Clinical And Radiological Comparison between Direct Fixation vs. Indirect Fixation in posterior malleolus Fractures

Background: Fractures involving the posterior malleolus (PM) have a higher incidence of traumatic arthritis and poorer prognoses compared to those without such involvement. The aim of this work was to determine the optimal method of fixation for treating PM fractures. Methods: This prospective, case series study was carried out on 40 patients aged from 18 to 65 years old, both sexes, underwent surgical management for trimalleolar ankle fractures. Patients were divided into two equal groups: Group I: Treated with anterior-to-posterior (AP) screw fixation using an indirect reduction technique and Group 2: Treated with posterior-to-anterior (PA) screw fixation or plate using direct reduction via a posterolateral approach. Results: Regarding postoperative, follow-up findings, short form (SF)-General Health was significantly higher in PA group than AP group (P=0.029). Operative time demonstrated a significant moderate negative correlation with American orthopedic foot and ankle society (AOFAS) scores in the PA group (r = -0.689, P = 0.001). The size of the PM showed a stronger negative correlation in the PA group (r = -0.485, P = 0.032) compared to the AP group (r = -0.322, P = 0.162). These findings suggest that operative time and PM size are more predictive of AOFAS outcomes in the PA fixation method. Conclusions: PM fracture fixation via the PA approach is an effective technique, with 95% of patients in the PA group achieving full range of motion and complete union, compared to 85% in the AP group.