How to address the posterior malleolus in ankle fractures? A decision-making model based on the computerised tomography findings

Sánchez, E.; Olaya-González, Carlos; Abarquero-Diezhandino, Ana; Sánchez-Morata, Enrique; Vilá-Rico, Jesús

doi:10.1007/s00264-020-04481-5

Cited by 29 publications

(19 citation statements)

References 29 publications

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“…Many studies had shown that [12,[14][15][16][17][18], for the measurement of posterior fragments, lateral X-ray was inferior to CT scanning in repeatability, reliability and accuracy. CT scanning enabled to better understand the anatomical structure of posterior fragments and the images of CT scanning were used as the basis for classi cation and surgery [19]. Therefore, the sagittal angle and posterior fragment area, fragment area ratio, fragment transverse diameter ratio, length ratio, fragment height and of PMFs were measured by CT scanning and contact area was measured based on CT three-dimensional reconstruction.…”

Section: Discussionmentioning

confidence: 99%

The influence of sagittal angle of posterior malleolus fracture on ankle joint stability：a retrospective study of 87 cases

Zhang

Yang

et al. 2022

Preprint

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BackgroundPrevious studies have studied more factors on the ankle stability of the posterior ankle fracture, which is related to a stereostructure of the fracture fragment. Previous studies have shown that the ankle stability may be affected by the sagittal surface of the fracture block, with less research in this field. The aim of this study was to explore the influence of the sagittal angle(SA) on ankle joint stability by scanning and reconstructing three types of posterior malleolus fractures(PMFs) with different sagittal angle (SA).MethodsThe CT data of 87 patients with PMFs were collected retrospectively and reconstructed. PMFs were divided into three types: posterolateral-oblique type (type I), medial-extension type (type II) and small-shell type (type III).The collected sagittal angle data were statistically analyzed with the posterior fragment area, fragment area ratio (FAR), fragment transverse diameter ratio (FWR), fragment length ratio (FLR), fragment height (FH), and contact area (CA).Results(1)SA was positively correlated with posterior fragment area(r = 0.804,P < 0.01),with regression equation s = 0.085*SA + 0.34;(2)SA was positively correlated with FAR(r = 0.392,P < 0.01),with regression equation FAR = 0.004*SA + 0.092;(3)SA was positively correlated with FWR(r = 0.261,P < 0.05), with regression equation FWR = 0.03*SA + 0.4624;(4)SA was positively correlated with FLR(r = 0.481,P < 0.01), with regression equation FLR = 0.05*SA + 0.209;(5) SA was positively correlated with CA (r = 0.474, P < 0.01),with regression equation CA = 7.942*SA + 160.866;(6)SA was positively correlated with FH(r = 0.474,P < 0.01), with regression equation FH = 0.046*SA + 1.406.ConclusionThe sagittal angle was positively correlated with posterolateral-oblique type (type I) of Posterior malleolus fractures, and SA could be considered to reflect the ankle joint stability of PMFs.Level of evidence: Level III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 99%

The influence of sagittal angle of posterior malleolus fracture on ankle joint stability：a retrospective study of 87 cases

Zhang

Yang

et al. 2022

Preprint

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“…The posterior malleolus is affected in around 40% of ankle fractures [146]. Anatomical reduction of the articular surface and fibular notch are essential for ankle stability and functional outcomes.…”

Section: Role Of the Posterior Malleolusmentioning

confidence: 99%

“…Anatomical reduction of the articular surface and fibular notch are essential for ankle stability and functional outcomes. To address the posterior malleolus when treating ankle fractures, surgeons should choose the most adequate approach based on the fracture pattern and their own experience [3,[14][15][16][17]99,146,152,154,155]. Anatomical reduction and stable fixation of the posterior malleolus are critical to improve outcomes [1,3,[14][15][16][17]21,43,46,50,84,86,99,144,146,153,154].…”

Section: Role Of the Posterior Malleolusmentioning

confidence: 99%

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

Regauer¹,

Mackay

Nelson

et al. 2022

JCM

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Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.

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“…57 Vacas-Sánchez et al proposed a CT-based algorithm for fixation of the posterior malleolus and Wang et al showed good functional outcomes following operative treatment of the posterior malleolus. 58 , 59 …”

Section: Non-operative Treatmentmentioning

confidence: 99%

Current management of trimalleolar ankle fractures

et al. 2021

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A trimalleolar ankle fracture is considered unstable and treatment is generally performed operatively. Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus. Trimalleolar ankle fractures have a rising incidence in the last decade with up to 40 per 100,000 people per year. With a growing number of elderly patients, trimalleolar ankle injuries will become more relevant in the form of fragility fractures, posing a particular challenge for trauma surgeons. In patients with osteoporotic trimalleolar ankle fractures and relevant concomitant conditions, further evidence is awaited to specify indications for open reduction and internal fixation or primary transfixation of the ankle joint. In younger, more demanding patients, arthroscopic-assisted surgery might improve the outcome, but future research is required to identify patients who will benefit from assisted surgical care. This review considers current scientific findings regarding all three malleoli to understand the complexity of trimalleolar ankle injuries and provide the reader with an overview of treatment strategies and research, as well as future perspectives. Cite this article: EFORT Open Rev 2021;6:692-703. DOI: 10.1302/2058-5241.6.200138

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How to address the posterior malleolus in ankle fractures? A decision-making model based on the computerised tomography findings

Cited by 29 publications

References 29 publications

The influence of sagittal angle of posterior malleolus fracture on ankle joint stability：a retrospective study of 87 cases

The influence of sagittal angle of posterior malleolus fracture on ankle joint stability：a retrospective study of 87 cases

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

Current management of trimalleolar ankle fractures

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