Posterior Inferior Tibiofibular Ligament Release to Achieve Anatomic Reduction of Posterior Malleolar Fractures

We assessed the clinical and radiographic outcomes of posterior inferior tibiofibular ligament (PITFL) release to achieve anatomic reduction of posterior malleolar fractures (PMFs). Nineteen PMFs (>25% of tibial plafond) that could not be reduced after anatomic reduction of distal fibula fractures were managed by PITFL release. The syndesmosis was stressed intraoperatively and by 2 surgeons unaware of the postoperative measurements to increase reliability. The pre- and postoperative fracture gaps and articular step-offs were measured on lateral radiographs of all patients and computed tomography (CT) scans of 12. Tibiofibular clear space and overlap measures at the final follow-up visit were used to evaluate postoperative syndesmotic stability. Postoperative function was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale score. The mean pre- and postoperative fracture gap and step-off of the PMFs was 4.9 mm and 0.4 mm and 2.8 mm and 0.4 mm, respectively. On CT scan, the mean pre- and postoperative fracture gap and step-off was 5.2 mm and 0.5 mm and 3.3 mm and 0.6 mm, respectively. The preoperative and final follow-up tibiofibular clear space and overlap did not differ significantly. The mean follow-up period was 26.7 months, and the mean AOFAS scale score was 90.6 points at the final follow-up. Direct visualization and reduction of PMFs through PITFL release led to satisfactory clinical and radiographic outcomes without causing ankle instability.