: 14.8±3.5 months). Although baseline characteristics were similar in the two groups, there were significant differences in operation time (86.73±17.44 min vs. 111.23±10.05 min, P<0.001) and intraoperative blood loss (112.60±25.05 ml vs. 149.47±44.30 ml, P<0.001). Although fracture healing time (10.90±0.66 weeks vs. 11.27±0.94 weeks, P=0.087) was shorter in the anterolateral group than in the posterolateral group, the difference was not significant. Postoperative complications occurred in one and three patients in the anterolateral and posterolateral approach groups, respectively. VAS scores were significantly lower in the anterolateral group than in the posterolateral group (1.43±0.50 vs. 1.83±0.75, P=0.019), although there was no significant difference in SF-36 scores between the groups (73.63±4.07 vs. 72.70±4.04, P=0.377). However, AOFAS scores were higher in the anterolateral group than in the posterolateral group (80.43±4.32 vs. 75.43±11.32, P=0.030).Conclusion: Both the anterolateral and posterior lateral approaches can achieve good results in the treatment of supination-external rotation type IV ankle fractures. Compared with the posterolateral approach, the anterolateral approach is advantageous for the treatment of supination-external rotation type IV ankle fractures given its safety and ability to reduce trauma, provide clear exposure, and allow for exploration and repair of the inferior tibiofibular anterior syndesmosis within the same incision.