Vol. 7, Issue 1, Part A (2025)

Background: Tri-malleolar fractures are complex injuries involving all three malleoli (medial, lateral, and posterior) and require surgical fixation to restore joint congruity and prevent post-traumatic arthritis. The posteromedial approach to the distal tibia offers direct visualization of the posterior malleolus while minimizing soft tissue trauma.

Objective: To evaluate the clinical and functional outcomes of tri-malleolar fractures reduced using the posteromedial approach to the distal tibia.

Methods: A retrospective study was conducted on 17 patients treated surgically between 2022 and 2024. Data collected included operative time, follow-up duration, pre- and post-operative AOFAS scores, VAS pain scores at rest and during walking, gender, and age, Statistical analysis was performed using SPSS version 26. Paired t-tests were used to compare pre- and post-operative AOFAS scores. Pearson correlation was also performed.

Results: The mean operative time was 64.1 minutes, with a mean follow-up of 12.8 months. There was a statistically significant improvement in AOFAS scores from a mean of 38.5 pre-operatively to 81.4 post-operatively (p<0.001). Post-operative, VAS scores at rest were mostly 0 (mean=0.35), and during walking were generally ≤ 1 (mean=0.94). No major complications were reported.

Conclusion: The posteromedial approach to the distal tibia is an effective and safe technique for managing tri-malleolar fractures, resulting in significant functional improvement and minimal post-operative pain.