Fluoroscopic visualization in ankle surgery: Evaluating the effects of lateral malleolus fixation order.

Ankle fractures, particularly those involving the lateral and posterior malleolus, are complex injuries requiring careful surgical management. This study investigates how the sequence of lateral malleolus fixation affects the intraoperative visualization of the posterior malleolus fracture during fluoroscopy. A retrospective and prospective approach was used, comparing outcomes in patients who underwent surgery for combined lateral and posterior malleolar fractures. In the retrospective group, lateral malleolus fixation with a plate often obstructed fluoroscopic visualization of the posterior malleolus, complicating fracture reduction. The prospective group was adjusted to prioritize posterior malleolar fracture visualization before lateral malleolus fixation, using temporary Kirschner wires if necessary. The study aimed to determine if the initial fixation strategy influenced surgical outcomes, including fracture healing and functional recovery. Results showed that for fractures involving the visible posterior malleolar area, no significant differences in outcomes were observed between the two groups. However, for fractures extending into the obstructed region, the prospective approach provided clearer visualization, potentially leading to more accurate reduction and fixation. This study concludes that the appropriate fixation strategy should be based on the extent of the posterior malleolar fracture. For fractures involving the visible area, traditional fixation of the lateral malleolus can be used. For those involving the obstructed area, a more cautious approach with temporary fixation or prior reduction of the posterior malleolus is recommended. This study emphasizes the importance of preoperative assessment to guide surgical planning and optimize patient outcomes. Level of evidence: III.