Single-Window Versus Two-Window Posterolateral Approach for Malleolar Fractures

Inclusion Criteria: * Patients aged between 18 and 65 years. * Diagnosis of an acute, closed, unstable rotational ankle fracture with concomitant involvement of the posterior malleolus and lateral malleolus (trimalleolar or bimalleolar equivalent fractures). * Fracture morphology explicitly indicating surgical reduction and internal fixation via a posterolateral approach (e.g., Bartonicek Type II, III, or IV). * Ability to provide informed consent and willingness to comply with the 12-month postoperative rehabilitation and follow-up protocol. Exclusion Criteria: * Open fractures, severe tibial pilon variants, or fractures with intra-articular comminution extending beyond the posterior malleolus. * Persistent Syndesmotic Instability: Patients demonstrating persistent distal tibiofibular syndesmotic instability (confirmed by intraoperative hook test) after the fixation of the posterior and lateral malleoli, which inherently requires additional trans-syndesmotic fixation (e.g., syndesmotic screws or suture-button devices). This exclusion is strictly applied to eliminate methodological bias, as the experimental single-window approach intentionally restricts direct lateral access for trans-syndesmotic interventions. * Delayed surgical intervention exceeding 7 days from the initial trauma, leading to organized hematoma or compromised soft-tissue envelopes. * Pre-existing conditions detrimental to soft-tissue healing and functional assessment, including severe peripheral arterial…