10 Years of Data on Trimalleolar Fractures: Imaging and Fixation Trends

What are the trends in utilizing preoperative computed tomography and various fixation approaches when surgeons need to address a trimalleolar ankle fracture? A study in Foot and Ankle Orthopaedics took on the task of answering this question.¹

In a retrospective cohort study, the authors gathered data on preoperative CT scans, along with rates for posterior and syndesmotic fixation in these injuries.¹ They included information from 1,191 patients over a 10-year time frame at an adult, level-1 trauma center. Inclusion encompassed Orthopaedic Trauma Association (OTA)/AO classifications of 44B3, 44C3.3, 44C1.3, 44C2.3 and 44A3, using a fracture registry and CPT codes.

Within the group studied, they collected data on use of preoperative CT, demographics, comorbidities, and fixation methods.¹ Then, comparative analyses allowed for review of changes in demographics, trends in preop CT usage, and fixation types year over year.  OTA/AO Fracture type 44B3.2 was the most common in the study population.¹ The rate of posterior fixation did not significantly increase in the time interval (average 1.4% per year). However, the rate of syndesmotic fixation increased by 2.58% per year and the rate of preoperative CT usage increased by 2.76% per year.¹

The authors note current controversies in approaches to the posterior malleolar component of trimalleolar ankle fractures.1 They also state that preoperative CT images may help surgeons better understand details of fracture morphology and could contribute to management decisions. They contend that this descriptive study aims to serve as a basis for further research on indications for posterior and syndesmotic fixation and overall evaluation of impact on outcomes. Specifically, they say that recent emergence of flexible fixation devices for the syndesmosis may also be a contributor to this study’s observation on the increase in syndesmotic fixation rates.¹

Reference

1. Kocan J, Joseph E, Mercado P, Haider MN, Pavlesen S, Rohrbacher B. Computed Tomography Scans and Fixation Rates for Trimalleolar Ankle Fractures Over 10 Years at a Level 1 Trauma Center. Foot Ankle Orthop. 2024;9(1):24730114231216984. doi: 10.1177/24730114231216984.