The functional and radiographic outcome of fixation of trimalleolar fracture: A prospective study

Background: Ankle injuries gain importance because body weight is transmitted through it and locomotion depends upon the stability of this joint. Trimalleolar fractures are one of the most complex fractures around ankle. As with all intra articular fractures, trimalleolar fractures necessitate reduction and stable internal fixation. The purpose of this study is to assess the functional and radiographic outcome and results of surgical treatment of trimalleolar fractures by specific modalities. To attain a proper anatomical alignment and stability of ankle joint and further applying a syndesmotic screw if needed. Materials and methods: A prospective review was conducted for 28 patients between January 2018 to December 2019 with closed trimalleolar fracture. Open reduction and internal fixation were done with specific modalities. Patients were evaluated with subjective and objective assessments of the patients’ ankles were done using a modification of the scoring system proposed by Olerud and Molander and radiologically by Kristenson criteria. The functional and radiographic outcome of ORIF and advantages of the procedures were recorded. Functional and radiographic evaluations were performed at immediate post op, 6 weeks, 3 months and 6 months, 1 year after surgery. At each follow up, patients were assessed for syndesmotic reduction, loss of fixation, and implant failure and any arthritis changes. The reduction in quality was evaluated on immediate postoperative radiography. Results: In the present study of 28 patients with trimalleolar fractures treated by open reduction and internal fixation. Excellent results were achieved in 23 (82.1%) patients, good in 4 (14.3%), and poor in 1 (3.6%) patient. The patient with poor result had mild pain with activities of daily living, diminution in the abilities to run and to do work, reduced motion of ankle and narrowing of joint space. Conclusions: Operative treatment for trimalleolar fractures results in good functional and radiographic outcome postoperatively. Anatomical reduction of the fracture is associated with better functional outcome. Early treatment without delay, anatomic reduction and fracture fixation, stringent postoperative mobilization and rehabilitation should help improve outcome in an operated trimalleolar fracture.