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The Bone & Joint Journal
Vol. 99-B, Issue 11 | Pages 1496 - 1501
1 Nov 2017
Bali N Aktselis I Ramasamy A Mitchell S Fenton P

Aims

There has been an evolution recently in the management of unstable fractures of the ankle with a trend towards direct fixation of a posterior malleolar fragment. Within these fractures, Haraguchi type 2 fractures extend medially and often cannot be fixed using a standard posterolateral approach. Our aim was to describe the posteromedial approach to address these fractures and to assess its efficacy and safety.

Patients and Methods

We performed a review of 15 patients with a Haraguchi type 2 posterior malleolar fracture which was fixed using a posteromedial approach. Five patients underwent initial temporary spanning external fixation. The outcome was assessed at a median follow-up of 29 months (interquartile range (IQR) 17 to 36) using the Olerud and Molander score and radiographs were assessed for the quality of the reduction.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_19 | Pages 17 - 17
1 Nov 2016
Bali N Ramasamy A Mitchell S Fenton P
Full Access

Introduction

Fixation of posterior malleolar fragments associated with ankle fractures aims to stabilise the syndesmosis and prevent posterior subluxation. Haraguchi described 3 types of posterior malleolar fractures, with type 2 being a medial extension injury, these fractures often involve medial and posterior fragments. We describe the techniques and outcomes for a double window posteromedial approach allowing optimal reduction and stabilisation.

Methods

A retrospective review was performed at 2 units, Bristol Royal Infirmary and QE Hospitals Birmingham, between August 2014 and April 2016. Inclusion criteria were all patients having this posteromedial approach for closed ankle fracture fixation. Patients were assessed for complications and postoperative ankle function with the Olerud and Molander scoring system.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_21 | Pages 3 - 3
1 Apr 2013
Jackson J Parry M Mitchell S
Full Access

Introduction

Post-traumatic arthritis is the commonest cause of arthritis of the ankle. Development of arthritis is dependent on the restoration of pre-injury anatomy. To assess the effect of grade of lead surgeon on the accuracy of surgical reduction, we performed a retrospective radiographic analysis of all ankle fractures undergoing open reduction and internal fixation, in a single institution.

Method

All patients treated by surgical intervention in an 11 month period (January to November 2011) were included, with the grade of lead surgeon performing the operation recorded.105 patients, 48 males and 53 females, were included with a mean age of 41 years (range: 17–89). Standard antero-posterior (AP) and mortise views were analysed for tibiofibular overlap, ankle clear space and talocrural angle and compared to standardised values from the literature. Lead surgeon grade was stratified as either, trauma consultant, senior registrar (years 4+) or junior registrar (years 1–3).