Direct Cannulated Screw Fixation of Bartoníček-Rammelt Type 2 and Type 3 Posterior Malleolar Fractures
Abstract
Introduction: The importance of the posterior malleolus in ankle stability has been demonstrated in numerous studies, and most authors agree that surgical fixation is indicated when the fragment involves more than 25-30% of the articular surface. However, the optimal fixation method remains controversial. Objective: To evaluate the mid-term outcomes of isolated fixation of posterior malleolar fractures using cannulated screws, with particular emphasis on functional recovery, joint stability, and complication rates. Materials and Methods: A retrospective study was conducted between January 2018 and December 2022. Inclusion criteria were age >18 years, posterior malleolar fractures treated exclusively with cannulated screws, and a minimum follow-up of 24 months. Clinical and radiographic evaluations were performed preoperatively and postoperatively. Results: Fifty-eight patients were included. The mean fragment size was 28.4% of the articular surface. Anatomic reduction was achieved in 82.7% of cases, with a union rate of 100%. At follow-up, ankle dorsiflexion was reduced by 25% and plantar flexion by 20%. The American Orthopaedic Foot & Ankle Society (AOFAS) score improved from 58.4 to 88.6, while the Visual Analog Scale (VAS) pain score decreased from 7.1 to 2.8. The overall complication rate was 17.2%. Conclusions: Direct fixation of the posterior malleolus with cannulated screws is an effective strategy for the management of these fractures, achieving high rates of anatomic reduction and a complication profile comparable to that of other fixation methods.Downloads
References
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