Importance of Fixation of Posterior Malleolus Fracture in Trimalleolar Fractures: A Retrospective Study

Karaca, Şemsettin; Enercan, Meriç; Özdemir, Güzelali; Kahraman, Sinan; Cobanoglu, Mutlu; Küçükkaya, Metin

doi:10.5505/tjtes.2016.44844

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…The posterior malleolus is a component of the distal tibiofibular complex, and it participates in and maintains ankle joint stability [ 14 – 16 ]. The ankle joint bears loads of approximately 3–5 times of body weight when individuals are standing or walking with heavy loads [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the epidemiological characteristics of posterior malleolus fracture in adults

Luo

et al. 2023

J Orthop Surg Res

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Background This study explores the latest epidemiological characteristics of posterior malleolus fracture and compares the epidemiological differences of posterior malleolus fracture in different periods, regions, and adult age groups. Methods Clinical information of inpatients with posterior malleolus fracture in Shanghai Tongji Hospital and Karamay Central Hospital from January 2014 to February 2022 was reviewed and collected. The imaging data of patients were acquired using the Picture Archiving and Communication Systems. A statistical analysis was performed as to gender, current age, year of admission, injury mechanism, fracture type, and posterior malleolus fracture classification. Moreover, a comparative analysis was conducted on the injury mechanisms and morphological differences of posterior malleolus fracture at different periods, regions, and age groups. Results A total of 472 patients (210 patients from Shanghai Tongji Hospital and 262 patients from Karamay Central Hospital) with posterior malleolus fracture and an average age of 48.7 ± 15.6 were included in this study. The peak of posterior malleolus fracture occurs in the age group of 50–59. The injury mechanisms mainly involve low-energy fall and sprain (411 cases, 87.1%), followed by traffic accidents (52 cases, 11.0%), and fall injury from height (9 cases, 1.9%). With aging, the number of fall and sprain cases increases and reaches the peak at the age of 50–59, followed by progressive decline. Traffic accidents presents a relatively flat small peak in the age group of 40–59. The number of cases according to different fracture types shows the following ascending order: trimalleolar fracture-supination external rotation (335 cases, 71.0%) > bimalleolar fracture (60 cases, 12.7%) > trimalleolar fracture-pronation extorsion (43 cases, 9.1%) > posterior malleolus + tibial shaft fracture (19 cases, 4.0%) > simple posterior malleolus fracture (15 cases, 3.2%). The numbers of cases corresponding to the Haraguchi I Type, II Type, and III Type of posterior malleolus fractures were 369 (78.2%), 49 (10.4%), and 54 (11.4%), respectively. The Tongji IIA Type represented the highest number of cases (249 cases, 52.8%), followed by the IIB Type (120 cases, 25.4%), I Type (54 cases, 11.4%), IIIB Type (36 cases, 7.6%), and IIIA type (13 cases, 2.8%). The trimalleolar fracture-supination external rotation, Haraguchi I Type and Tongji IIA Type of posterior malleolus fractures all presented an obvious peak of incidence in the age group of 50–59. However, no obvious statistical difference was observed in the injury mechanism, Haraguchi classification, and Tongji classification of posterior malleolus fractures among different years and regions in recent years (P > 0.05). Conclusions The injury mechanism of posterior malleolus fracture mainly involves low-energy fall and sprain cases. The trimalleolar fracture-supination external rotation, Haraguchi I type and Tongji IIA type of posterior malleolus fracture are predilection fracture types, and all present an obvious incidence peak in the age group of 50–59. Elderly patients have high risks of falling and their bones are more fragile, conditions which are potential risk factors of posterior malleolus fracture. Early positive control has important significance. This study provides references for relevant basic and clinical studies of posterior malleolus fracture.

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Section: Discussionmentioning

confidence: 99%

Analysis of the epidemiological characteristics of posterior malleolus fracture in adults

Luo

et al. 2023

J Orthop Surg Res

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“…4 Complications reported include a reduced range of motion, pes planus foot deformity, multiple revision surgeries, and ankle instability. 7,9,10 Our aim in this systematic review was to evaluate the evidence regarding the identification, outcomes, complications, and further management of TP tendon entrapment in patients with ankle and pilon fractures.…”

Section: Introductionmentioning

confidence: 99%

“…8 Patients suffering with TP entrapment can manifest months to years later with poorer surgical outcomes. 9 , 10 TP entrapment has been noted in ankle fracture surgery when encountered with inability to reduce the ankle mortise intraoperatively. 11 In severe cases, the posterior neurovascular bundle travelling alongside the TP tendon has also been reported to be trapped within PM fracture fragments.…”

Section: Introductionmentioning

confidence: 99%

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Posterior tibialis tendon entrapment as a complication of posterior malleolar fractures in complex ankle fractures

