Long-term outcomes after a trimalleolar fracture involving the posterior malleolar fragment: an 11-year follow-up

PMCID: PMC12176937

PMID: 40531350

DOI: 10.1007/s00402-025-05959-w

Journal: Archives of orthopaedic and trauma surgery

Publication Date: 2025-6-18

Authors: Chidda A, Soares S, Tannast M, Schwab J, Seidel A

Key Points

• PMF fixation did not improve long-term clinical outcomes in trimalleolar ankle fractures
• Fixated group had significantly larger PMF sizes (lateral x-ray: 30.1% vs 20.6%, p<0.001)
• Clinicians should carefully consider the potential risks and limited benefits of PMF fixation

Summary

This retrospective comparative study examined long-term clinical and radiological outcomes of trimalleolar ankle fractures with posterior malleolar fragment (PMF), comparing patients who underwent PMF fixation versus those who did not. The 11.3-year follow-up study included 69 patients, analyzing clinical outcomes through SF-12 and EFAS scores, and radiological progression using Kellgren-Lawrence osteoarthritis (OA) classification.

Surprisingly, despite patients in the PMF fixation group having larger fragment sizes and more complications, there were no statistically significant differences in long-term clinical outcomes between fixated and non-fixated groups. However, the fixated group demonstrated more advanced OA progression (p=0.013), suggesting that PMF fixation may not provide definitive long-term functional advantages and could potentially accelerate joint degeneration.