RESUMO
Introduction: Optimal treatment of ankle fractures with posterior malleolus fragment is controversial. Posterior malleolus is signi?cant stabilizer preventing posterior subluxation of ankle. Posterior malleolus fracture have generally been neglected because of these fragment is considered to be reduce spontaneously after open reduction of the lateral malleolus by ligamentotaxis by posterior-inferior tibiofibular ligament. Fixation of this fragment is important in the role of ankle mechanics. We Objectives: compare in this study better surgical & functional outcome for this posterior malleolus fracture fixation by AP SCREW and PA SCREW Methods: We prospectively evaluated 30 patients (15 patients for AP screw fixation and 15 patients for PA screw fixation who underwent for fixation by anterior posterior screw by percutaneous method and posterior lateral approach for posterior anterior screw fixation. We assigned alternating patient who received AP SCREW fixation VS PA SCREW fixation based on order in which they presented to our institution.We use American Orthopedics foot and ankle society (AOFAS) score, range of motion of ankle and X-Ray finding. The mean Follow up was 15 Months(Range 12-20 Months). Full union without any loss of reduction was obtained in 27 out of 30 Result & Discussion: patients. As anterior posterior screw is a blind procedure, the risk of injury to anterior tibial artery & nerve, purchase of screws distal threads for fragment is debatable. In posterior plating better visualization of fragment and anatomy will help in better fixation of posterio malleoi fragment. Assessment of treatment outcome using the AOFAS demonstrated significant high score of 97.4 in group with posterior antero screw fixation with posterior lateral approach compare to score of 80 in group anterior posterior screw fixation. In com Conclusions: parison to the anterior-posterior screw fixation,open reduction and fixation of the, posterolateral key fragment of the ankle using posterolateral approach via Posterior anterior screw resulted in a more accurate fracture reduction outcome 12 months after surgery