Abstract:Objective To observe the clinical efficacy of two modified approaches of ankle jointsthrough the classified treatment of trimalleolar fracture surgery. Methods From December 2014 to December 2019, 32 patients with trimalleolar fractures were treated at the Department of Orthopedics, People’s Hospital of Zhuanglang County, Gansu Province. They were 20 males and 12 females, aged from 20 to 65 years (mean, 47.1 years). Classified by the AO for an ankle injury, 11 cases belonged to A3 and 21 cases to B3. According to preoperative X-ray film and 3D CT examination, all cases were divided into two groups.Modified incisions from lateral to medial were adopted when posterior malleolus fractures were lateral (lateral group, 22 cases). Modified incisions from medial to lateral were used when posterior ankle fractures were medial (medial group, 10 cases).The medial malleolus and the posterior malleolus werefixed with hollow compression screws and the lateral malleolus was fixed with steel plates. The operation time of two approaches, exposurerangeof posterior malleolus during operation, fracture healing time, and postoperative complications were observed and recorded. At the last follow-up, ankle function was assessedby theOlerud-Molander ankle fracture function score. Results In the 32 patients, the operation time of the two groups ranged from 60 to 110min (mean, 80 min). The fracture of the posterior malleolus was clearly exposed during operation in two groups. Of the two groups, 32 patients were followed up for 12 to 18 months (mean, 14 months). All fractures healed from 4 to 8 months after the operation. Incision subcutaneous infection was observed in 3 cases.No such complicationsoccurred like deep infection, nonunion of anklebone or traumatic arthritis. Accessed by the Olerud-Molander ankle fracture function score at the last follow-up, the ankle function was excellent in 19 cases, good in 11, and fair in 2. Conclusion Treatment of trimalleolar fracture by two modified approachesof ankle joint shows clearly fracture and good reduction, which reduces the occurrence of traumatic arthritis and is worth popularizing.