Analysis of Functional and Radiological Outcome of Posterior Malleolus Fixation in Trimalleolar Fractures of Ankle: A Prospective Study

Background: Trimalleolar fractures of the ankle involving the posterior malleolus represent complex injuries that significantly impact ankle stability and function. Despite advancements in orthopedic surgery, the role and method of fixation of the posterior malleolus remain subjects of ongoing debate. Objective: This study aimed to evaluate the functional and radiological outcomes of posterior malleolus fixation in trimalleolar fractures, comparing outcomes between screw and plate fixation techniques. Materials and Methods: A prospective analytical study was conducted on 40 patients presenting with trimalleolar ankle fractures, treated between October 2022 and September 2024 at a tertiary care trauma center. All patients underwent posterior malleolus fixation using either cannulated cancellous screws or plates. Clinical and radiological outcomes were assessed at regular intervals using radiographs and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Patients were followed for a minimum of 12 months postoperatively. Results: The study population had a mean age of 45.78 years, with males constituting 75% of the cohort. The most common mechanism of injury was a road traffic accident (72%). The average time for radiological union was 11.15 ± 1.5 weeks. AOFAS scores indicated excellent outcomes in 67.5% of patients, good in 22.5%, and fair in 10%. Posterior malleolus fixation with plates was associated with a significantly higher proportion of excellent outcomes compared to screw fixation ( P = 0.035). Conclusion: Posterior malleolus fixation plays a critical role in achieving optimal outcomes in trimalleolar ankle fractures. Plate fixation offers superior functional results over screw fixation in selected cases. Tailored surgical planning based on computed tomography evaluation of fragment size and morphology enhances outcomes and minimizes complications.