Lateral malleolus-first fixation improves short-term recovery in patients with trimalleolar fractures.

Objective: To evaluate the impact of different surgical fixation sequences on ankle joint stability and functional recovery in patients with trimalleolar fractures.

Methods: A retrospective analysis was conducted on the medical records of 144 patients with trimalleolar fractures treated at Xi'an International Medical Center Hospital. Among these, 78 patients underwent the fixation sequence of lateral malleolus-posterior malleolus-medial malleolus (Group A), while 66 patients underwent the sequence of posterior malleolus-lateral malleolus-medial malleolus (Group B). Perioperative parameters, including operation time, intraoperative blood loss, healing time, hospital stay, and treatment cost, were compared between the two groups. Patient recovery was assessed using the Radiographic Union Score for Hip (RUSH) and Visual Analogue Scale (VAS) at postoperative 3 months and Biard-Jackson scores at postoperative 3 and 12 months. Logistic regression analysis was used to identify risk factors influencing postoperative joint function recovery. The incidence of postoperative complications was also compared between the two groups.

Results: Group A demonstrated significantly shorter operation time (P < 0.001) and reduced intraoperative blood loss (P < 0.001) compared to Group B. No significant differences were observed in healing time (P = 0.905), hospital stay (P = 0.374), or treatment cost (P = 0.454) between the two groups. Similarly, RUSH (P = 0.780) and VAS (P = 0.590) scores at post-operative 3 months showed no significant differences between the two groups. However, Group A exhibited significantly higher Biard-Jackson scores at postoperative 3 months compared to Group B (P < 0.001), with no significant difference noted at postoperative 12 months (P = 0.157). The overall incidence of complications did not differ significantly between the groups (P = 0.164). Independent risk factors for prognosis included the treatment plan (P = 0.025), body mass index (P = 0.042), distal tibiofibular injury (P = 0.002), and intraoperative blood loss (P = 0.021).

Conclusion: Patients with trimalleolar fractures who underwent fixation in the sequence of lateral malleolus-posterior malleolus-medial malleolus showed improved ankle joint functional recovery at postoperative 3 months compared to those treated with the posterior malleolus-lateral malleolus-medial malleolus sequence. No significant differences were observed at postoperative 12 months. Operation time and intraoperative blood loss were critical factors influencing short-term recovery outcomes.