Operative Treatment of Posterior Malleolar Fractures

Abstract

Fractures of the posterior malleolus can occur in conjunction with fibular and medial malleolar fractures or in isolation. The indications for fixation of the posterior malleolus remain controversial except for the fragment sizes. A number of different surgical approaches and techniques for internal fixation of posterior malleolar fractures have been reported. Newer techniques such as direct exposure and plating of the posterior malleolus are chosen more frequently than traditional techniques of indirect reduction and percutaneous screw fixation. These attributes help to minimize the occurrence of postoperative complications.

Malunions and nonunions following tibial malleolar and tibial plafond fractures: current concepts

“…Surgeons managing these complex fractures should be comfortable with the various approaches to the distal tibia and be prepared to use whichever approach is suitable for the individual soft tissues and fracture pattern 17 . In ankle fractures, the presence of tibial posterior malleolus fracture, which occurs in about one-third of ankle injuries, correlates with poorer prognosis and worse clinical outcomes 2 . In recent years, the orthopaedic community is paying increasing attention to the correct analysis and classification of posterior malleolus fractures, but there is still a lack of consensus regarding the best surgical management of these injuries 2 .…”

“…However, this percutaneous technique was endowed with several disadvantages, including the limited effectiveness of ligamentotaxis, the impossibility to remove loose fragments eventually observed at the fracture site, and the potential for tibialis anterior nerve or artery damage. Furthermore, the anteroposterior partially threated screw may not provide enough interfragmentary compression when the thread of the lag screw partially crosses the fracture line 2,22 . Currently, the posterior approach is the preferred choice when percutaneous antero-posterior fixation is not indicated 21 .…”

“…Ankle fractures or fracture-dislocations account for about 4-5% of all body fractures, with approximately 120-180/100,000 affected persons/year. The traumatic mechanism of injury generally consists of a torsional force applied to the joint, while the fracture pattern varies depending on the position of the foot (supination/ pronation) and on the direction of the rotation (internal/external rotation) 1,2 . Tibial pilon fractures are relatively infrequent, accounting for 5-7% of all fractures of tibia 3 .…”

Numerical Simulation of the Posterior Malleolus Fracture with the Finite Element Method

“…Fractures of the posterior malleolus can occur in conjunction with fibular and medial malleolar fractures or in isolation [3,4]. The present research focuses on posterior malleolus fracture, which is considered to be a rare injury mechanism in comparison with lateral and medial malleolus fracture [4,5]. This fracture is located in the back of the ankle joint, while surgery for its fixation is considered necessary if the amount of joint involvement is greater than 25% and the articular step-off is greater than 2 mm [6].…”

Numerical Simulation of the Posterior Malleolus Fracture With the Finite Element Method

“…This research focuses on posterior malleolus fracture which is considered as a rare injury mechanism in comparison with lateral and medial malleolus fracture [2], [3]. This fracture is located in the back of ankle joint, while surgery for its fixation is considered necessary if the broken part is greater than the 25% of the articular surface [4]. The operational treatment is carried out with the assembly of two screws from the back to the front part of tibia and a stabilizing plate where the screws are fixed [5].…”