Comparison Of The Efficacy Of Modified Posterior Medial Approach And Posterior Lateral Approach In The Treatment Of Posterior Malleolus Fracture

Objective: To investigate the clinical effect of modified posterior medial approach and posterior lateral approach in the treatment of posterior malleolus fracture.Methods: A total of 72 patients with posterior ankle fracture who met the experimental criteria were selected and randomly divided into modified posteromedial approach group(improved group)and posterolateral approach group(control group)according to the surgical approach.Preoperative waiting time,operative time,intraoperative blood loss,intraoperative fluoroscopy times,postoperative hospital stay,fracture healing time,full weight bearing time and complications were compared between the two groups.Functional assessment was performed using the American Society of Foot and Ankle Surgery(AOFAS)scoring system and The efficacy of the treatment was evaluated by the Kofoed scale of joint function.Results: In the end,63 patients were followed up for at least 12 months(mean follow-up was 12-24 months).The operative time,intraoperative fluoroscopy times,fracture healing time and full weight bearing time in the modified group were significantly better than those in the control group(P<0.001).However,there were no significant differences in preoperative waiting time,blood loss and postoperative hospital stay between the two groups(P>0.05).The AOFAS score of the improved group was slightly higher than that of the control group(90.2 vs 88.5,P=0.247).Ankle function scores were also slightly higher than those in the control group(88.9 vs 85.8,P=0.20).The incidence of postoperative complications was lower in the modified group than in the control group(6.7% vs 12.1%;OR was 0.52,95%CI was0.09-3.06),but there was no significant difference between the two(P=0.461).Conclusions: The improved posteromedial approach and the posterolateral approach were similar in the treatment of posterior malleolus fractures.However,the modified posterior medial approach is characterized by less operative time,faster recovery of fracture healing and ankle function,and lower rates of incision complications.The application of modified posterior medial approach in surgery can improve the quality of life of patients and can be popularized in clinical work.