The efficacy of the posteromedial approach to the distal tibia in tri-malleolar fractures

Background: Tri-malleolar fractures are complex injuries involving all three malleoli (medial, lateral, and posterior) and require surgical fixation to restore joint congruity and prevent post-traumatic arthritis. The posteromedial approach to the distal tibia offers direct visualization of the posterior malleolus while minimizing soft tissue trauma. Objective: To evaluate the clinical and functional outcomes of tri-malleolar fractures reduced using the posteromedial approach to the distal tibia. Methods: A retrospective study was conducted on 17 patients treated surgically between 2022 and 2024. Data collected included operative time, follow-up duration, pre- and post-operative AOFAS scores, VAS pain scores at rest and during walking, gender, and age, Statistical analysis was performed using SPSS version 26. Paired t-tests were used to compare pre- and post-operative AOFAS scores. Pearson correlation was also performed. Results: The mean operative time was 64.1 minutes, with a mean follow-up of 12.8 months. There was a statistically significant improvement in AOFAS scores from a mean of 38.5 pre-operatively to 81.4 post-operatively (p