Selection of Internal Fixation Method for Posterior Ankle Fracture

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Jun-bo Tu et al.

Abstract

Ankle fracture is one of the common lower limb fractures in clinic. Clinically, simple posterior malleolus fractures are unique, accounting for about 1% of ankle fractures [1, 2]. However, ankle fractures with posterior ankle fractures accounted for 14-44% [3, 4]. Some researchers found that compared with patients with ankle fracture without posterior malleolus, patients with posterior malleolus fracture had worse postoperative effect and higher risk of traumatic ankle arthritis. There are still many controversies about the surgical indications and internal fixation methods of posterior malleolus fractures. Presently, the widely accepted surgical indications for posterior malleolus fractures include: posterior malleolus fractures involving more than 25% of the articular surface, fracture block displacement more than 2 mm, ankle instability or posterior superior talar dislocation [11-13]. In clinical application, the internal fixation methods of posterior malleolus fracture mainly include lag screw fixation and supporting plate fixation. The results of biomechanical model experiment in vitro and finite element analysis of mechanical model showed that the most stable fixation strategy was the back support plate [14, 15]. However, so far, there is no clear standard about whether all posterior malleolus fractures need plate fixation [10, 14]. Most of the present studies have discussed the surgical indications of posterior malleolus fracture, but the clinical reports of individualized selection of posterior malleolus fixation are rare. Biomechanical theory proved that the size of the posterior malleolus is the key to fixation [14]. In clinical work, some surgeons advocate the use of high-strength plate fixation, and some surgeons prefer to use minimally invasive screw fixation. In addition, according to the experience of the surgical team, some surgeons fixed the smaller posterior malleolus with 2-3 screws and fixed the larger posterior malleolus with plates. Specifically, there are few clinical reports about the standard of bone block size and the choice of internal fixation.

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