Muslim Aqeel Abbas

Department of Surgery and Orthopedic, College of Medicine, Wasit University, Iraq

Abstract 

Background: Tri-malleolar injuries are complicated injuries, which entail a combination of medial, lateral
(fibular), and posterior malleoli injury. In their treatment, they need operative fixation to provide the
restoration of congruity within the articular structures and help to prevent post-traumatic osteoarthritis.
Posterior malleolus The posteromedial approach to the distal tibia exposes the posterior malleolus directly
with minimum disruption of adjacent soft-tissue.
Objective: The aim was to compare the clinical and functional outcome of tri-malleolar fracture treated
surgically through posteromedial approach to the distal tibia.
Methods: A retrospective study was carried out with 17 patients who have been operated with the fixation
during the period of January 2022 to December 2024. Some of the variables that were analysed were the
length of the operation, period of follow-up, pre and post operative AOFAS ankle-hindfoot scores, VAS
pain scores (rest, and ambulation), age of patient, and sex. Paired t-tests and Pearson correlation
coefficients were used with Statistical IBM SPSS v.26.
Results: the average operating time recorded was 64.1/6.8 minutes with a follow up being 12.8/2.2
months. The AOFAS scores were significantly better during the postoperative period measured at 81.43
± 4.7 compared with 38.53 during the preoperative period, which is an improvement of 42.92 with a
standard deviation of 5.3. The rest and walking VAS scores were 0.35 and 0.94 respectively. No
significant complications were noted.
Conclusion: The posteromedial method of the distal tibia is a safe, effective, and reproducible method of
treating tri-malleolar fractures that provides remarkable functional outcome and has minimal post
operative pain.

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