Aims
There has been an evolution recently in the management of unstable fractures of the ankle
with a trend towards direct fixation of a posterior malleolar fragment. Within these
fractures, Haraguchi type 2 fractures extend medially and often cannot be fixed using a
standard posterolateral approach. Our aim was to describe the posteromedial approach to
address these fractures and to assess its efficacy and safety.
Patients and Methods
We performed a review of 15 patients with a Haraguchi type 2 posterior malleolar fracture
which was fixed using a posteromedial approach. Five patients underwent initial temporary
spanning external fixation. The outcome was assessed at a median follow-up of 29 months
(interquartile range (IQR) 17 to 36) using the Olerud and Molander score and radiographs
were assessed for the quality of the reduction.
Results
The median Olerud and Molander score was 72 (IQR 70 to 75), representing a good
functional outcome. The reduction was anatomical in ten, with a median step of 1.2 mm
(IQR 0.9 to 1.85) in the remaining five patients. One patient had parasthaesiae affecting the
medial forefoot, which resolved within three months.
Conclusion
We found that the posteromedial approach to the ankle for the surgical treatment of
Haraguchi type 2 posterior malleolar fractures is a safe technique that enables good
visualisation and reduction of the individual fracture fragments with promising early
outcomes