Posterior Malleolar Fragment Fixation in Trimalleolar Fractures

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.