APPLICATION OF POSTEROLATERAL APPROACH FOR TREATMENT OF BIMALLEOLAR AND TRIMALLEOLAR FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PANZijie ¹ , CUIXiang ² , ZHUYanfeng ³ , QIHongzhe ² ,  CHENHua ² , TANGPeifu ²

1. Department of Surgery, No. 522 Military Hospital of Chinese PLA, Luoyang Henan, 471000. P. R. China;
2. Department of Orthopedics, General Hospital of Chinese PLA;
3. No. 2 Department of Orthopaedics, Hospital of Hebei Province Traditional Chinese Medicine (Hospital Affiliated to Hebei College of Traditional Chinese Medicine);

Corresponding author：

CHENHua, Email: chenhua0270@126.com

Keywords：

Ankle joint; Trimalleolar fracture; Bimalleolar fracture; Posterolateral approach

DOI：

10.7507/1002-1892.20160308

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Objective To evaluate the advantage of single posterolateral approach for exposing the fragments of lateral malleolus and posterior malleolus in treating bimalleolar and trimalleolar fractures. Methods Between January 2013 and June 2015, 47 patients with ankle fractures were treated. Of 47 cases, 16 were male and 31 were female with an average age of 47.7 years (range, 25-65 years); the locations were the left side in 21 cases and the right side in 26 cases. According to types system of Lauge-Hansen, 11 cases were rated as pronation-external rotation and 36 cases as supination-external rotation. There were 9 cases of bimalleolar fractures and 38 cases trimalleolar fractures. CT examination showed that posterior malleolus fracture involved more than 35% of the joint surface in 11 cases, and 9 cases had comminuted posterior malleolus fracture. Of 47 cases, 44 had fresh fractures with a mean disease course of 4 days (range, 8 hours to 7 days), and 3 had old fracture with the disease course of 43, 58, and 62 days respectively. Posterior malleolus fractures were fixed with T-type plates in 12 cases, one-third tubular plates in 10 cases, and cannulated screws in 25 cases. Results The operation time was 60-100 minutes (mean, 80 minutes); the bleeding volume was 50-100 mL (mean, 72 mL). Primary healing of incision was obtained in all patients, and no postoperative complications of infection, cutaneous necrosis, deep venous thrombosis, and sural nerve injury occurred. The CT examinations after operation showed anatomical reduction of fractures. All patients were followed up from 12 to 20 months (mean, 16 months). No fixation failure or reduction loss was found at last follow-up. All patients could walk normally. The active dorsiflexion of the affected ankles was within 5° less than normal side in 43 cases (91.5%) and 5-10° less than normal side in 4 cases (8.5%). The passive dorsiflexion of the affected ankles was within 5° less than normal side in 44 cases (93.6%) and 5-10° less than normal side in 3 cases (6.4%). According to the Olerud-Molander scoring system, the results were excellent in 40 cases, good in 5 cases, and fair in 2 cases; and the excellent and good rate was 95.7% at last follow-up. Conclusion The single posterolateral approach could simultaneously expose the fragments of lateral malleolus and posterior malleolus, with less complication of the incision, short operation time, and clear exposure of posterior malleolus. The surgery could be performed under direct vision. It especially is suitable for bimalleolar and trimalleolar fractures with lateral malleolus and posterior malleolus.

Citation： PANZijie, CUIXiang, ZHUYanfeng, QIHongzhe, CHENHua, TANGPeifu. APPLICATION OF POSTEROLATERAL APPROACH FOR TREATMENT OF BIMALLEOLAR AND TRIMALLEOLAR FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(12): 1488-1492. doi: 10.7507/1002-1892.20160308 Copy

