Fixation of Posterior Malleolar Fractures Provides Greater Syndesmotic Stability

Gardner, Michael J.; Brodsky, Adam; Briggs, Stephen; Nielson, Jason H.; Lorich, Dean G.

doi:10.1097/01.blo.0000203489.21206.a9

Cited by 303 publications

(243 citation statements)

References 47 publications

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“…If there is still instability in the presence of a Volkmann triangle, the fragment must be fixed. Fixing the Volkmann triangle is a better option than fixing the ankle mortise with a positioning screw [25].…”

Section: Resultsmentioning

confidence: 99%

The Volkmann dogma: a retrospective, long-term, single-center study

Heim¹,

Niederhauser

Simbrey

2010

Eur J Trauma Emerg Surg

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Introduction There has been (and still is) some controversy about the treatment of malleolar fractures with an additional fracture of the posterior malleolus (Volkmann triangle) in the last few years. Should a posterior malleolus with a fragment that is larger than 25% of the articular surface be fixed? Can long-term results be influenced by the fixation of the Volkmann triangle? Materials and methods In a consecutive series of 43/56 patients with a dislocated malleolar fracture, clinical and radiological results were analyzed after a follow-up of 7.3 years (4-11 years). There were 15 men with an average age of 53 years and 28 women with an average age of 62 years, respectively. Eleven fragments were fixed. At inspection, 16 patients displayed a cartilage lesion at the talar dome.Results No or only slight arthrosis was found on X-rays of 37/43 patients. Six patients showed moderate or severe arthrosis. The Olerud-Molander score was 95.5 in patients without a Volkmann triangle, 98.5 in the presence of a small, unfixed fragment, and 90.6 with a large fixed fragment. Patients with no cartilage damage on perioperative inspection presented less severe arthrosis in the long-term results, while those with documented cartilage damage during the operation had more severe arthrosis. The Olerud-Molander score was 97.2 without cartilage damage and 94.5 with cartilage damage. Conclusion In conclusion, the presence of a Volkmann triangle impairs prognosis; fixation, even with anatomic results, does not return the score to ''normal.'' Cartilage damage seems to play a crucial role in the long-term outcome.

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Section: Resultsmentioning

confidence: 99%

The Volkmann dogma: a retrospective, long-term, single-center study

Heim¹,

Niederhauser

Simbrey

2010

Eur J Trauma Emerg Surg

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“…Our biomechanical study suggested fixation of the posterior malleolus fracture restores more stability to the syndesmosis than transsyndesmotic fixation alone [10]. Studies using preoperative MRI to evaluate ankle fractures suggest fracture patterns that include an associated posterior malleolar fracture reliably have an intact posteroinferior tibiofibular ligament (PITFL) [10,11].…”

Section: Introductionmentioning

confidence: 99%

Posterior Malleolar Stabilization of Syndesmotic Injuries is Equivalent to Screw Fixation

Miller¹,

Carroll²,

Parker³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

211

150

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Background Fixation of unstable ankle fractures, including fixation of posterior malleolus fracture fragments with the attached, intact posteroinferior tibiofibular ligament (PITFL), reportedly provides more stable fixation than transsyndesmotic screws. Questions/Purposes To confirm this observation we compared the Foot and Ankle Outcome Score (FAOS) and radiographic maintenance of fixation for fractures treated through direct posterior malleolar fixation versus syndesmotic screw fixation. Methods We prospectively followed 31 one patients with unstable ankle fractures treated with (1) open posterior malleolus fixation whenever the posterior malleolus was fractured, regardless of fragment size (PM group; n = 9); (2) locked syndesmotic screws in the absence of a posterior malleolar fracture (S group; n = 14); or (3) combined fixation in fracture-dislocations and more severe soft tissue injury (C group; n = 8). All patients had preoperative MRI confirming syndesmotic injury and an intact PITFL; postoperative and followup radiographs were evaluated for syndesmotic congruence. The minimum followup was 12 months (mean, 15 months; range, 12-31 months).

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“…[19][20][21] Nonetheless, fragments bigger than 25-30% of the articular surface and with articular incongruence (anteroposterior difference greater than 2 mm), the internal fixation of the fragment is indicated. 6,22,23 In this sense, a posterolateral approach provides a more direct access due to space created between the fibular and Achilles tendons. 6 In addition, bilateral weight-bearing at early stages of rehabilitation may enhance the outcomes of the internal fixation.…”

Section: Discussionmentioning

confidence: 99%

Fracture of the posterior malleolus: an underdiagnosed condition

Silva¹,

Maia

Ferreira

et al. 2017

Int J Res Orthop

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<p class="abstract">The ankle joint is the most commonly injured joint during sports activity. While ankle sprains occur more frequently, ankle fractures are less common. Due to its low incidence, the isolated fracture of the posterior malleolus still represents a diagnosis challenge. This article reports a case of a female with a posterior malleolus isolated fracture after falling while performing sports activity. Clinical examination and conventional radiography were consistent with diagnosis of a simple ankle sprain and the patient was discharged with a conservative approach for lateral ankle sprain. Due to persistent pain the patient return for additional examination, which the differential diagnosis revealed an isolated fracture of the posterior malleolus without displacement of the fragment. The patient was immobilized with a suropodalic splint for 4 weeks followed by additional conservative. At the fourth month of follow-up, the patient was asymptomatic and showed good clinical and functional outcomes. This case highlights the importance of a comprehensive medical history and detailed clinical examination which may reveal pathological features that require a differential diagnosis<span lang="EN-IN">.</span></p>

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Fixation of Posterior Malleolar Fractures Provides Greater Syndesmotic Stability

Cited by 303 publications

References 47 publications

The Volkmann dogma: a retrospective, long-term, single-center study

The Volkmann dogma: a retrospective, long-term, single-center study

Posterior Malleolar Stabilization of Syndesmotic Injuries is Equivalent to Screw Fixation

Fracture of the posterior malleolus: an underdiagnosed condition

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