Outcomes of posterior malleolar fractures with intra-articular impacted fragment

Xie, Wenyong; Lü, Hao; Zhan, Sizheng; Liu, Yijun; Xu, Hailin; Fu, Zhong-guo; Zhang, Dianying; Jiang, Baoguo

doi:10.1007/s00402-021-04002-y

Cited by 15 publications

(9 citation statements)

References 37 publications

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“…Although surgeons have attached great importance to the reduction in intra-articular fragments, some fragments still have to be removed. This may lead to an uneven articular surface which is associated with a poor prognosis [25]. In addition, although there was no significant difference in the OMASs between the small-, large-and double-fragment groups, it is interesting that the average score in the small-fragment group was lower than that in the other two groups.…”

Section: Discussionmentioning

confidence: 91%

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: 91%

Posterior malleolus fracture: a mid-term follow-up

Yuan

Lü

et al. 2023

J Orthop Surg Res

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“…Early studies have shown that the dissection of IAIF is an important risk factor affecting the prognosis in PVPM fracture [19] . On top of this, reduction quality was reported negatively associated with IAIF size, indicative of the impairing role of IAIF during reduction process [13] . So far there were only sporadic reports of the effect of IAIFs on the prognosis of patients with ankle fractures [13,14,21] , suggesting that the IAIF's presence may contribute to traumatic arthritis [13] .…”

Section: Discussionmentioning

confidence: 97%

“…On top of this, reduction quality was reported negatively associated with IAIF size, indicative of the impairing role of IAIF during reduction process [13] . So far there were only sporadic reports of the effect of IAIFs on the prognosis of patients with ankle fractures [13,14,21] , suggesting that the IAIF's presence may contribute to traumatic arthritis [13] . The purpose of this retrospective study using postoperative one-year data was to evaluate the early clinical effect in patients with PVPM fracture by analyzing AOFAS, SF-36, VAS and their association with the presence of IAIF.…”

Section: Discussionmentioning

confidence: 97%

“…Although the presence of IAIF may hamper reduction of articular surface, there is not enough evidence to convince that the complete reduction of the IAIF in the posterior tibial plafond is a must. Since no study has concluded the positive association between the IAIF reduction and PVPM fracture prognosis, which may result in potential injury to the adjacent neurovascular and soft tissues, a debate about whether the IAIF must be reduced in PVPM fractures persists [12][13][14] . Therefore, it is paramount to study the necessity of IAIF reduction, which may be critical in determining the prognosis of the PVPM fractures.…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Study of the Clinical Outcomes of Pilon Variant Posterior Malleolar Fracture involving Intra-Articular Impacted Fragments

You

Chen

Sun

et al. 2023

Preprint

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INTRODUCTION Intra-articular impacted fragment (IAIF) is commonly found in the Pilon variant posterior malleolar (PVPM) fracture. Poor quality of reduction may result in articular incongruity, leading to ankle function impairment and ultimately traumatic arthritis. However, the debating remains on if the IAIF must be reduced, and how the presence or malreduction of the IAIF influences the prognosis in PVPM fractures. This retrospective study is to evaluate the prognostic effect of the IAIF reduction in the PVPM fractures. METHODS We studied 22 patients with PVPM fractures admitted to our hospital between June 2020 and June 2021, who were treated with open surgery and followed-up for 12 months retrospectively. The patients were divided into two groups: six patients without IAIF (No-IAIF group) and 16 patients with IAIF (IAIF group). Burwell-Charnley scoring system and ankle CT scan were used to evaluate the radiographic outcomes. At postoperative 12 months, American Orthopedic Foot and Ankle Score (AOFAS) was set as primary outcome. Visual Analog Scale (VAS) pain score, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were secondary outcomes and associated complications were recorded. Postoperative articular stepping ≥2mm or articular incongruity on the sagittal view of CT scans was considered “poor” reduction, otherwise “anatomical”. The study abided by the Declaration of Helsinki and is approved by Human Ethics Committee of our hospital. All persons gave their informed consent prior to their inclusion in the study. RESULTS The articular surface of five of six patients in No-IAIF group and eight of 16 patients in IAIF group were considered “anatomically” reduced. Statistical difference of AOFAS, SF-36 and VAS was found significant between the No-IAIF and IAIF groups at postoperative 12 months. In the fractures considered with “anatomical” reduction, significant difference was only seen in SF-36 between the patients with and without IAIF. Three of 22 patients received syndesmotic fixations. No difference of associated complications was noted. DISCUSSION The results of this study indicated that the short-term clinical effect was dependent of the presence the IAIF. Importantly, the reduction satisfactory was statistically associated with improved clinical outcomes at 12 months postoperatively. SIGNIFICANCE The presence of the IAIF negatively affect the clinical outcome and the anatomical reduction of the articular congruity will positively affect the prognosis of PVPM fracture.

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“…However, there is still a lack of consensus on whether the fixation of the posterior malleolus is always necessary. Treatment strategies that take the size and displacement of the posterior fracture fragment into consideration remain an issue of debate [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

In Vivo Foot Segmental Motion and Coupling Analysis during Midterm Follow-Up after the Open Reduction Internal Fixation of Trimalleolar Fractures

Hoekstra

Vinckier

Staes

et al. 2023

JCM

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Purpose: Trimalleolar ankle fractures (TAFs) are common traumatic injuries. Studies have described postoperative clinical outcomes in relation to fracture morphology, but less is known about foot biomechanics, especially in patients treated for TAFs. The aim of this study was to analyze segmental foot mobility and joint coupling during the gait of patients after TAF treatment. Methods: Fifteen patients, surgically treated for TAFs, were recruited. The affected side was compared to their non-affected side, as well as to a healthy control subject. The Rizzoli foot model was used to quantify inter-segment joint angles and joint coupling. The stance phase was observed and divided into sub-phases. Patient-reported outcome measures were evaluated. Results: Patients treated for TAFs showed a reduced range of motion in the affected ankle during the loading response (3.8 ± 0.9) and pre-swing phase (12.7 ± 3.5) as compared to their non-affected sides (4.7 ± 1.1 and 16.1 ± 3.1) and the control subject. The dorsiflexion of the first metatarsophalangeal joint during the pre-swing phase was reduced (19.0 ± 6.5) when compared to the non-affected side (23.3 ± 8.7). The affected side’s Chopart joint showed an increased range of motion during the mid-stance (1.3 ± 0.5 vs. 1.1 ± 0.6). Smaller joint coupling was observed on both the patient-affected and non-affected sides compared to the controls. Conclusion: This study indicates that the Chopart joint compensates for changes in the ankle segment after TAF osteosynthesis. Furthermore, reduced joint-coupling was observed. However, the minimal case numbers and study power limited the effect size of this study. Nevertheless, these new insights could help to elucidate foot biomechanics in these patients, adjusting rehabilitation programs, thereby lowering the risk of postoperative long-term complications.

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Outcomes of posterior malleolar fractures with intra-articular impacted fragment

Cited by 15 publications

References 37 publications

Posterior malleolus fracture: a mid-term follow-up

Posterior malleolus fracture: a mid-term follow-up

A Retrospective Study of the Clinical Outcomes of Pilon Variant Posterior Malleolar Fracture involving Intra-Articular Impacted Fragments

In Vivo Foot Segmental Motion and Coupling Analysis during Midterm Follow-Up after the Open Reduction Internal Fixation of Trimalleolar Fractures

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