Management of posterior malleolar fracture in Trimalleolar Pottrsquo;s ankle in focus of Haraguchi classification

Abstract

Background: The true incidence of posterior malleolar fractures (PMF) is not well established and occurs in 7 to 44% of all ankle fractures. There is no current consensus on when a PMF should be fixed. The aim of this work was to evaluate the "predictive outcome value" of Haraguchi classification after surgical management of posterior malleolar fractures. Methods: This prospective randomized study was conducted on 30 patients aged from 18 to 65 years old, both sexes, with trimalleolar ankle closed fractures. Patients were further subdivided according to Haraguchi classification of fractures into three types: (1) the posterolateral-oblique type (2) the medial-extension type extended to the anterior part of the medial malleolus, and (3) the small-shell type. Patients were assessed after 6 weeks clinically according to American Orthopedic Foot and Ankle Society (AOFAS) and radiologically and final follow up visit was 2 years after surgery. Results: Pre- and post-operative AOFAS score and preoperative pain score were insignificantly different among the different types of fractures. Post-operative pain score was significantly lower in type I fracture compared to type III fracture (p-value =0.005) and was insignificantly different between types I and III. Conclusion: CT scan is recommended for all ankle fractures with high energy trauma. Haraguchi classification guides the proper fixation of the posterior mallolar fragment and predicts the outcome. The surgical treatment provided positive outcomes in terms of improved AOFAS scores and reduced pain scores postoperatively, but Haraguchi type-II posterior malleolar fractures showed significantly poorer foot and ankle outcomes.