Preoperative “software-based reduction and fixation” using a 3D workstation software for posterior malleolus intra-articular fracture: A case report

Abstract Intra-articular fractures of the posterior malleolus are common in ankle fractures and are frequently difficult to treat during surgery. Posterolateral and posteromedial approaches are commonly used to access the fracture fragments. However, visualization of fragments during surgery is limited because of the thick soft tissue surrounding the fracture fragments. In this study, a new technique of preoperative simulation was used to achieve the optimal position of the fracture fragments, plate, and screws, namely “software-based reduction and fixation,” using a three-dimensional (3D) workstation software, following which the surgery was performed. A 71-year-old man who presented with posterior dislocation of the left ankle with trimalleolar fracture was hospitalized following a fall. The position of the posterior malleolus fracture fragment was preoperatively determined using computed tomography (CT) and reduced using the 3D workstation software. The imported implant data were overlaid on the patient's dataset, enabling determination of the precise position of the plate and the trajectories of the screws. Finally, surgery was performed by referring to the displays of the preoperative simulation and image intensifier. Postoperative radiographs and CT scans showed that the fracture fragments were well reduced and that the implant position and screw trajectories were precisely reproduced in accordance with the preoperative simulation. All fracture fragments were united 3 months after surgery without any complications. This clinical case demonstrated that preoperative simulations using a 3D workstation software and “software-based reduction and fixation” are useful for treating posterior malleolus fractures.