Comparison of the effects of different screw insertion directions via a posterolateral approach in the treatment of ankle joint fractures

FENG Jun; LU Hui

doi:10.3969/j.issn.1002-3429.2025.21.014

Abstract：Objective To investigate the impact of the posteroanterior versus anteroposterior screw fixation via a posterolateral approach on recovery of patients with ankle fractures.Methods A retrospective analysis was conducted on the clinical data of 103 patients with ankle fractures treated between April 2021 and April 2023.The patients were divided into the posteroanterior approach group(n=52)and the anteroposterior approacch group(n=51).Perioperative indicators,including length of postoperative hospital stay,weight-bearing duration,and ankle function scores,were compared between the groups.Results The total incision length in anteroposterior approach group was shorter than that in posteroanterior approach group;however,the number of intraoperative fluoroscopic views,time to first ambulation and total duration of hospitalization in anteroposterior approach group were significantly longer than those in posteroanterior approach group(P<0.01).The duration of complete weight-bearing activity in the anteroposterior approach group was obvious longer than that in the posteroanterior approach group(P<0.01).At 12 months after operation,visual analogue scale(VAS)pain score was lower in posteroanterior approach group than in anteroposterior approach group,while the American Orthopedic Foot&Ankle Society(AOFAS)score was higher than that in anteroposterior approach group(P<0.05,P<0.01).The VAS pain score and AOFAS scores in posteroanterior approach group were higher at 12 months after operation than those at 3 months after operation(P<0.05).The range of motion(ROM)of ankle dorsiflexion and plantar flexion at 12 months after operation in the two groups were higher than that at 3 months after operation,and the ROM of posteroanterior approach group was higher than that of anteroposterior approach group at 3 months and 12 months after operation(P<0.05,P<0.01).No significant difference was found in the incidence of postoperative complications in the two groups(P>0.05).The medial clear space(MCS),and tibiofibular clear space(TFCs)were smaller,while tibiotalar angle was greater at 12 months after operation in both groups,as compared with those at 3 months after operation(P<0.01).At 12 months after operation,MCS and TFCs in anteroposterior approach group were greater than those in posteroanterior approach group(p<0.05),while no significant difference was observed in the tibiotalar angle between the two groups(P>0.05).In terms of fracture healing time,the proportion of≥24 weeks in posteroanterior approach group was higher than anteroposterior approach group(P<0.05).Conclusion Screw fixation via posteroanterior approach for ankle fractures can shorten postoperative recovery time,promote fracture healing,and enhance ankle joint function recovery,demonstrating high safety and effectiveness.