Positioning strategies in surgical management of trimalleolar ankle fractures: Floppy Lateral vs Prone for Ankle ORIF
Abstract
Objective. Trimalleolar ankle fractures are complex injuries typically managed via open reduction and internal fixation (ORIF). While prone positioning is traditional for posterior malleolus access, floppy lateral positioning may improve the workflow for combined approaches. This study compared perioperative and radiographic outcomes between these two techniques.
Methods. A retrospective cohort study of 87 adult patients (prone: n = 45; floppy lateral: n = 42) was conducted at a Level I trauma center (2020-2024). Outcomes included operative time, fluoroscopic exposure, reduction quality, and postoperative complications.
Results. No significant differences were found in mean operative time (111.9 vs. 108.6 minutes; p = 0.235) or fluoroscopic exposure (39.0 vs. 38.4 seconds; p = 0.761). Both groups achieved high rates of anatomical reduction (92.77% vs. 92.42%; p = 0.561) with comparable complication rates and clinical outcomes.
Conclusion. Floppy lateral positioning provides equivalent surgical efficiency and radiographic outcomes to prone positioning. The choice of position can be safely guided by surgeon preference and patient-specific safety considerations.
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© © Ortopedici Traumatologi Ospedalieri d’Italia (O.T.O.D.i.) , 2026
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