Posterior Fracture Dislocation of the Ankle: Technique and Clinical Experience Using a Posteromedial Surgical Approach

Objective: The purpose of this study is to revisit the posteromedial surgical approach to the ankle and report the clinical outcomes of this technique in a cohort of 17 patients. Design: Retrospective. Setting: Level I trauma center. Patients: Seventeen patients between 1990 and 2006 were treated using a posteromedial surgical approach to the ankle. Thirteen presented with a posterior ankle fracture dislocation and 4 with an ankle fracture without dislocation producing a large posterior malleolar fragment. There were 6 males and 11 females, from 23 to 80 years of age (mean 45.2 years). Intervention: All but 2 patients underwent open reduction and internal fixation of the posterior malleolar fracture using a single posteromedial approach. A combined surgical approach (posteromedial and posterolateral) to the ankle was used in 2 cases. Main Outcome Measurements: The Foot and Ankle Outcomes Questionnaire was used to evaluate postoperative ankle pain, function, stiffness and swelling, and giving way. Posttraumatic osteoarthritis was assessed using an adapted 4-point radiographic grading system. Results: Follow-up data on 12 patients were obtained at a mean interval of 9.4 years. There were no wound complications. The average global foot and ankle score was 87 points (range 69-100). The degree of arthrosis was grades 0 in 3 ankles, I in 1 ankle, II in 5 ankles, and III in 3 ankles. Conclusions: The posteromedial approach offers an effective technique for fracture reduction and buttress plate fixation of large posterior malleolar fragments. Good short- and mid-term clinical results should be expected.