Comparison of Percutaneous Screw Fixation and Conservative Treatment of Posterior Malleolar Fractures: A Radiological and Functional Outcomes Analysis

ABSTRACT Aim: The aim of this study was to compare the clinical and radiological results in patients with trimalleolar fractures with a small posterior malleolar fragment of the ankle joint with and without percutaneous screw fixation. Materials and Methods: The study involved patients (18-65 years) with (Group 1) or without (Group 2) percutaneous screw fixation of posterior malleolus fractures between January 2017 and December 2023. Clinical and radiological evaluation was conducted at various time points up to the last follow-up. Functional evaluation was conducted using American Orthopaedic Foot and Ankle Scores (AOFAS), Visual Analogue Scores (VAS), and dorsiflexion restriction. Radiological evaluation included the measurement of the gap and step between at the fracture site and presence of ankle osteoarthritis. Results: In this study, sixty-five patients (Group 1: 33, Group 2: 32) who met the inclusion criteria were followed up for a mean of 31.65±6.4 (24–44) months. There were no significant differences in the clinical results between the groups (p > 0.05). At the final radiograph, the mean gap and step distances in Group 1 were lower than in Group 2 (p < 0.001). There was no significant difference between the groups regarding the presence of ankle osteoarthrosis (p = 0.658). Conclusion: This study indicates that while percutaneous screw fixation of small posterior malleolus fragments does not significantly improve clinical outcomes compared to non-fixation, it does result in better radiological alignment. The findings suggest that maintaining joint congruity may be more crucial than fixation in preventing posttraumatic ankle osteoarthritis. Further research is needed to explore these findings.