The Posterolateral Approach for the Treatment of Trimalleolar Fractures

Anatomical reduction and fixation, early functional treatment, and prevention of posttraumatic osteoarthritis are the utmost goals in the treatment of articular fractures in the lower extremity. Especially in articular fractures of the ankle, where a high load transfer is omitted through a very small area, anatomical reduction is crucial. Historically, ankle fractures with involvement of large posterolateral fragments (Volkmann triangle) were reduced by an indirect technique. This procedure may be technically demanding and can be associated with important exposure to teratogenic irradiation. Additionally, impacted articular fragments cannot be reduced, and very large fragments tend to dislocate secondarily, thus leading to bad results. An easy, safe, and fast alternative to the indirect reduction technique is the fixation under direct visual control of the posterior tibial margin. Therefore, we advocate the posterolateral approach for the reduction Volkmann triangle in complex fractures of the ankle joint. It allows stable fixation of the posterior key fragment of the tibia with its syndesmosis. Impacted articular fragments can be reduced, and by the placement of a posterior buttress plate, secondary dislocation can be avoided. By the same incision, the placement of a posterior antiglide plate to the fibula is possible, and through a simple maneuver, the approach to the medial malleolus is granted.