Abstract：
The present study shows how posterior malleolus fractures (PMFs) and distal fibular fractures were fixed using the posterolateral approach with the patient in lateral decubitus position, not previously described in the literature. This technique has been used in 60 consecutive patients (42 women and 18 men; mean age 54.7; range 21-92 years), 33 of which presented as fracture dislocations from March, 2021 to December, 2023. After PMFs fixation in lateral decubitus position, release of the sacral support allowed patients to be placed supine (without de-sterilizing the operative field), in order to proceed with medial malleolus or posteromedial fragment fixation. Fractures were classified according to the Lauge Hansen classification as SER4 (n = 50), PER4 (n = 7), SAD (n = 1), and PAB (n = 2). Fractures were classified according to Rammelt & Bartonicek, as type B (n = 40), C (n = 13), and D (n = 7). During the same period of time 14 fractures involving the PM, classified as type A, were treated with indirect fixation, whilst 6 geriatric and/or poor mobility patients with fracture dislocations were treated with retrograde hindfoot nail fixation. Follow-up period ranged from 4-36 months (mean = 14.4; SD = 8.8). Complications occurred in 5 patients (8.3%; 3 had delayed (medial) wound healing, one developed CRPS and one required implants removal and arthroscopy because of metal irritation and stiffness). No deep infections, thromboembolic events, fracture malreductions or malunions were recorded and all patients returned to the preinjury mobilization status. In conclusion, PM fracture fixation was feasible and safely performed with patients in lateral decubitus position.
摘要：
本研究显示了后踝骨折（PMFs）和腓骨远端骨折如何使用后外侧入路固定，患者处于侧卧位。以前文献中没有描述过。该技术已在60名连续患者中使用（42名女性和18名男性；平均年龄54.7；范围21-92岁），其中33例显示为2021年3月12日至2023年的骨折脱位。PMFs固定在侧卧位后，释放骶骨支撑允许患者仰卧放置（不对手术区域进行消毒），以便进行内踝或后内侧碎片固定。根据LaugeHansen分类将骨折分类为SER4（n=50），PER4（n=7），SAD(n=1)和PAB(n=2)。根据Rammelt&Bartonicek对骨折进行分类,作为B型（n=40），C(n=13)和D(n=7)。在同一时间段内，涉及PM的14处骨折，归类为A型，用间接固定治疗，同时，对6名老年和/或行动不便的骨折脱位患者进行了逆行后足钉固定术。随访时间为4-36个月（平均=14.4；SD=8.8）。5例患者发生并发症（8.3％；3例伤口延迟（内侧）愈合，由于金属刺激和僵硬，一个开发了CRPS，一个需要移除植入物和关节镜检查）。没有深部感染,血栓栓塞事件,记录骨折复位不良或不愈合,所有患者恢复到损伤前的动员状态.总之,对于侧卧位的患者，PM骨折固定术是可行且安全的。
