Influence of Fragment Size and Postoperative Joint Congruency on Long-Term Outcome of Posterior Malleolar Fractures

Hooff, Cornelis Christiaan Drijfhout van; Verhage, Samuël Marinus; Hoogendoorn, J. M.

doi:10.1177/1071100715570895

Cited by 165 publications

(132 citation statements)

References 24 publications

(32 reference statements)

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“…The ankle range of motion (ROM) was measured, and the difference of the dorsiflexion between the injured and uninjured side was calculated and presented as dorsiflexion restriction [19, 20]. Visual Analog Scale (VAS) was used to evaluate local pain.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis.MethodsPatients with a PMF involving over 25% of the articular surface were recruited and assigned to the direct reduction (DR) group or the indirect reduction (IR) group. Following reduction and fixation of the fracture, the quality of fracture reduction was evaluated in post-operative CT images. Clinical and radiological follow-ups were performed at 6 weeks, 3 months, 6 months, 12 months, and then at 6 month-intervals postoperatively. Functional outcome (AOFAS score), ankle range of motion, and Visual Analog Scale (VAS) were evaluated at the last follow-up. Statistical differences were compared between the DR and IR groups considering the patient demographics, quality of fracture reduction, AOFAS score, and VAS.ResultsTotally 116 patients were included, wherein 64 cases were assigned to the DR group and 52 cases were assigned to the IR group. The quality of fracture reduction was significant higher in the DR group (P = 0.038). In the patients who completed a minimum of 12 months’ follow-up, a median AOFAS score of 87 was recorded in the DR group, which was significantly higher than that recorded in the IR group (a median score of 80). The ankle range of motion was slightly better in the DR group, with the mean dorsiflexion restriction recorded to be 5.2° and 6.1° in the DR and IR group respectively (P = 0.331). Similar VAS score was observed in the two groups (P = 0.419).ConclusionsThe direct reduction technique through a posterolateral approach provide better quality of fracture reduction and functional outcome in the management of PMF over 25% of articular surface, as compared with the indirect reduction technique using ligamentotaxis.Trial registration NCT02801474 (retrospectively registered, June 2016, ClinicalTrails.gov).

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Section: Methodsmentioning

confidence: 99%

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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“…Disappointingly, this still included over 40% of the patients in whom the posterior malleolus had been fixed. 56 The authors of a CT-based study dismissed earlier papers that are based on plain radiographs. However, their own retrospective series had CT data for only 57% of the 42 patients.…”

Section: Cite This Articlementioning

confidence: 99%

Posterior malleolus fractures

Solan

Sakellariou

2017

The Bone & Joint Journal

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The posterior malleolus component of a fracture of the ankle is important, yet often overlooked. Pre-operative CT scans to identify and classify the pattern of the fracture are not used enough. Posterior malleolus fractures are not difficult to fix. After reduction and fixation of the posterior malleolus, the articular surface of the tibia is restored; the fibula is out to length; the syndesmosis is more stable and the patient can rehabilitate faster. There is therefore considerable merit in fixing most posterior malleolus fractures. An early postoperative CT scan to ensure that accurate reduction has been achieved should also be considered. Cite this article:

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“…Therefore, the authors suggested that anatomic reduction and internal fixation should be used when the posterior malleolus fracture fragment size is >25% of the articular surface. In a previous study, Drijfhout van Hooff et al divided 131 patients into three groups depending on the fragment size: <5%, 5%-25%, or >25% 21 . The average follow-up period was 6.9 years (range, 2.5-15.9).…”

Section: Management Of Posterior Malleolus Fracturesmentioning

confidence: 99%

Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination‐External Rotation Type IV Ankle Fractures

Wang

Zhang

Yin

et al. 2017

Orthopaedic Surgery

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Objective: To investigate the effect of internal fixation on postoperative ankle function in patients with supinationexternal rotation type IV ankle fractures, including medial malleolus fractures and deltoid ligament injury.Methods: Between January 2012 and June 2014, patients with medial structure injuries were enrolled in this study and assigned to the medial malleolus fracture group or the deltoid ligament group. The surgical procedures for the two groups were documented. The follow-up endpoint was the time point when the steel plate or screw was removed from the lateral ankle. The Olerud-Molander ankle scoring system was used to assess ankle function.Results: A total of 84 patients with supination-external rotation type IV ankle fractures had complete medical records and were included in this study. The average age of the patients was 44.16 years (range, 15-75). The patient sample included 39 males and 45 females. Overall, 49 patients (19 males and 30 females) suffered a medial malleolus fracture. The average age of these patients was 40.20 years (range, 15-75). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 81.6% (40 patients) of these patients. Overall, 35 patients (20 males and 15 females) experienced a deltoid ligament injury. The average age of these patients was 44.21 years (range, 17-73). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 11.5% (four patients) of these patients. Open reduction was performed in patients with medial malleolus fractures, and two 4.0-mm cannulated screws were used to fixate the posterior malleolus and the medial malleolus. The sutureanchor technique was used to repair the ligaments in patients with deltoid ligament injuries. The follow-up endpoint was the time point when the steel plate and screws were removed from the lateral ankle in patients. The average follow-up period was 13.4 months (range, 11-17). The Olerud-Molander ankle scoring system was used to assess postoperative ankle function. The average score for the patients in the medial malleolus fracture group was 90.3 points (range, 85-95). The average score for the patients in the deltoid ligament injury group was 87.7 points (range, 80-95). No significant differences were found in the scores between the two groups. Conclusion:Medial malleolus fracture and deltoid ligament injury are two different presentations of supinationexternal rotation type IV ankle fractures. Anatomic reduction of the articular surface concurrent with restoration of ankle stability can achieve favorable results for these two injuries.

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Influence of Fragment Size and Postoperative Joint Congruency on Long-Term Outcome of Posterior Malleolar Fractures

Abstract: Level IV, retrospective case series.

Cited by 165 publications

References 24 publications

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Posterior malleolus fractures

Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination‐External Rotation Type IV Ankle Fractures

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