# Long-term outcomes after a trimalleolar fracture involving the posterior malleolar fragment: an 11-year follow-up

## TL;DR

This study compares long-term outcomes of ankle fracture patients who had surgery with and without fixation of a specific bone fragment, finding similar clinical results but more joint degeneration in the fixation group.

## Contribution

The study provides long-term follow-up data (11 years) comparing clinical and radiological outcomes of trimalleolar fractures with and without posterior malleolar fragment fixation.

## Key findings

- Fixation of the posterior malleolar fragment was associated with more advanced osteoarthritis but similar long-term clinical outcomes.
- There was no statistical difference in patient-reported outcome measures between fixation and non-fixation groups.
- Patients with fixation had larger posterior malleolar fragments and more postoperative complications.

## Abstract

We compared long term clinical and radiological outcomes of patients with trimalleolar ankle fractures including a posterior malleolar fragment (PMF) between those who underwent PMF fixation and those who did not. We also compared complication rates and identified independent risk factors associated with worse outcome.

We included 69 consecutive patients undergoing operation for a trimalleolar fracture between 2008 and 2013. Mean follow-up was 11.3 years. Patients completed the SF-12 and EFAS scores. Radiological osteoarthritis (OA) was assessed using the Kellgren-Lawrence classification. Postoperative complications were classified according to Sink. PMF size was measured on preoperative x-ray and CT and classified according to the Haraguchi classification.

The non-fixated group (n = 48) had a mean PCS score of 47.9, a mean MCS score of 54.1, a mean EFAS score of 17.1, and a mean EFAS-Sport score of 4.35. The fixated group (n = 21) had a mean PCS score of 49.2, a mean MCS score of 56.5, a mean EFAS score of 17.5, and a mean EFAS-Sport score of 6.05. There was no statistical difference between the two groups in the long term clinical PROMS. Patients in the fixated group developed more advanced OA (p = 0.013).

Patients who underwent PMF fixation had a larger PMF size, more complications and more advanced OA, but with similar long term clinical outcomes than the non-fixated group.

III, Retrospective comparative study.