Safety of the modified posteromedial approach in complex ankle fractures: Comparative analysis versus posterolateral access.

Autor: Porta J; Sanatorio Allende. Ciudad de Córdoba, Argentina., Toledo I; Sanatorio Allende. Ciudad de Córdoba, Argentina., Mangupli M; Sanatorio Allende. Ciudad de Córdoba, Argentina., Vazquez L; Sanatorio Allende. Ciudad de Córdoba, Argentina., Heredia N; Instituto Modelo de Cardiología, Ciudad de Córdoba, Argentina., Segura F; Instituto Modelo de Cardiología, Ciudad de Córdoba, Argentina; Centro Privado de Ortopedia y Traumatología. Ciudad de Córdoba, Argentina; Universidad Nacional de Córdoba, Nuevo Hospital San Roque. Ciudad de Córdoba, Argentina., Segura FP; Centro Privado de Ortopedia y Traumatología. Ciudad de Córdoba, Argentina; Universidad Nacional de Córdoba, Nuevo Hospital San Roque. Ciudad de Córdoba, Argentina; Universidad Católica de Córdoba. Ciudad de Córdoba, Argentina. Electronic address: fpablosegura@gmail.com.
Jazyk: angličtina
Zdroj: Injury [Injury] 2023 Nov; Vol. 54 Suppl 6, pp. 110858.
DOI: 10.1016/j.injury.2023.110858
Abstrakt: Introduction: The aim of the study was to evaluate the safety of the modified posteromedial approach (MfPM) in the surgical management of complex ankle fractures in terms of local complications.
Methods: Retrospective multicenter review of a series of malleolar fractures surgically treated by posterior ankle approaches between 2016 and 2022. Two approaches were used. In the MfPM group patients were placed in a prone position and the incision was made 1 cm medially to the Achilles tendon. In the posterolateral access (PL) group patients were placed in a prone or lateral decubitus position and the incision was made between the lateral malleolus and the Achilles tendon. Complications evaluated were divided into wound complications, infections, neuritis, vascular alterations and others.
Results: 81 ankle fractures with a posterior malleolar fragment treated by open reduction and internal fixation were identified. 20 cases were approached through the MfPM approach and 61 through the PL access. The mean follow up was 18.60 months (range 4-78 months). In the MfPM group the local complication rate was 10% (2/10 patients), both corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. In the PL group a complication rate of 8,19% (5/61 patients) was found, all of them corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. There were no significant differences between the two approaches regarding postoperative local complications (z score 0.249 - P: 0.803).
Conclusion: The MfPM approach is safe and may become as readily used as the PL due to the low incidence of postoperative local complications, especially in fractures with a large fragment and posteromedial extension in which greater access to the posterior pilon can facilitate instrumentation for anatomic reduction and fixation.
Competing Interests: Declaration of Competing Interest The authors have no relationship with any commercial company that has a direct financial interest in the subject or materials discussed in this article or that manufactures products for the market.
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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