Ankle fractures involving the posterior malleolus: patient characteristics and 7-year results in 100 cases

Abstract

Introduction The presence of a posterior malleolar (PM) fragment has a negative prognostic impact in ankle fractures. The best treatment is still subject to debate. The aim of this study was to assess the medium-to-long-term clinical and functional outcome of ankle fractures with a PM fragment in a larger patient population. Materials and methods One hundred patients (69 women, 31 men, average age 60 years) with ankle fractures including the PM were evaluated clinically and radiographically. Patients with Bartoníček–Rammelt type 3 and 4 fracture displayed a significant female preponderance. Fixation of the PM was performed in 63% and tailored to the individual fracture pattern. Results Internal fixation of the PM fragment was negatively correlated with the need for syndesmotic screw placement at the time of surgery (p = 0.010). At an average follow-up of 7.0 years, the mean Foot Function Index (FFI) was 16.5 (SD: 21.5), the Olerud Molander Ankle Score (OMAS) averaged 80.2 (SD: 24) and the American Orthopedic Foot & Ankle Society (AOFAS) ankle/hindfoot score averaged 87.5 (SD: 19.1). The maximum score of 100 was achieved by 44% of patients. The physical (PCS) and mental health component summary (MCS) scores of the SF-36 averaged 47.7 (SD: 12.51) and 50.5 (SD: 9.36), respectively. Range of motion was within 3.4 (SD: 6.63) degrees of the uninjured side. The size of the PM fragment had no prognostic value. There was a trend to lower outcome scores with slight anterior or posterior shift of the distal fibula within the tibial incisura. Patients who underwent primary internal fixation had significantly superior SF-36 MCS than patients who underwent staged internal fixation (p = 0.031). Conclusions With an individualized treatment protocol, tailored to the CT-based assessment of PM fractures, favorable medium and long-term results can be expected.

Complications following surgical treatment of posterior malleolar fractures: an analysis of 300 cases

“…Staged fixation, that was identified as a negative prognostic factor with respect to functional outcome in our previous study [10], also was an independent risk factor for complications. This most likely reflects the severity of injury, as this is employed in highly unstable fracture-dislocations or with critical soft tissue conditions [4].…”

“…The treatment of ankle fractures involving the PM has undergone considerable changes over the past decade [4][5][6][7][8][9][10][11][12][13]. The aim of our study was to identify risk factors for complications following surgical treatment in a sizeable number of patients.…”

“…Infections requiring revision occurred in 3 out of 225 (1.3%) lateral approaches and in 1 out of 6 (16.7%) medial approaches. Among 100 patients from the whole cohort who had a physical follow-up examination at our hospital for another study [10], a sensory deficit was found in 11 patients. The superficial peroneal nerve was affected permanently in 2 patients, and temporarily in another 2.…”

“…The treatment of ankle fractures and fracture-dislocations involving the PM has undergone considerable changes over the past decade [5,6]. With an individualized approach to the fracture morphology as assessed with preoperative computed tomography (CT) scanning, the historically poor outcomes of trimalleolar ankle fractures could be improved substantially [7][8][9][10]. However, although the indications to surgery and techniques of reduction and fixation have been refined, there is still controversy with respect to the individual approach and concerns have been raised about possible complications with the increased use of posterior approaches [11][12][13].…”

Fractura trimaleolar

“…Esta estructura anatómica también se conoce con el nombre de triángulo de Volkmann (1,3). El compromiso del MP en las fracturas maleolares ocurre hasta en un 50% de los casos y se asocia a un peor pronóstico (4). El manejo asociado a estructuras mediales y laterales está bien establecido, sin embargo, el manejo de fracturas del maléolo posterior aún es controversial (5).…”