Effect of Posterior Malleolus Fracture on Syndesmotic Reduction

Fitzpatrick, Elizabeth; Goetz, Jessica E.; Sittapairoj, Tinnart; Siddappa, Vinay Hosuru; Femino, John E.; Phisitkul, Phinit

doi:10.2106/jbjs.17.00217

Cited by 45 publications

(42 citation statements)

References 18 publications

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“…This may result in tibiotalar joint incongruity, which substantially increases joint contact pressure [13,22,23]. Moreover, mal-positioned screws in a posterior malleolar fracture could inadvertently cause mal-reduction of the syndesmosis and lead to separation of the fibula from the anatomical location in the incisura [10,13,16]. Fitzpatrick et al [10] conducted a cadaveric study of 9 specimens with a supinationexternal rotation injury with a posterior malleolus fracture.…”

Section: Discussionmentioning

confidence: 99%

“…While less than 1% of ankle fractures are isolated posterior malleolar fractures, the majority of this fracture commonly occurs in relation to lateral or medial malleolar fractures [1,8]. Indications for surgery in cases of posterior malleolar fractures are subject to ongoing debate [9,10]. Typically, the size of the posterior malleolar fragment is taken into account when considering operative fixation.…”

Section: Introductionmentioning

confidence: 99%

“…In general, if posterior subluxation of the tibiotalar joint is seen in the presence of a posterior malleolus fracture operative fixation is indicated. Finally, when the articular surface of the distal tibia is involved, or the integrity of the syndesmosis is jeopardized, surgical intervention should be considered [9,10,13]. When reduction and internal fixation of a posterior malleolar fracture are indicated, achieving anatomic fixation can be challenging.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative planning and surgical technique for optimizing internal fixation of posterior malleolar fractures: CT versus standard radiographs

et al. 2020

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Background: A proper reduction and internal fixation of posterior malleolar fractures can be challenging, as intraoperative fluoroscopy often underestimates the extent of the fracture. Our aim was to assess the value of a modified classification system for posterior malleolar fractures, which is based on computed tomography (CT) images, optimizing screw trajectory during fluoroscopic-guided surgery, and to compare it to the Lauge-Hansen classification system to the CT-based classification. Methods: A retrospective review of all ankle fracture operations from January 2014 to December 2016 was performed. Fractures were included if a CT scan was performed within 1 week of the surgery, and the posterior malleolar fragment occupied one third or more of the antero-posterior talar surface or jeopardize the ankle stability. Eighty-five adult ankle fractures with posterior malleolar fragments were included in this study. Fractures were categorized into one of three types, namely "postero-lateral," "postero-medial," or "postero-central," according to the location of the fracture fragment on axial CT image. An optimal trajectory angle for a single-lag screw fixation was measured on the CT cut between a central antero-posterior line and the line intersecting the posterior fragment perpendicular to the major fracture line. Mean trajectory angles were calculated for each fracture type. Fractures were also categorized according to the Lauge-Hansen system. Results: The mean trajectory angle was 21°lateral for "postero-lateral" fragments, 7°lateral for "postero-central" fragments, and 28°medial for "postero-medial" fragments (p < 0.01 for comparisons among the groups). The range of trajectory angles within each group was about 10°, as compared to about 20°within each Lauge-Hansen type. There were no differences in trajectory angle among the Lauge-Hansen groups (p > 0.05 for all comparisons). Conclusions: There are 3 distinct anatomic subgroups of posterior malleolar fragments, each with an ideal screw trajectory that needs to be used in order to achieve an optimal reduction and fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative planning and surgical technique for optimizing internal fixation of posterior malleolar fractures: CT versus standard radiographs

et al. 2020

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“…Cuando las fracturas del MP se sintetizan de forma no anatómica conllevan una reducción inadecuada de la sindesmosis (4) . Clásicamente, la vía más comúnmente utilizada para la reducción y la síntesis del MP ha sido la indirecta, en la que, de forma percutánea, se fija el fragmento con tornillos desde anterior a posterior guiados bajo control de escopia.…”

Section: Discussionunclassified

“…Según la bibliografía reciente (4,5) , la reducción anatómica del MP es un predictor de buen resultado tras el tratamiento quirúrgico de la fractura de tobillo.…”

Section: Introductionunclassified