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Current intraoperative assessment methods, including fluoroscopy and arthroscopy, each possess inherent limitations when used independently. This study aimed to validate the effectiveness of a novel intraoperative evaluation tool, the SGSC (Step, Gap, Syndesmosis, Congruity) \u201ctraffic light\u201d checklist, that integrates arthroscopic and fluoroscopic assessment, and to evaluate its predictive value for clinical prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study enrolled 36 patients who underwent surgical treatment for trimalleolar fractures. Validation proceeded in two stages: first, we calculated inter-rater reliability (Kappa statistic) and concordance with postoperative CT as the reference standard to establish the reliability and validity of the SGSC checklist (accuracy validation); second, patients were stratified into \u201cAll-Green\u201d and \u201cNon-All-Green\u201d groups based on intraoperative SGSC assessment, and we compared AOFAS scores and early radiographic degenerative changes at final follow-up (prognostic validation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For accuracy validation, inter-rater agreement between the two assessors demonstrated excellent reliability (Kappa\u2009=\u20090.827; 95% CI: 0.644-1.000). The overall concordance between SGSC checklist assessments and postoperative CT findings was 91.67%. Regarding prognostic value, the All-Green group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925) achieved a mean AOFAS score of 88.9\u2009\u00b1\u20093.0, significantly exceeding the 78.4\u2009\u00b1\u20094.4 observed in the Non-All-Green group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911) (t\u2009=\u20098.32,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Furthermore, early radiographic degenerative changes (Kellgren-Lawrence grade\u2009\u2265\u20092) developed in only 8% (2\/25) of the All-Green group compared with 45.5% (5\/11) in the Non-All-Green group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.012).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The SGSC checklist represents a valid and reliable intraoperative assessment instrument. Achieving \u201cAll-Green\u201d status effectively predicts superior short-term functional outcomes and a lower incidence of early degenerative changes. However, these preliminary findings are limited by small sample size and retrospective design. Prospective studies are needed to confirm clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-026-06390-5","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T15:44:55Z","timestamp":1781797495000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validity and prognostic value of a novel intraoperative assessment tool for reduction in trimalleolar fractures: the SGSC checklist approach"],"prefix":"10.1007","volume":"146","author":[{"given":"Hua","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoqiang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiatian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubing","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baojun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"issue":"8","key":"6390_CR1","doi-asserted-by":"publisher","first-page":"e19","DOI":"10.2106\/JBJS.RVW.19.00207","volume":"8","author":"S Rammelt","year":"2020","unstructured":"Rammelt S, Bartonicek J (2020) Posterior Malleolar Fractures: A Critical Analysis Review. 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