Posterior Malleolar Fracture Fixation with Plate and Screws- Case Series

Background: Posterior malleolar fractures are complex injuries that can significantly impact ankle function. While various fixation methods exist, the optimal treatment remains debated. This study aims to evaluate the outcomes of posterior malleolar fracture fixation using plates and screws. Methods: A retrospective case series of 10 patients with posterior malleolar fractures treated surgically was conducted. All fractures were fixed using distal end radius locking plates and screws through either a posterolateral or posteromedial approach. Patient demographics, injury characteristics, surgical details, and outcomes were analyzed. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 months post-operatively. Secondary outcomes included time to union and complications. Results: The mean age of patients was 40.6 years (range 28-55), with an equal gender distribution. Road traffic accidents were the most common mechanism of injury (50%). The mean time to union was 13.2 weeks (range 11-16). The mean AOFAS score at 6 months was 87.4 (range 82-92), indicating good to excellent functional outcomes. Complications occurred in 40% of cases, including superficial wound infection (10%), delayed union (10%), mild ankle stiffness (10%), and hardware irritation (10%). One case (10%) potentially required reoperation for hardware removal. Conclusion: Plate and screw fixation of posterior malleolar fractures can achieve satisfactory short-term radiological and functional outcomes. However, the non-trivial complication rate highlights the complexity of these injuries. While our results are promising, longer-term follow-up and larger comparative studies are needed to definitively establish the optimal fixation method for posterior malleolar fractures.