Percutaneous fixation of posterior malleolar fractures in patients with unstable ankle fractures treated with a fibular intramedullary nail: a description of a technique and review of outcomes.

Objectives (1) To describe the percutaneous technique used to reduce and fix a posterior malleolar fracture with anteroposterior (AP) screws in patients managed with a fibular intramedullary nail, (2) describe the selection of patients to whom this technique can be applied, and (3) report the clinical and patient reported outcome of this intervention. Design Retrospective review. Setting Academic orthopaedic trauma center. Patients Thirty-two consecutive patients with a mean age of 65 years (range, 39-90) over a thirteen-year period identified from a prospective database. Intervention Unstable ankle fractures managed surgically with a fibular nail and percutaneous fixation of the posterior malleolar component. Main outcome measurements The primary short-term outcome was complications related to posterior malleolar fracture fixation. The primary mid-term outcome was the Olerud-Molander Ankle Score (OMAS). Secondary outcomes included the Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol-5D (EQ-5D), health, pain and satisfaction. Results Thirty of the 32 (94%) posterior malleolar fractures united uneventfully. Post-operative loss of talar reduction occurred in two patients (6.3%), which in one patient (3.1%) eventually required a hindfoot nail arthrodesis. There were no soft tissue complications related to the AP screws or the fibular nail fixation. At a mean follow-up of 3.7 years (range, 1-8) the median OMAS, MOXFQ, EQ-5D, health, pain and satisfaction scores were 80.0, 23.4, 0.85, 80.0, 85.0 and 87.5 respectively. Conclusion Percutaneous ankle fracture fixation with a fibular nail and posterior malleolar screws results in reliable fracture stabilisation, good patient outcomes and high treatment satisfaction. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.