Outcomes of posterior malleolar fixation in ankle fractures in a major trauma centre

Jeyaseelan, Luckshmana; Bua, Nelson; Parker, Lee D.; Trockels, Amaury; Vris, Alexandros; Heidari, Nima; Malagelada, Francesc

doi:10.1016/j.injury.2020.12.006

Cited by 17 publications

(12 citation statements)

References 24 publications

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“…This demonstrated that the small-fragment in the posterior malleolus did not receive sufficient attention. Fixation of the posterior malleolar fragment was able to restore syndesmosis stability and led to improved clinical outcomes [20,21]. Recent studies have revealed that morphology rather than size should be considered when determining the treatment of posterior malleolar fractures [9,[22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Posterior malleolus fracture: a mid-term follow-up

Yuan

Lü

et al. 2023

J Orthop Surg Res

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Background The treatment of posterior malleolar fractures is changing rapidly, and the evidence base is still catching up. This study aimed to assess the mid-term prognosis of posterior malleolar fractures based on different morphological types and provides evidence for the treatment of posterior malleolar fractures. Methods We retrospectively analyzed the data of inpatients with posterior malleolar fractures from 1 January 2012 to 31 December 2019 at one high-volume tertiary trauma center. Fracture morphology was classified into small-shell fragment, single-fragment (small-fragment and large-fragment) and multifragment (double-fragment and compressive-fragment) by computed tomography according to our previous study. All patients were followed up at an average of 5.06 (range, 2.21–8.70) years. The Olerud-Molander Ankle Score (OMAS), EuroQol-5 Dimensions (EQ-5D) and American Orthopedic Foot and Ankle Society (AOFAS) score were recorded. Results Seventy-nine patients were included, and 7 patients were classified into the small-shell group, 52 patients into the single-fragment group and 20 patients into the multifragment group. Of all the patients, the average OMAS, EQ-5D and AOFAS scores were 85.9, 82.8 and 92.5, respectively. In the single-fragment group, patients who underwent surgical fixation in the posterior malleolus had significantly better scores (P = 0.037, 0.033 and 0.027). Among the patients with small fragments, the surgical fixation group also had higher OMAS (93.1 ± 7.5 vs. 83.5 ± 19.5, P = 0.042) and AOFAS scores (98.1 ± 3.1 vs. 91.0 ± 14.1, P = 0.028). The mean OMAS, EQ-5D and AOFAS scores were 85.5, 85.7 and 91.7, respectively, in patients with multiple fragments who underwent surgical fixation. Conclusion This study shows that in fractures with a single fragment, surgical fixation of the posterior malleolar fragment led to a better prognosis in the midterm. All single fragments should be fixed regardless of size. Fixation of the posterior region in all single- and multi-fragments in posterior malleolar fractures led to satisfactory outcomes. Level of Evidence Level III, follow-up study.

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Section: Discussionmentioning

confidence: 99%

Posterior malleolus fracture: a mid-term follow-up

Yuan

Lü

et al. 2023

J Orthop Surg Res

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“…33 Further surgery for lateral or medial implant removal was required in 4 patients (12.1%), which is comparable to published literature. Jeyaseelan et al 12 reported implant issues in 15% of 160 patients treated with either screw or buttress plate fixation of the associated posterior malleolar fracture, who ultimately required secondary surgery. One potential disadvantage of the percutaneous technique is damage to local tendon or neurovascular structures over the dorsal aspect of the ankle.…”

Section: Discussionmentioning

confidence: 99%

“…35 Although potentially offering biomechanical advantages, 36 complication rates of 23% after buttress plate fixation in a group of patients with a mean age of 51.5 years (13.5 years younger than the current cohort) have been reported and were primarily soft tissue in nature, including both superficial and deep infection. 12,37 Cases of significant wound breakdown requiring skin grafting and postoperative compartment syndrome resulting in amputation have been reported. 9,33 Conversely, in the current study, we experienced no wound healing complications secondary either to AP screws or fibular nailing.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8] However, this approach has complications, including sural nerve injury, wound infection, malreduction, and implant removal. 1,[9][10][11][12] A recent cohort study including 160 patients with surgically treated posterior malleolar fractures, predominantly with antiglide plating, reported complication rates of up to 30% with 21% requiring reintervention. 12 At least one case exists of catastrophic ischemia resulting in amputation after such surgery.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Fixation of Posterior Malleolar Fractures in Patients With Unstable Ankle Fractures Treated With a Fibular Intramedullary Nail: A Description of a Technique and Review of Outcomes

