Clinical and radiological outcomes of surgical treatment using a posterolateral approach based on computed tomography-based fracture morphology in posterior malleolar fractures: A single-center retrospective analysis.

Authors

Cahit Ancar, Yavuz Onel

Published in

Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. Volume 32. Issue 9. Pages 1132-1140.

Abstract

The aim of this study was to evaluate the clinical and radiological outcomes of posterior malleolar fractures (PMFs) treated surgically via a posterolateral approach and to investigate the prognostic value of Bartoníček-Rammelt fracture morphology in predicting functional outcome, reduction quality, and osteoarthritis development.
In this single-center retrospective study, 61 patients with PMFs who were treated surgically via a posterolateral approach between January 2020 and December 2023 and had a minimum follow-up of 24 months were included. Fractures were classified ac-cording to the Bartoníček-Rammelt classification (BRC). Clinical outcomes were assessed using the Olerud-Molander Ankle Score (OMAS), while radiological outcomes were evaluated based on articular step-off and the Kellgren-Lawrence osteoarthritis grade. Multivariable linear regression analysis was performed to identify independent predictors of functional outcome.
The mean follow-up duration was 38.2±8.8 months. The mean OMAS was 89.9±10.2. Articular step-off was <1 mm in 82.0% of the patients. OMAS scores differed significantly among the BRC fracture types (p=0.039), with lower scores observed in more complex fracture patterns. In the adjusted multivariable regression model including fracture morphology, articular step-off, osteoar-thritis grade, syndesmotic fixation, and post-operative complications, articular step-off (p<0.001) and osteoarthritis grade (p<0.001) remained independent predictors of OMAS, whereas fracture morphology was not independently associated with functional outcome.
Bartoníček-Rammelt fracture morphology was associated with functional outcome in unadjusted analyses. How-ever, after adjustment for articular reduction quality, osteoarthritis grade, syndesmotic fixation, and post-operative complications, fracture morphology was not independently associated with OMAS. Articular reduction quality and osteoarthritis grade were the strongest independent determinants of functional outcome, emphasizing the importance of achieving anatomical reduction in PMFs.

PMID:
42703663
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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