J Korean Fract Soc.  2021 Jan;34(1):8-15. 10.12671/jkfs.2021.34.1.8.

Comparing Outcomes of Screw Fixation and Non-Fixation for Small-Sized Posterior Malleolar Fragment in Ankle Trimalleolar Fractures

  • 1Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea


This study was undertaken to compare outcomes of screw fixation and non-fixation of a small-sized posterior malleolar fragment involving less than 25% articular surface in ankle trimalleolar fractures.
Materials and Methods
A total of 32 consecutive ankles (32 patients), with posterior malleolar fragment involving 15%-25% of the joint surface, were enrolled in the study. Patients were divided into 2 groups according to whether the fragment was fixed or not (fixed: 20 ankles, non-fixed: 12 ankles). The minimum follow-up period was 12 months. Median size of the posterior malleolar fragment in the fixed and non-fixed groups were 24.6% (range, 22.3%-25.0%) and 22.1% (range, 17.4%-24.3%), respectively. Complications as well as clinical and radiographic outcomes were compared and analyzed between the two groups.
Clinical outcomes, including American Orthopaedic Foot & Ankle Society (p=0.501), visual analogue scale (p=0.578), and ankle range of motion (p=0.552), showed no difference between groups at the final follow-up. No differences were obtained in the radiographic outcomes, including joint stepoff (p=0.289) and fragment gap (p=0.289). Complications, including 1 case of delayed union and 1 case of wound infection, were reported in the fixed group.
Clinical outcomes and radiographic outcomes of the non-fixation group were satisfactory and comparable to the fixation group. Our results indicate that anatomical reduction with small-sized posterior malleolar fragment in ankle trimalleolar fractures is sufficient for satisfactory outcomes, without the need for additional internal fixation.


Ankle; Posterior malleolus fracture; Small-sized fragment; Screw fixation; Non-fixation
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