Posterior versus lateral plating of lateral malleolus fractures using a posterolateral approach

Aim We compared the clinical outcomes of fixing lateral malleolus fractures with lateral or posterior plating in combined lateral and posterior malleolar ankle fractures. Methods We randomized thirty patients with ankle fractures involving the posterior and lateral malleoli into two groups. In group 1, we dissected laterally, raising a lateral skin and subcutaneous flap to allow lateral fixation of the lateral malleolus. In group 2, we did not raise the flap fixing the lateral malleolus posteriorly by deep dissection and retracting the peroneal tendons laterally. During the follow-up period, we assessed pain at six months and at the end of the follow-up, ankle range of motion, wound complications, reoperation rates, fracture union, implant failure, and foot and ankle disability index (FADI). Results The mean follow-up period was 24.33 months. The mean age of the included participants was 41.76 ± 7.3 years. The mean visual analogue score VAS score at six months follow-up was 2.13 ± 0.54 in group 1 and 3.6 ± 0.76 in group 2, which decreased to one in group 1 and two in group 2 at the end of follow-up. The mean FADI was 89.8 ± 3.76 in group 1 and 90.7 ± 2.45 in group 2. The reoperation rate was 6.6% in group 1 and 26.6% in group 2 Fixation of all posterior malleolus fractures was done in all patients, union was achieved with no complications. Conclusion There is no clinical difference between lateral and posterior plating of the lateral malleolus through the posterolateral approach.