Posterior Malleolar Fragment Fixation in Trimalleolar Fractures
- kshepherd72
- Aug 6, 2025
- 1 min read
Guidelines for managing posterior malleolar fragments (PMFs) in trimalleolar fractures are limited, particularly concerning the fixation of medium-sized fragments (5–25%). One study aims to address this gap.
Study design
Key aspects of the study’s design include:
A multicenter randomized control trial conducted from 2014–2022 across two Dutch trauma centers (NCT02596529).
81 patients with AO-44-B3 fractures randomized ORIF (FIX, n=41) and no fixation (NO-FIX, n=40).
The primary outcome measured was one-year American Academy of Orthopaedic Surgeons functional score.
Secondary outcomes included assessments of osteoarthritis (OA), pain, health status, step-off, and complications.
Results
The study revealed key findings on the functional and health outcomes for patients with AO-445-B3 fractures treated with different approaches.
Function: No significant difference (AAOS: FIX 90 vs. NO-FIX 93; p=0.141)
OA: Comparable (FIX 17% vs. NO-FIX 20%; p=0.763)
Pain: Higher after fixation (median 20 vs. 10; p=0.032)
Health: Similar (80 vs. 83; p=0.596)
Step-off >1 mm: FIX 56% vs. NO-FIX 71% (p=0.193)
Complications: More in FIX (18% vs. 5%; p=0.071)
Fixation of medium-sized PMFs did not improve function or radiographic outcomes at one-year and showed higher pain and complications. Further follow-up is needed to assess potential delayed benefits.





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