J Foot Ankle Surg Asia-Pac 4:63–68Ībdelgawad AA, Kadous A, Kanlic E (2011) Posterolateral approach for treatment of posterior malleolus fracture of the ankle. Trimalleolar fractures: fixing the posterior malleolus by posterolateral approach. Can J Surg 48:487–490ĭhillon M, Dureja K, Patel S (2017) How we do it. Talbot M, Steenblock TR, Cole PA (2005) Posterolateral approach for open reduction and internal fixation of trimalleolar ankle fractures. Tornetta P, Ricci W, Nork S et al (2011) The posterolateral approach to the tibia for displaced posterior malleolar injuries. Verhage SM, Boot F, Schipper IB, Hoogendoorn JM (2016) Open reduction and internal fixation of posterior malleolar fractures using the posterolateral approach. Kumar A, Mishra P, Tandon A et al (2018) Effect of CT on management plan in malleolar ankle fractures. īartoníček J, Rammelt S, Kostlivý K et al (2015) Anatomy and classification of the posterior tibial fragment in ankle fractures. Yi Y, Chun D-I, Won SH et al (2018) Morphological characteristics of the posterior malleolar fragment according to ankle fracture patterns: a computed tomography-based study. Haraguchi N, Haruyama H, Toga H, Kato F (2006) Pathoanatomy of posterior malleolar fractures of the ankle. Solan MC, Sakellariou A (2017) Posterior malleolus fractures: worth fixing. Lübbeke A, Salvo D, Stern R et al (2012) Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study. Mak MF, Stern R, Assal M (2018) Repair of syndesmosis injury in ankle fractures: current state of the art. Verhage SM, Krijnen P, Schipper IB, Hoogendoorn JM (2019) Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures. Application in clinical practice is the subject of a future study in our institution.īerkes MB, Little MTM, Lazaro LE et al (2013) Articular congruity is associated with short-term clinical outcomes of operatively treated SER IV ankle fractures. The approach allows optimal exposure to address fractures of the posterior malleolus, of the lateral malleolus, and of the anterolateral portion of the ankle through a single incision. The PAMELA opens a new perspective in the optimal management of complex fractures of the ankle. Hardware placement can be done with optimal access to any exposed surfaces.

An anterolateral arthrotomy, respecting the anterior talofibular and tibiofibular ligaments, offers a sharp view on the talo-tibio-fibular junction. The lateral malleolus is exposed by retracting the peroneal tendons medially. The interval between the peroneal tendons and the flexor hallucis longus muscle provides optimal access to the posterior malleolus. Structures at risk, including the superficial peroneal and sural nerves, the lesser saphenous vein, and the peroneal artery are easily identified and protected. The cutaneous flap benefits from a rich interconnected arterial supply. Assessment included density of the vascular supply around the lateral malleolus, identification of the structures at risk, quality of exposure of the bony structures, and convenience of hardware fixation. MethodsĬadaveric dissection, including a vascular study, was performed on eight specimens. Our objective is to propose a novel surgical approach for optimal management of injuries including both a fracture of the posterior malleolus and a complex lesion of the lateral and/or anterolateral portions of the ankle.

However, this approach does not allow access to the anterolateral structures of the ankle, which represent important landmarks to allow an anatomical reduction in case of complex ankle fracture. The posterolateral approach is used in most cases of surgical treatment of ankle fractures involving the posterior and lateral malleoli.

Malleolus lateral