Comparing Two Surgical Approaches for Fixing Posterior Malleolus Fragments in Ankle Fractures
This study looks at two accepted surgical approaches used to repair a specific part of the ankle-the posterior malleolus-in patients who have trimalleolar ankle fractures. In some patients, surgeons directly fix the broken piece of bone in the back of the ankle. In others, surgeons use indirect techniques to reduce and stabilize the fragment without directly exposing it. Both methods are commonly used today, but it is not known which leads to better stability and long‑term recovery.
Patients who require surgery and meet the study's criteria will be invited to participate. Before surgery, each person receives standard X‑rays and a CT scan, and fills out questionnaires about their daily function and overall health. During surgery, after the main ankle bones are fixed, the surgeon performs a series of stress tests on the ankle joint to see whether the syndesmosis-the ligaments between the tibia and fibula-needs to be stabilized. These tests are standard and help determine the best treatment for each patient.
The surgery itself and all choices about implants, positioning, and fixation are made by the treating surgeon based on their usual clinical practice. After surgery, patients return for checkups at about 6 weeks, 3 months, 6 months, and 12 months. At these visits, patients complete short surveys about pain, activity, and function, and receive routine X‑rays (except at the initial 2‑week wound check).
The goal of the study is to find out whether directly fixing the posterior malleolus fragment leads to better ankle stability, fewer complications, and improved function compared with indirect treatment. The study does not add extra costs, procedures, or risks beyond standard care. What we learn may help guide future treatment decisions and improve recovery for patients with this type of ankle fracture.