Wordie

Carter

MacDonald

et al. 2022

Journal of Orthopaedic Trauma

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Objectives: To (1) describe the percutaneous technique used to reduce and fix a posterior malleolar fracture with anteroposterior screws in patients managed with a fibular intramedullary nail, (2) describe the selection of patients to whom this technique can be applied, and (3) report the clinical and patient reported outcome of this intervention.Design: Retrospective review.Setting: Academic orthopaedic trauma center.Patients: Thirty-two consecutive patients with a mean age of 65 years (range, 39-90) over a thirteen-year period identified from a prospective database.Intervention: Unstable ankle fractures managed surgically with a fibular nail and percutaneous fixation of the posterior malleolar component. Main Outcome Measurements:The primary short-term outcome was complications related to posterior malleolar fracture fixation. The primary mid-term outcome was the Olerud-Molander Ankle Score. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, EuroQol-5D, health, pain, and satisfaction.Results: Thirty of the 32 (94%) posterior malleolar fractures united uneventfully. Postoperative loss of talar reduction occurred in 2 patients (6.3%), which in 1 patient (3.1%) eventually required a hindfoot nail arthrodesis. There were no soft-tissue complications related to the anteroposterior screws or the fibular nail fixation. At a mean follow-up of 3.7 years (range, 1-8), the median Olerud-Molander Ankle Score, Manchester-Oxford Foot Questionnaire, EuroQol-5D, health, pain, and satisfaction scores were 80.0, 23.4, 0.85, 80.0, 85.0, and 87.5, respectively.Conclusions: Percutaneous ankle fracture fixation with a fibular nail and posterior malleolar screws results in reliable fracture stabilization, good patient outcomes, and high treatment satisfaction.

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“…Средняя оценка по шкале MOXFQ у пациентов 1-й группы составила 20,10 балла, при этом средний показатель у пациентов 2-й группы был 24,03 балла. Разница была статистически значимой[10].Представленные результаты исследований свидетельствуют о необходимости выполнения остеосинтеза ЗКББК независимо от его размера для повышения стабильности голеностопного сустава, получения более высоких функциональных результатов у пациентов, а также улучшения их качества жизни после травмы. Контраргументом может выступать более высокая частота осложнений в случае выполнения фиксации ЗКББК, однако, на наш взгляд, это обстоятельство может быть связано с тем, что пациентам с более тяжелыми нестабильными переломами лодыжек и ЗКББК чаще выполняется фиксация задних отделов голеностопного сустава.…”

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Modern Views on Clinical Application of Posteromedial and Posterolateral Approaches in Posterior Malleolus Osteosynthesis in Case of Unstable Ankle Fractures

Belenkiy¹,

Sergeev²,

Mayorov³

et al. 2022

СПНО (MPSE)

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malleolus simultaneously via the same approach reduces intraoperative soft tissue trauma. In modern traumatology open reduction and internal fixation of posterior malleolus is performed regardless of the fragment size. This is due to the fact that the displacement of intra-articular fragments is a factor typically leading to worse functional outcomes and can be eliminated by the surgeon. Posteromedial and posterolateral approaches provide good visualization of distal posterior tibia. Notably execution of these approaches is technically possible and is not associated with high risk of injury to vascular-nervous bundle and other anatomic structures.

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Outcomes of posterior malleolar fixation in ankle fractures in a major trauma centre

Cited by 17 publications

References 24 publications

Posterior malleolus fracture: a mid-term follow-up

Posterior malleolus fracture: a mid-term follow-up

Percutaneous Fixation of Posterior Malleolar Fractures in Patients With Unstable Ankle Fractures Treated With a Fibular Intramedullary Nail: A Description of a Technique and Review of Outcomes

Modern Views on Clinical Application of Posteromedial and Posterolateral Approaches in Posterior Malleolus Osteosynthesis in Case of Unstable Ankle Fractures

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