The Exploration Of The Indications For Fixations Of Posterior Malleolas Fractures

Objective To explore the indications for fixations of posterior malleolarfractures.Methods42patients with malleolar fractures involving posterior anklewere treated in our hospital from January2007to January2012.Accordingto preoperative CT scans of ankle, the cases were divided into the fixationgroup and the non-fixation group. Cases in the fixation group were thepatients with posterior malleolar fractures articular surface higher than10%the distal tibial articular surface and/or dislocation of the posteriormalleolar fractures greater than2mm,and were treated with posteriormalleolus internal fixations (27cases).Cases in the non-fixation group werethe patients with posterior malleolar articular fractures surface less than10%the distal tibial articular surface and dislocation of the posteriormalleolar fractures less than2mm,and were treated with posterior malleolarnon-operative treatments (15cases).The average healing time of posteriormalleolar fractures, postoperative complications, AOFAS ankle andhindfoot scores, and other aspects were compared during the follow-uppostoperatively. Results All of42patients with ankle fractures achieved bony unionwithin6months. In the fixation group,1case had postoperative superficialinfection of the wounds in the medial ankle and lateral ankle, and thewound got healed completely with anti-infection therapy. One case in theevery group had postoperative superficial necrosis in the wound skin edges,and got healed by dress changing. For the other cases, there was no woundinfection, no internal fixation loosening, no breakage or failure during thefollow-ups. Ankle functions were evaluated one year after the operationsaccording to the ankle-hindfoot score standard of American OrthopedicFoot and Ankle Society (AOFAS).The score of the fixation group was(83.74±10.35),with excellent ankle functions in10cases, good in12cases,fair in5cases, and poor in0case, and the rate of patients achievingexcellent and good ankle functions reached81.5%;the score of non-fixationgroup was (85.60±10.40) with excellent ankle functions in7cases, goodin5cases, fair in3cases and no poor case. The rate of patients achievingexcellent and good ankle functions reached80.0%.The function evaluationresults of both groups were no statistical difference(P>0.05).Conclusion It is reasonable to consider “posterior malleolar fracturesarticular surface higher than10%the distal tibial articular surface and/ordislocation of the posterior malleolar fractures greater than2mm” as theindications for internal fixation of posterior malleolar fractures.