Operative Management of AO Type 44 Ankle Fractures: Determinants of Outcome

Velleman, Jos; Nijs, Stefaan; Hoekstra, Harm

doi:10.1053/j.jfas.2017.08.021

Cited by 20 publications

(18 citation statements)

References 33 publications

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“…However, a lot of recent literature argue that surgical xation of small fragments of the posterior malleolus may have a better effect on the clinical effects [8,13,15]. And also, posterior malleolus xation relates to syndesmotic stability [14,[28][29][30]. Then it may allow an opportunity to avoid standard syndesmotic xation with screws, which bring about many complications [31].…”

Section: Discussionmentioning

confidence: 99%

“…The size of posterior malleolus fracture ranges from shell-like fragments to fragments involving more than 40% of the distal tibia articular surface. Although most foot and ankle orthopedic surgeons agree that the fragments involving more than 25-30% of the surface of the distal tibial should be xed [10][11][12], there are still many surgeons believe that the surgical indications of posterior malleolar fragment should be expanded [8,[13][14][15]. When the posterior malleolar fragment size is small , it can be reduced and xed by minimally invasive approach, such as percutaneous reduction and cannulated screw xation [15].…”

Section: Introductionmentioning

confidence: 99%

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A Modified Posterolateral Approach for the Treatment of Posterior Malleolar Fracture

Fang¹,

Kong²,

Chen³

2020

Preprint

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Background: To observe the clinical effect of a modified posterolateral approach internal fixation in the treatment of posterior malleolar fracture. Method: From January 2015 to October 2018, 30 cases involving lateral and posterior malleolar fracture patient data were treated in our department. we observed operation time, fracture healing time and postoperative complications. At the time of the last follow-up, we evaluated ankle joint function by the American Orthopedic Foot Ankle Society (AOFAS) ankle- hindfoot scale, the Short Form-36 (SF-36) outcome Tools and the American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Questionnaire. Result: In this group of 30 patients, the operation time of the patients was 80-120min (median 90min). The 25 patients were followed up for more than 1 year. 3 ~ 5 months after the operation, all the patients had bony healing. 3 cases with superficial wound infection. No other complication was found. The mean AOFAS scores at the postoperative 6-month, 12-month, and final follow-up were 78.4 (range, 72–90), 89.4 (range, 80–96), and 90.8 (range, 84–96), respectively. The mean SF-36 scores at the postoperative 12-month and final follow-up were 82.4 (range, 77.6–90.6) and 84.6 (range, 77.8–92.6), the mean AAOS scores at the postoperative 12-month and final follow-up were87.8 (range, 79–95), 90.6 (range, 82–96). Conclusion: Modified posterolateral approach avoided stripping the muscular origins of flexor hallucis longus, reduced the adhesion, and can fix the lateral and posterior malleolar fracture in the same incision, is worth popularizing in clinical.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Modified Posterolateral Approach for the Treatment of Posterior Malleolar Fracture

Fang¹,

Kong²,

Chen³

2020

Preprint

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“…Sin embargo, los estudios existentes en la actualidad son insuficientes para soportar estos porcentajes como dogma (1) , no existiendo evidencia científica para un tamaño mínimo de MP a partir del cual debería ser sintetizado (1,24,25) . De la misma forma, no se ha encontrado una relación directa entre el tamaño del MP y la aparición de artrosis de tobillo (10,11,24,26,27) .…”

Section: Discussionunclassified

“…Numerosas publicaciones recientes aconsejan sintetizar todas las fracturas desplazadas del MP, independientemente del tamaño de este, recomendando una reducción anatómica de la misma (1,26,28,29) .…”

Section: Discussionunclassified

Cómo sintetizar el maléolo posterior. ¿La mejor opción es la síntesis directa?

Martínez-Giménez¹,

Verdú-Román²,

Agulló-Bonus³

2019

MACT

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“…The presence of a posterior malleolus fracture is associated with poorer functional outcomes compared to more simple fractures. 2 Fractures involving the posterior malleolus frequently include damage to the articular cartilage which is likely to contribute significantly to rapid onset of severe arthritis. 3 These injuries occur secondary to a pronation-external rotation type force and result in a Weber B or C type pattern of injury to the distal fibula with or without a medial injury.…”

Section: Introductionmentioning

confidence: 99%

A survey of the management of posterior malleolar ankle fractures in South Africa

2019

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Background: Posterior malleolus fractures are associated with poorer functional outcomes compared to simpler malleolar fractures. Traditional teaching states that if a posterior malleolus fracture involves less than 25% of the distal tibia, it can be managed without fixation. Current literature has shown that fixation should not be based on the size of the posterior fragment but rather on the fracture pattern, instability and awareness that reduction and fixation is biomechanically advantageous. We hypothesised that current management of ankle fractures with posterior malleolus involvement in South Africa is not evidence-based and is suboptimal. We sought to assess the training, experience and decision-making of surgeons and trainees who are involved in the management of ankle fractures. Another aim was to develop evidence-based algorithms for the management of posterior malleolus and complex ankle fractures. Methods: An email survey consisting of questions related to the management of ankle fractures was sent to specialists, registrars and medical officers who voluntarily completed an online survey. Results: A total of 103 out of 456 emails sent drew responses to the survey. Responses included 28% from consultants, 54% from registrars and 18% from medical officers. Forty-six per cent of responders believed that posterior malleolus fractures can be managed non-operatively if less than 20% of the tibial plafond is involved. Only 49% would CT scan a posterior malleolus prior to operating. Thirty-eight per cent of the responders were not familiar or comfortable with the posterior-lateral approach used for fixation of the posterior malleolus directly. Conclusion: Understanding of ankle fractures has progressed. A significant proportion of responders to the survey are not following best practice and current literature. Posterior malleolus fractures are not benign and have poorer outcomes compared to bi-malleolar or lateral malleolus ankle fractures. All patients with posterior malleolus fractures should receive pre-operative CT scan. All posterior malleolar fractures that can be held with a plate or screws should be fixed.

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Operative Management of AO Type 44 Ankle Fractures: Determinants of Outcome

Cited by 20 publications

References 33 publications

A Modified Posterolateral Approach for the Treatment of Posterior Malleolar Fracture

A Modified Posterolateral Approach for the Treatment of Posterior Malleolar Fracture

Cómo sintetizar el maléolo posterior. ¿La mejor opción es la síntesis directa?

A survey of the management of posterior malleolar ankle fractures in South Africa

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Operative Management of AO Type 44 Ankle Fractures: Determinants of Outcome

Cited by 20 publications

References 33 publications

A&nbsp;Modified Posterolateral Approach&nbsp;for the Treatment of Posterior Malleolar&nbsp;Fracture

A&nbsp;Modified Posterolateral Approach&nbsp;for the Treatment of Posterior Malleolar&nbsp;Fracture

Cómo sintetizar el maléolo posterior. ¿La mejor opción es la síntesis directa?

A survey of the management of posterior malleolar ankle fractures in South Africa

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A Modified Posterolateral Approach for the Treatment of Posterior Malleolar Fracture

A Modified Posterolateral Approach for the Treatment of Posterior Malleolar Fracture