Abstract：Objective To evaluate the outcome of posterolateral approach to the fibula for trimalleolar fractures, especially the fracture in posterior malleolus. Methods Thirty-two patients with trimalleolar fractures treated via posterolateral transmalleolar approach from July 2006 to July 2011 were analyzed retrospectively. All underwent open reduction and internal fixation, including 22 Lauge-Hansen grade Ⅳ supination-external rotation ankle fractures and 10 Lauge-Hansen grade Ⅳ pronation-external rotation ankle fractures. Results All fractures had bone union after the follow-up of average 15.5 months (range, 12-18 months). Average American Orthopedic Foot & Ankle Society (AOFAS) score was 90.75 points, suggesting an excellent result. Kellgren grading system for posttraumatic arthritis severity was grade 0 in eight patients, grade Ⅰ in 18, grade Ⅱ in five, and grade Ⅲ in one, which turned out to be satisfactory. Conclusions Posterolateral approach to the fibula for trimalleolar fractures allows direct reduction and fixation of posterior malleolus fragment in treatment of trimalleolar factures and the clinical outcome is satisfactory. Moreover, the approach deserves clinical practice.
DONG Jing-ming,TIAN Xu,MA Bao-tong. Treatment of trimalleolar factures through posterolateral transmalleolar approach[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(6): 536-540.
［2］Koval KJ, Lurie J, Zhou W, et al. Ankle fractures in the elderly: what you get depends on where you live and who you see. J Orthop Trauma, 2005, 19（9）:635-639.
［4］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.
［5］McKinley TO, Rudert MJ, Tochigi Y, et al. Incongruity-dependent changes of contact stress rates in human cadaveric ankles. J Orthop Trauma, 2006, 20（10）:732-738.
［6］Warner WC, Farber LA. Trimalleolar fractures. South Med J, 1965, 58(10):1292-1295.
［7］Harold BK, Ian JA, Robert SA, et al. AOFAS clinical rating system. American Orthopaedic Foot and Ankle Society Foot & Ankle International, 1994, 15(7):1-9.
［8］Kellgren JH, Lawrence JS. Radiographic assessment of osteoarthritis. Ann Rheum Dis, 1957, 16（4）:494-502.
［9］Brown TD, Johnston RC, Saltzman CL, et al. Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma, 2006, 20（10）:739-744.
［11］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.
［12］Carmont MR, Davies MB. Buttress plate stabilization of posterior malleolar ankle fractures: a familiar technique through an unfamiliar approach. Curr Orthop, 2008, 22（5）:359-364.
［13］Miller AN, Carroll EA, Parker RJ, et al. Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res, 2010, (468):1129-1135.
［14］Sheerin DV, Turen CH, Nascone JW. Reconstruction of distal tibia fractures using a posterolateral approach and a blade plate. J Orthop Trauma, 2006, 20（4）:247-252.
［15］Bhattacharyya T, Crichlow R, Gobezie R, et al. Complications associated with the posterolateral approach for pilon fractures. J Orthop Trauma, 2006, 20（2）:104-107.
