Text

Objectives and questions: In the treatment of ankle fractures involving the lateral malleolus, the importance of the anterior syndesmosis complex has become apparent in recent years. There are several approaches to visualize the anterior syndesmosis complex simultaneously, but it is unclear which approach provides the best view and the least postoperative wound problems. We compared a fork-shaped anterolateral approach to the lateral ankle complex with a hockey-stick-shaped posterolateral approach.We hypothesized that the fork-shaped anterolateral incision would result in more postoperative wound complications than the hockey-stick-shaped posterolateral incision.

Material and methods: It is a retrospective study with prospectively collected dataperformedat our hospital, AZ Groeninge in Kortrijk (Belgium).A single surgeon performed the surgery. The minimumfollow-up was 6 months. Exclusion criteria included: age lesser than 14 years, posterolateral approach for addressing a posterior malleolus fracture, open ankle fractures (Gustilo classification 2 or more), concomitantipsilateral distal tibia or pilon fractures, and early loss of follow-up. Skin condition needed to be acceptable to do surgery. SPSS (IBM software) was used for statistical data analysis.

Results: We obtained a consecutive case series of 62 patients with an osteosynthesis of an ankle fracture including a fracture of the lateral malleolus at our hospital from 2014 to 2024. 37 patients had a fork-shaped anterolateral incision (group A) and 25 patients had the Hockey stick-shaped posterolateral approach (group B).Various socio-demographic variables were accounted for in statistical analysis including sex, age, BMI, tabacco abusus, ethylism, diabetes.... (T-test/chi square test, p>0.05) Likewise, the significance of the type of lateral malleolus fracture (according to the AO classification) was compared between the 2 groups (p>0.05). In group A, a total of 11 patients had a wound problem compared to group B where only 1 patient presented with a wound problem. This difference was found statistically significant (Mann Whitney u test, p = 0.02). No other potential risk factor was statistically significantly associated with wound problems.

Discussion and conclusions: The reversedHockey stick approach forvisualization of the anterior syndesmosis had significantly fewer wound complicationsin the treatment of lateral malleolus fractures in comparison to the fork-shaped anterolateral incision.