Syziu,

Aamir,

Mason

2024

Bone Jt Open

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AimsPosterior malleolar (PM) fractures are commonly associated with ankle fractures, pilon fractures, and to a lesser extent tibial shaft fractures. The tibialis posterior (TP) tendon entrapment is a rare complication associated with PM fractures. If undiagnosed, TP entrapment is associated with complications, ranging from reduced range of ankle movement to instability and pes planus deformities, which require further surgeries including radical treatments such as arthrodesis.MethodsThe inclusion criteria applied in PubMed, Scopus, and Medline database searches were: all adult studies published between 2012 and 2022; and studies written in English. Outcome of TP entrapment in patients with ankle injuries was assessed by two reviewers independently.ResultsFour retrospective studies and eight case reports were accepted in this systematic review. Collectively there were 489 Pilon fractures, 77 of which presented with TP entrapment (15.75%). There were 28 trimalleolar fractures, 12 of which presented with TP entrapment (42.86%). All the case report studies reported inability to reduce the fractures at initial presentation. The diagnosis of TP entrapment was made in the early period in two (25%) cases, and delayed diagnosis in six (75%) cases reported. Using modified Clavien-Dindo complication classification, 60 (67%) of the injuries reported grade IIIa complications and 29 (33%) grade IIIb complications.ConclusionTP tendon was the commonest tendon injury associated with pilon fracture and, to a lesser extent, trimalleolar ankle fracture. Early identification using a clinical suspicion and CT imaging could lead to early management of TP entrapment in these injuries, which could lead to better patient outcomes and reduced morbidity.Cite this article: Bone Jt Open 2024;5(3):252–259.

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“…TPT entrapment in ankle injuries is a rare but reported complication that is difficult to visualise on imaging and can significantly affect function outcomes postoperatively [ 10 – 12 ]. In the context of ankle fracture, TPT entrapment can present months to years following initial injury and has been noted in several cases to be the primary cause of mal-reduction in the ankle mortise intraoperatively [ 7 , 13 , 14 ]. Of note, Eastman et al .…”

Section: Introductionmentioning

confidence: 99%

Tibialis posterior tendon entrapment in posterior malleolar and pilon injuries of the ankle: a retrospective analysis

Aamir,

Syziu,

Andritsos

et al. 2023

Eur J Orthop Surg Traumatol

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Background The Tibialis Posterior tendon (TPT) is the only tendon to encounter the distal tibia and is therefore at greatest risk of injury in fractures of the distal tibia. Although TPT injury has been reported rarely with injuries around the ankle, they often have been missed and present late. Aim Our aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia, i.e. Pilon (PLM) and posterior malleolar fractures (PMF). Methods A retrospective analysis of PMF and Pilon fractures over an 8-year period was undertaken. Patients who had undergone surgical fixation of their PMF or PLM were identified from 2014 to 2022, using our prospectively collected database. Any fracture which had undergone a preoperative CT was included. Analysis of their pre-operative CT imaging was utilised to identify TPT entrapment, where if < 50% of the tendon cross section was present in the fracture site, this was denoted as a minor entrapment and if ≥ 50% of the tendon was present in the fracture site was denoted as major. Results A total of 363 patients were identified for further analysis, 220 who had a PMF and 143 with PLM injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture line entered the TPT sheath, there was a 45% rate (72/172) of entrapment as compared to 3.7% (7/190) in fractures not entering the sheath (p < .001). There was no significant difference in TPT entrapment in PMF as compared to PML (p = 0.353). Conclusion In our assessment, we found significant prevalence of 22% of TPT entrapment in fractures involving the posterior tibia. PMF and PLF had no statistically significant difference in the rate of TPT entrapment. Additionally, we found that there was a significant risk of TPT entrapment when the CT images display the fracture line entering the tendon sheath. We recommend that surgeons consider taking care assessing pre-operative imaging to seek to identify the TPT and to assess intraoperatively where entrapment does occur.

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Importance of Fixation of Posterior Malleolus Fracture in Trimalleolar Fractures: A Retrospective Study

Abstract: BACKGROUND:The aim of this retrospective study was to evaluate treatment effect and importance of posterior malleolus (PM) fixation in surgically treated trimalleolar fractures.

Cited by 11 publications

References 19 publications

Analysis of the epidemiological characteristics of posterior malleolus fracture in adults

Analysis of the epidemiological characteristics of posterior malleolus fracture in adults

Posterior tibialis tendon entrapment as a complication of posterior malleolar fractures in complex ankle fractures

Tibialis posterior tendon entrapment in posterior malleolar and pilon injuries of the ankle: a retrospective analysis

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