Comparison of Functional Outcome Between AP Lag Screws Versus Posterior Buttress Plating for Posterior Malleolar Fixation in Tri-Malleolar Ankle Fracture

Abstract

Background: Posterior malleolar fracture occurs commonly in up to 44% of all ankle fractures. Anterior to posterior lag screw or posterior buttress plate techniques are usually practiced for the operative management of such fractures. This study aimed to compare the functional outcome between anterior to posterior (AP) lag screw versus posterior buttress plating for posterior fixation in tri-malleolar ankle fracture. Methods and materials: This quasi-experimental study was conducted at the Department of Orthopedics & Traumatology, Chittagong Medical College Hospital, Chattogram, Bangladesh from November 2020 to October 2021. The study included 28 patients with ankle fractures, divided into two groups of 14 cases each. Group A received anterior to posterior (AP) lag screw fixation, while Group B underwent posterior buttress plating. Data analysis was performed using MS Office tools and SPSS version 23.0. Result: No statistically significant differences were observed in age (p = 0.64), gender (p = 1.0), or fracture type (p = 0.71) between the AP and posterior buttress plating groups. AOFAS scores showed significant correlations for pain (p = 0.045) and function (p = 0.019). Group A (AP lag screw) had satisfactory functional outcomes in 57% of cases, while Group B had 86% satisfaction. The range of motion in the affected ankle did not significantly differ between the two groups. Conclusion: In terms of AOFAS scores and functional outcomes, the buttress plating method for posterior fixation shows certain advantages over the anterior-to-posterior lag screw technique in the treatment of tri-malleolar ankle fractures.