High Association of Posterior Malleolus Fractures with Spiral Distal Tibial Fractures

Abstract

Associations between fracture patterns are important and can ensure proper diagnosis and guide treatment. Occult posterior malleolus fractures associated with distal spiral tibia fractures often are underrecognized and the morbidity of a missed posterior malleolus injury can be substantial. We determined the association between the two injuries and evaluated the ability of a new protocol to improve management of these associated fractures. Of 62 consecutive patients with fractures of the distal third of the tibia, we retrospectively evaluated the first 39 patients and prospectively used a diagnostic protocol including computed tomography of the ankle in the subsequent 23 patients. The minimum followup was 3 months (mean, 25 months; range, 3-68 months). Twenty-four patients (39%) had fractures of the posterior malleolus. Before initiation of the protocol, intraarticular fractures were recognized in 33% (with one delayed diagnosis and one missed diagnosis), and after institution of the protocol, the detection rate was 48% with no known missed injuries and complete followup; however, with the limited power the detection rates were similar without and with the protocol. A spiral distal tibial shaft fracture with a proximal fibula fracture should alert the surgeon to investigate an occult ankle injury, particularly of the posterior malleolus. A protocol including computed tomography of the ankle may detect more injuries in a larger study.

Predictive Radiographic Markers for Concomitant Ipsilateral Ankle Injuries in Tibial Shaft Fractures

“…Two recent studies utilizing CT imaging to evaluate for concomitant ankle fractures demonstrated a higher incidence of injury ranging from 39–43%. 8,10 However, both of these studies limited their investigation to distal one-third diaphyseal tibia fractures. Our results indicate that concomitant articular ankle injuries are more common than previously reported.…”

“…Additionally, although distal one-third spiral tibial shaft fractures have been shown to have a strong association with concomitant ankle fractures, no publication has explicitly quantified the predictive ability of this, or other, radiographic fracture patterns. 8–10 Therefore, our hypothesis for this study is twofold: 1) the incidence of concomitant ankle injuries and tibial shaft fractures is underappreciated and is higher than previously reported; and 2) common radiographic characteristics such as location and pattern of the tibial and fibular shaft fractures exist that can quantitatively predict the presence or absence of an ankle injury.…”

Intramedullary Nail Fixation of Distal Tibia Fractures: Tips and Tricks

“…[25][26][27] Distal third tibial shaft fracture location, spiral type fracture pattern, or an associated spiral fibula fracture is predictive of an intraarticular component. [25][26][27] Distal third tibial shaft fracture location, spiral type fracture pattern, or an associated spiral fibula fracture is predictive of an intraarticular component.…”

Intramedullary nail versus plate treatments for distal tibial fractures: A meta-analysis

“…Tibial fractures are the most common long bone fractures [2], while distal tibail fractures are even more complicated due to its proximity to ankle, and the close relationship with thin soft tissue envelope and severe comminution [3e5]. Additionally, distal tibial fractures are associated with posterior malleolus fractures [6].…”