Longterm outcome of 886 posterior malleolar fractures: A systematic review of the literature

Veltman, Ewout S.; Halma, Jelle J.; Gast, Arthur de

doi:10.1016/j.fas.2015.05.003

Cited by 59 publications

(52 citation statements)

References 34 publications

(78 reference statements)

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“…The lack of instability (except in one extreme case), combined with the fact no increase in peak ankle joint contact pressure was found for the fracture scenarios points to posterior malleolus fractures being relatively benign in nature. This supports the findings of an earlier review of the literature on the biomechanical and clinical evaluation of posterior malleolar fractures [18] and a recent study of the long-term outcome of 886 combined cases of posterior malleolar fractures from 1978 to 2014 undertaken by Veltman et al [17]. Veltman et al found that conservative treatment of posterior malleolar fractures showed comparable results on long-term outcome to surgical treatment, with no evidence to support the current consensus of fixing posterior malleolus fractures of greater than 25% of the tibial plafond.…”

Section: Discussionsupporting

confidence: 89%

“…It has been reported that larger fractures of the posterior malleolus can result in posterior subluxation of the talus and articular incongruity of the tibial plafond which, if not corrected can lead to posterior instability of the ankle and secondary traumatic arthritis [8, 14, 15] and whilst smaller fractures may not result in posterior subluxation, it has been suggested that they can still potentially lead to tibiotalar instability [16] and degenerative changes. Posttraumatic osteoarthritis resulting from fractures of the posterior malleolus can occur due to malreduction of the fracture fragment, cartilage damage due to the trauma and ankle instability [17]. …”

Section: Introductionmentioning

confidence: 99%

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3‐D computer modelling of malunited posterior malleolar fractures: effect of fragment size and offset on ankle stability, contact pressure and pattern

Alonso-Rasgado

Jimenez-Cruz

Karski

2017

Journal of Foot and Ankle Research

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BackgroundThe positioning of the fracture fragment of a posterior malleolus fracture is critical to healing and a successful outcome as malunion of a posterior malleolar fracture, a condition seen in clinical practice, can affect the dynamics of the ankle joint, cause posterolateral rotational subluxation of the talus and ultimately lead to destruction of the joint. Current consensus is to employ anatomic reduction with internal fixation when the fragment size is larger than 25 to 33% of the tibial plafond.MethodsA 3-dimensional finite element (FE) model of ankle was developed in order to investigate the effect of fragment size (6–15 mm) and offset (1–4 mm) of a malunited posterior malleolus on tibiotalar joint contact area, pressure, motion of joint and ligament forces. Three positions of the joint were simulated; neutral position, 20° dorsiflexion and 30° plantarflexion.ResultsCompared to the intact joint our model predicted that contact area was greater in all malunion scenarios considered. In general, the joint contact area was affected more by section length than section offset. In addition fibula contact area played a role in all the malunion cases.ConclusionsWe found no evidence to support the current consensus of fixing posterior malleolus fractures of greater than 25% of the tibial plafond. Our model predicted joint instability only with the highest level of fracture in a loaded limb at an extreme position of dorsiflexion. No increase of peak contact pressure as a result of malunion was predicted but contact pattern was modified. The results of our study support the view that in cases of posterior malleolar fracture, posttraumatic osteoarthritis occurs as a result of load on areas of cartilage not used to loading rather than an increase in contact pressure. Ankle repositioning resulted in increased force in two ankle ligaments. Our finding could explain commonly reported clinical observations.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

3‐D computer modelling of malunited posterior malleolar fractures: effect of fragment size and offset on ankle stability, contact pressure and pattern

Alonso-Rasgado

Jimenez-Cruz

Karski

2017

Journal of Foot and Ankle Research

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“…Persistent talar subluxation was present in seven patients (1% of all patients). Two patients had persistent nerve damage[38].…”

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confidence: 99%

Treatment of Posterior Malleolus Fracture through Posterolateral Approach

Kumar¹,

Lü²,

Ratish³

et al. 2019

OJO

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Posterior malleolus fractures are quite common and usually result from rotational ankle injuries. For the management of posterior malleolus fractures, more studies are still required, though it is already well-recognized for medial and lateral structure. Therefore, fracture of posterior malleolus is striking subject of study among orthopedic surgeons. Most orthopedic surgeons recommend fixing the posterior malleolus fracture if it is larger than 25% to 33% of the distal articular surface. Further attention is required for the reduction and fixation of fractures involving posterior malleolus. Several approaches and methods for fixation of posterior malleolus have been defined in the literature. Previously, the most common method of fixation of the posterior malleolus is by indirect reduction and anteroposterior screws, it is minimally invasive, the anterior incision does not allow satisfactory visualization of the fragment, so good anatomical reduction is difficult to achieve thorough this approach. Operative management goals to reach a stable ankle with maximal function, decrease the risk of post-traumatic degenerative changes, and diminish the risk of complication. Nowadays, posterolateral approach is gaining the popularity due to adequate visualization and accurate anatomic reduction.

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“…Pequenas fraturas do rebordo tibial posterior foram frequentemente ignoradas ou fixadas usando um parafuso compressivo ântero-posterior sem redução apropriada obtendo resultados inferiores. [6][7][8] A fixação do maléolo posterior é importante para a estabilidade sindesmótica: restaura a integridade da incisura fibular da tíbia e facilita a redução anatómica do perónio. Além disso, há evidências crescentes do importante papel do maléolo posterior no desenvolvimento da artrose pós-traumática.…”

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“…12 Posteriormente, as fraturas maleolares posteriores viciosamen-te consolidadas levam a um desfecho funcional mau e a uma má qualidade de vida. 8 Ainda não há consenso no que se refere ao tamanho exato dos fragmentos de maléolo posterior que justificam redução aberta e fixação interna (RAFI). Fragmentos maiores do que 5% da superfície articular tibiotalar com um desnível articular de pelo menos 1 mm, progridem mais frequentemente em direção à artrose, que aqueles sem desnível.…”

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Via Póstero-Interna na Fixação de Fragmento Posterior em Fratura Complexa do Pilão Tibial

Martins

Varzielas

Mendes

2018

Gaz Med

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As fraturas do maléolo posterior são frequentes nas fraturas do tornozelo. A sua fixação é importante para a estabilidade sindesmótica e desempenha um papel importante na prevenção da artrose pós-traumática e, consequentemente, leva a um melhor resultado funcional. A qualidade de redução é melhor se utilizada uma via posterior em relação às técnicas habituais.Reportamos o caso de um homem de 52 anos com uma fratura do pilão tibial AO/OTA 43C3 e Bartonicek tipo 3. A redução anatómica e fixação do maléolo posterior foi realizada através de uma abordagem póstero-interna, com bons resultados funcionais 9 meses de pós-operatório.A abordagem póstero-interna constitui uma via segura para redução e fixação do maléolo posterior que permite também a redução e fixação da restante tíbia distal, permitindo uma rápida recuperação funcional e minimizando complicações degenerativas tardias.

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Longterm outcome of 886 posterior malleolar fractures: A systematic review of the literature

Cited by 59 publications

References 34 publications

3‐D computer modelling of malunited posterior malleolar fractures: effect of fragment size and offset on ankle stability, contact pressure and pattern

3‐D computer modelling of malunited posterior malleolar fractures: effect of fragment size and offset on ankle stability, contact pressure and pattern

Treatment of Posterior Malleolus Fracture through Posterolateral Approach

Via Póstero-Interna na Fixação de Fragmento Posterior em Fratura Complexa do Pilão Tibial

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