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Corresponding author: dengxiongewei, dengxiongwei1130@163.com

DOI: 10.12201/bmr.202601.00028

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  Abstract: Objective To compare the clinical outcomes between the posterolateral approach and the modified posteromedial trans?Achilles approach in the treatment of Haraguchi type II posterior malleolar fractures. Methods A retrospective analysis was conducted on 50 patients with Haraguchi type II posterior malleolar fractures treated between June 2022 and June 2025. There were 30 males and 20 females, with a mean age of 40.5 years. Injury mechanisms included sprain (32 cases) and traffic accidents (18 cases); all fractures were closed. According to the Lauge?Hansen classification, there were 17 cases of supination?external rotation (SER) stage III, 21 cases of SER stage IV, and 12 cases of pronation?external rotation (PER) stage IV. Patients were divided into a posterolateral approach group (25 cases) and a modified posteromedial trans?Achilles approach group (25 cases). Operative time, postoperative complications (wound healing and nerve injury), postoperative imaging findings, and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle?hindfoot score at 6 months postoperatively were compared between the two groups. Results All patients were followed up for 10–16 months (mean 12 months). The modified posteromedial group showed significantly shorter operative time than the posterolateral group (P<0.05). Complications included delayed wound healing in 2 cases and sural nerve traction injury in 2 cases in the posterolateral group, and delayed wound healing in 1 case and tibial nerve traction injury in 1 case in the modified posteromedial group. All nerve symptoms resolved by the 3?month follow?up, with no significant difference in overall complication rate between the groups (P>0.05). Imaging evaluation based on postoperative CT revealed a step?off >2 mm in 5 cases (20%) in the posterolateral group, whereas no cases in the modified posteromedial group had poor reduction, showing a statistically significant difference (P<0.05). At 6 months postoperatively, the excellent?good rate of AOFAS score was 60% in the posterolateral group and 96% in the modified posteromedial group, with a statistically significant difference (P<0.05). Conclusion The modified posteromedial trans?Achilles approach allows direct visualization for simultaneous reduction of the posterior and medial malleoli, achieves anatomical reduction of the posterior articular surface, shortens operative time, and yields better clinical outcomes compared with the posterolateral approach, making it a preferable surgical option for Haraguchi type II posterior malleolar fractures.

  Key words: Posterolateral; Modified posteromedial Achilles tendon; Surgical approach; Posterior malleolus fracture; Clinical efficacy

  Submit time: 11 January 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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