Posterior malleolus fixation in trimalleolar fractures: comparison of functional outcomes of plate and screw methods

Abstract

Aims: This study was planned to compare the clinical outcomes of plate and cannulated screw fixation methods for the posterior malleolus (PM) component in trimalleolar ankle fractures and to evaluate the effect of the time from trauma to surgery and the presence of dislocation on postoperative function. Methods: This retrospective study included 44 patients who underwent surgical treatment with PM fixation for trimalleolar fractures between 2019 and 2023. Patients were grouped by fixation method: screw (n=19) and plate (n=25), with all surgeries performed via a posterolateral approach. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at 6, 12, and 24 months. The presence of ankle dislocation and time from trauma to surgery (<24 vs. >24 hours) were recorded. Results: AOFAS scores showed no significant difference between plate and screw groups at any time point (p>0.05). However, patients with dislocation had significantly lower scores at all follow-ups (p<0.05). Timing of surgery had no significant effect on outcomes. Loss of reduction was rare (n=2). Conclusion: Plate and screw fixation yield comparable functional outcomes in PM fractures. Dislocation negatively impacts recovery, while surgical timing does not. Emphasis should be placed on anatomical reduction and addressing prognostic factors for optimal results.

Keywords

• Cannulated screw
• plate fixation
• posterior malleolus
• trimalleolar fracture

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