The Clinical Application Of Posterolateral Approach In The Treatment Of Displaced Posterior Malleolar Fracture

Objective To evaluate the clinical effects of treatnent of posterior malleolar fracture with posterolateral approach.Methods 32 cases with posterior malleolar fractures who were treated surgically with the posterolateral approach were selected from March 2015 to August2017,All cases were fixed via posterolateral approach with screws or T plate..According to the lauge-hansen ankle classification system.there were 25 cases of grade ? supination external rotation type,1 cases of grade ? supination extermal rotation type,6 cases of grade IV pronation extermal rotation type.All of the posterior malleolar fractures were treated with posterolateral incision reduction and cannulated lagserew or plate fixation,the“hook experiment,were used to check the stability of tibiofibular in the operation,when necessary,3 layers of eortieal bone serews were used to fix it.Plate was placed in the posterior or lateral of fibula when fixed the laternal malleolus fracture.Screws or plate fixed the posterior malleolus.Regular follow-up after operation,wound healing and fracture healing were observed.According to the ankle foot Scoring system score reeommended by the America association of foot and ankle surgery(AOFAS)to evaluate the function of ankle joint.Result All patients postoperative review X-ray or CT examination,the anatomical rate is 95.2%.The average fluoroscopy times 4.6.The wounds healed in all patients postoperatively 2 weeks,in the group,no obvious symptoms of infection.one patient suffered from incision seepage,which was cured after dressing change,and the other incisions achieved primary healing.one patient had numbness in the lateral foot distribution and had complete resolution following surgery three months.There is no one in the group don't get screw direction and location,All patients were followed up.According to the ankle foot scoring system score recommended by AOFAS:were excellent in 25 cases,good in 5 cases and moderate in 2 cases,the excellent rate was 93.75 percent.Conclusion Posterolateral approach with the prone position for open reduction and intermal fixation(ORIF)of posterior malleolar fractures can take reposition and fixation lateral malleolus and posterior malleolar fracture at the same time.Combined with medial incision surgery for the trimalleolar ankle fractures can be completed in a position.This approach has less injury to soft tissue and the risk of iatrogenic injury of the sural nerve and saphenous,better functional recovery of ankle joint.