Surgical treatment of Bartoní?ek type Ⅲ posterior malleolar fractures with anatomic locking plate fixation through a modified posteromedial approach
Objective To evaluate clinical and radiological outcomes of Bartoníček type Ⅲ poste-rior malleolar fractures that were fixed with a posterior locking plate by the modified posteromedial ap-proach.Methods The study enrolled 20 patients of Bartoníček type Ⅲ posterior malleolar fractures trea-ted from January 2019 to October 2023 in Yixing People's Hospital.There were 9 males and 11 females,aged 26-76 years(49.3±12.3)years.All underwent open reduction and internal fixation via the modified posteromedial approach with an anatomical locking compression plate.Postoperatively,the reduction quali-ty of the joint surface was evaluated by Burwell-Charnley's radiological evaluation system.Clinical out-comes were evaluated by the American orthopaedic foot and ankle society(AOFAS)ankle-hindfoot score and visual analogue scale(VAS).Posttraumatic arthritis and objectively quantified was assessed using the Domsic grading scale.The quantitative data conforming to normal distribution was expressed as mean±standard deviation((x)±s),and categorical data was expressed as number of cases.Results The incision healed in all patients.All patients were followed up for 12-36 months(15.5±5.4)months.According to the Burwell-Charnley radiological criteria,anatomical reduction was achieved in 18 cases and good in 2.The fracture healing time ranged from 12-24 weeks(12.7±3.3)weeks.At the last follow-up,the AOFAS ankle-hindfoot score ranged 71 to 100 points(88.9±7.3)points.Excellent results were found in 13 pa-tients,good in 5 and fair in 2,with the excellent-good rate of 90%(18/20).The VAS score ranged from 0 to 3 points(1.1±1.1)points.4 patients had radiographic evidence of posttraumatic ankle arthritis.According to the Domsic grading scale criteria,there were grade Ⅰ in 3 cases and Ⅱ in 1 case.There were no infection,nonunion and implant failure.Conclusion The modified posteromedial approach with distal locking plate internal fixation for Bartoníček type Ⅲ posterior malleolar fractures can result in simul-taneous exposure and reduction of posteromedial and posterolateral fragments of posterior malleolus,excel-lent anatomical reduction of the displaced fragment from the tibial plafond,persistent maintenance of joint stability and achievement of satisfactory clinical outcomes.