Does Fragment-Specific Fixation Provide Better Functional Outcomes Following Trimalleolar Ankle Fractures?

BackgroundFractures to the ankle account for nearly 10% of all fractures. The trimalleolar configuration of ankle fracture is a notoriously unstable injury encompassing injury to the medial, lateral, and posterior malleolus, often occurring as a result of rotational force to the ankle. Historically, poorer outcomes have been associated with fractures of the posterior malleolar component, which were broadly categorized as a single homogenous group. Recent advancements and greater appreciation of fracture pathomechanisms have aided fragment classification and hence tailored fixation. Aims. Our study compares the post-operative functional outcomes following novel fragment-specific plating (Volition) against conventional plating during the surgical fixation of trimalleolar ankle fractures. Post-operative functional outcomes were measured at 12 months using the Foot and Ankle Disability Index (FADI) and Manchester-Oxford Foot Questionnaire (MOXFQ) as patient-reported outcome measures (PROMs).MethodsWe conducted a retrospective cohort study of patients admitted to our orthopaedic department for a corrective surgery following a trimalleolar ankle fracture. Each fracture was confirmed via computed tomography (CT) imaging and corrected using either fragment-specific or conventional plating. Post-operatively, patients were followed up functionally and radiologically.ResultsOur study included 22 matched pairs of patients, each of who required surgical fixation for a trimalleolar ankle fracture. The FADI and MOXFQ questionnaires were conducted to assess functional outcomes during the post-operative period. The PROM data indicated that there were statistically significant superior outcomes in both the activity and pain subscales of the FADI (P > .05). However, no significant differences were observed in the MOXFQ scores.ConclusionThis study concludes that fragment-specific plating of the posterior malleolar component provides superior functional outcomes in terms of pain and activity levels following trimalleolar ankle fractures, as measured by the FADI. Larger studies with longer follow-up are needed to confirm these results and guide standardized treatment protocols.Level of Evidence:Level 2.