Posterior and anterior malleolus fixation is associated with lower syndesmosis malreduction rates.

BACKGROUND: Syndesmotic malreduction after ankle fracture fixation is associated with poor outcomes. This study evaluated the association between posterior and anterior malleolus fixation and the accuracy of syndesmotic reduction. METHODS: Seventy-four patients with posterior malleolus fractures were prospectively enrolled and divided into three groups: no posterior or anterior malleolus fixation (Group 1), posterior malleolus fixation only (Group 2), and combined posterior and anterior malleolus fixation (Group 3). Syndesmotic reduction was assessed using three CT-derived parameters. RESULTS: CT reduction indices improved in Groups 2 and 3 compared with Group 1, with the greatest improvement observed in Group 3. Syndesmotic malreduction occurred in 29% of Group 1, 10% of Group 2, and 0% of Group 3 patients. CONCLUSION: Posterior malleolus fixation was associated with improved syndesmotic reduction, while no malreductions were observed after combined posterior and anterior malleolus fixation in this cohort. Level II evidence.