1.	De Vries JS, Wijgman AJ, Sierevelt IN, et al. Long-term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg, 2005, 44(3):211-217.
2.	Fitzpatrick DC, Otto JK, McKinley TO, et al. Kinematic and contact stress analysis of posterior malleolus fractures of the ankle. J Orthop Trauma, 2004, 18(5):271-278.
3.	Michelson JD. Ankle fractures resulting from rotational injuries. J Am Acad Orthop Surg, 2003, 11(6):403-412.
4.	Langenhuijsen JF, Heetveld MJ, Ultee JM, et al. Results of ankle fractures with involvement of the posterior tibial margin. J Trauma, 2002, 53(1):55-60.
5.	S.Terry Canale, Jamas H.Beaty.坎贝尔骨科手术学.王岩, 唐佩福, 译. 12版.北京:人民军医出版社, 2014:2433-2434.
6.	张世民.骨折分类图表手册.北京:科学出版社, 2014:188-190.
7.	Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg, 1984, 103(3):190-194.
8.	Talbot M, Steenblock TR, Cole PA. Posterolateral approach for open reduction and internal fixation of trimalleolar ankle fractures. Can J Surg, 2005, 48(6):487-490.
9.	Minihane KP, Lee C, Ahn C, et al. Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone:a biomechanical study. J Orthop Trauma, 2006, 20(8):562-566.
10.	Schaffer JJ, Manoli A 2nd. The antiglide plate for distal fibular fixation. A biomechanical comparison with fixation with a lateral plate. J Bone Joint Surg (Am), 1987, 69(4):596-604.
11.	张俊, 沈燕国, 尹伟忠, 等.不同手术入路与体位在三踝骨折内固定手术中的应用.中国骨与关节损伤杂志, 2014, 29(6):565-567.
12.	Tornetta P 3rd, Ricci W, Nork S, et al. The posterolateral approach to the tibia for displaced posterior malleolar injuries. J Orthop Trauma, 2011, 25(2):123-126.
13.	Webb J, Moorjani N, Radford M. Anatomy of the sural nerve and its relation to the Achilles tendon. Foot Ankle Int, 2000, 21(6):475-477.
14.	Lawrence SJ, Botte MJ. The sural nerve in the foot and ankle:an anatomic study with clinical and surgical implications. Foot Ankle Int, 1994, 15(9):490-494.
15.	Lamontagne J, Blachut PA, Broekhuyse HM, et al. Surgical treatment of a displaced lateral malleolus fracture:the antiglide technique versus lateral plate fixation. J Orthop Trauma, 2002, 16(7):498-502.
16.	Weber M, Krause F. Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures:the effect of plate and screw position. Foot Ankle Int, 2005, 26(4):281-285.

1. De Vries JS, Wijgman AJ, Sierevelt IN, et al. Long-term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg, 2005, 44(3):211-217.
2. Fitzpatrick DC, Otto JK, McKinley TO, et al. Kinematic and contact stress analysis of posterior malleolus fractures of the ankle. J Orthop Trauma, 2004, 18(5):271-278.
3. Michelson JD. Ankle fractures resulting from rotational injuries. J Am Acad Orthop Surg, 2003, 11(6):403-412.
4. Langenhuijsen JF, Heetveld MJ, Ultee JM, et al. Results of ankle fractures with involvement of the posterior tibial margin. J Trauma, 2002, 53(1):55-60.
5. S.Terry Canale, Jamas H.Beaty.坎贝尔骨科手术学.王岩, 唐佩福, 译. 12版.北京:人民军医出版社, 2014:2433-2434.
6. 张世民.骨折分类图表手册.北京:科学出版社, 2014:188-190.
7. Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg, 1984, 103(3):190-194.
8. Talbot M, Steenblock TR, Cole PA. Posterolateral approach for open reduction and internal fixation of trimalleolar ankle fractures. Can J Surg, 2005, 48(6):487-490.
9. Minihane KP, Lee C, Ahn C, et al. Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone:a biomechanical study. J Orthop Trauma, 2006, 20(8):562-566.
10. Schaffer JJ, Manoli A 2nd. The antiglide plate for distal fibular fixation. A biomechanical comparison with fixation with a lateral plate. J Bone Joint Surg (Am), 1987, 69(4):596-604.
11. 张俊, 沈燕国, 尹伟忠, 等.不同手术入路与体位在三踝骨折内固定手术中的应用.中国骨与关节损伤杂志, 2014, 29(6):565-567.
12. Tornetta P 3rd, Ricci W, Nork S, et al. The posterolateral approach to the tibia for displaced posterior malleolar injuries. J Orthop Trauma, 2011, 25(2):123-126.
13. Webb J, Moorjani N, Radford M. Anatomy of the sural nerve and its relation to the Achilles tendon. Foot Ankle Int, 2000, 21(6):475-477.
14. Lawrence SJ, Botte MJ. The sural nerve in the foot and ankle:an anatomic study with clinical and surgical implications. Foot Ankle Int, 1994, 15(9):490-494.
15. Lamontagne J, Blachut PA, Broekhuyse HM, et al. Surgical treatment of a displaced lateral malleolus fracture:the antiglide technique versus lateral plate fixation. J Orthop Trauma, 2002, 16(7):498-502.
16. Weber M, Krause F. Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures:the effect of plate and screw position. Foot Ankle Int, 2005, 26(4):281-285.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF POSTEROLATERAL APPROACH FOR TREATMENT OF BIMALLEOLAR AND TRIMALLEOLAR FRACTURES

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