Posteroanterior Lag Screws Versus Posterior Buttress Plate Fixation of Posterior Malleolar Fragments in Spiral Tibial Shaft Fracture

Zhang, Kaibin; Cui, Rongfei; Gu, Yanqing; Wang, Dalin; Yan, Junwei; Yin, Zhaowei; Xu, Chao

doi:10.1053/j.jfas.2019.09.039

“…When the foot is in a forward or backward rotation position, external force is applied to the talus due to rotation or valgus, which may damage the inferior tibiofibular ligament [ 10 , 13 , 14 ]. One side of this ligament is connected to the distal posterior edge of the tibia, the posterior malleolus.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Predictive Factors of Tibial Fracture with Occult Posterior Ankle Fractures

Wang

¹

,

Yang

²

,

Dong

³

et al. 2021

Journal of Healthcare Engineering

View full text Add to dashboard Cite

Background. Few studies exist on the predictive factors of tibial fractures with hidden posterior ankle fractures. Objective. To study the incidence and predictive factors of tibial fractures with occult posterior ankle fractures. Methods. Tibial fracture patients were prospectively selected who were admitted to our hospital from January 2016 to May 2021 and their general clinical data, X-ray images, CT images, and other imaging data were collected and then divided them into posterior malleolus fracture group and nonposterior malleolus fracture group according to the presence or absence of posterior malleolus fractures. Multivariate regression analysis and receiver operating curves (ROC) were performed to analyze the influencing factors of tibial fracture with occult posterior ankle fracture. Results. CT showed that 25 (13.44%) patients had occult posterior ankle fractures among 186 patients with tibial fracture. There was no significant difference in gender, age, and locations of tibial fracture between the two groups ( P > 0.05 ). There were statistical differences in the types, locations, and lengths of patients with tibial fracture but without posterior malleolus fractures. The length of the tibia fracture group was significantly lower than the tibia with posterior ankle fracture group ( P < 0.05 ). Logistics regression analysis showed that tibial fracture with occult posterior ankle fracture was not significantly correlated with gender, age, and location of tibial fracture ( P > 0.05 ), but was significantly correlated with tibial fracture type, location, and length (HR = 1.830, P = 0.035 ; HR = 5.161, P = 0.004 ; HR = 1.126, P = 0.030 ). The ROC curve showed that the AUC of length of tibial fracture with occult posterior ankle fracture was 0.599. The YD index suggested that the best cut point for the prediction of tibial fracture with occult posterior ankle fracture was above 13.18%. The sensitivity and specificity of spiral tibial fracture and distal 1/3 tibial fracture for prediction were 88.00% and 63.35%, 92.00%, and 58.39%, respectively, which was significantly higher than that of tibial fracture length ( P < 0.05 ). Conclusion. Patients with tibial fractures have a higher incidence of occult posterior ankle fractures. Spiral tibial fractures and distal 1/3 tibial fractures have a higher predictive value for tibial fracture with occult posterior ankle fractures and can help clinical detection as soon as possible, which is a more accurate and appropriate treatment.

show abstract

“…According to our data analysis, although a routine preoperative X-ray could effectively diagnose TSFs, the diagnosis of PMFs was obviously insufficient. If not clearly diagnosed before the operation, the PMF might cause secondary displacement during or after surgery, which might result in posttraumatic arthritis of the ankle [ 11 , 34 – 36 ]. Hence, the incidence of the combined injury was far underestimated.…”

Section: Discussionmentioning

confidence: 99%

Incidence and missed diagnosis risk of occult posterior malleolar fractures associated with the tibial shaft fractures: a systematic review

Wang

¹

,

Chen

²

,

Zhu

³

et al. 2021

View full text Add to dashboard Cite

Background Tibial shaft fractures (TSFs) combined with occult posterior malleolar fractures (PMFs) are becoming widely recognized in the field of orthopedics. The purpose of this study was to determine the clinical incidence, missed diagnosis rate, and treatment strategies of this combined injury. Methods PubMed, Cochrane, and MEDLINE Ovid databases were searched for articles of English language from 1988 to 2020, identifying 1549 papers. Results Twenty-one of the 1278 identified studies were eligible for inclusion. Each study reported on the incidence of this combined injury, and 12 studies documented the missed diagnosis rate. Seventeen studies reported surgical intervention strategies for PMFs. In the present review, PMFs frequently occurred in spiral TSFs (70%), especially distal third spiral TSFs (70.4%), based on CT scans or additional MRI. Based on the original X-ray detection, approximately 50% of PMFs were missed in patients with a combined injury. In addition, the treatment strategies for PMFs were inconsistent. Most studies (11/17) believe that specific surgical management needs to be developed based on the fragment size, displacement, and stability of the PMF. Conclusions For patients with TSFs, spiral TSFs, especially distal third spiral TSFs, are closely related to PMFs and are often not sufficiently diagnosed by X-ray alone. Advanced CT and MRI examinations can significantly reduce the missed diagnosis rate of occult PMFs. According to available literature, the treatment strategy for PMFs associated with TSFs is questionable without convincing evidence of benefit.

show abstract

“…27 Similarly equivalent results were noted when comparing outcomes of screw versus plate fixation for PMFs in setting of tibial shaft fractures as well. 11 Percutaneous fixation may also be advantageous in cases where soft tissue damage or fracture blisters preclude a formal posterolateral approach. Multiple studies have attempted to classify PMF morphology.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] While isolated PMFs account for only 0.5% to 1% of all ankle fractures, 8,9 they can be associated with other lower extremity injuries such as spiral fractures of the distal tibial shaft. 10,11 The optimal treatment for the PM component of a trimalleolar ankle fracture remains controversial and depends on a number of factors. 12, 13 Historically, authors have described operative indications based on articular surface involvement greater than 25% to 30% or the degree of step-off or comminution.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Anatomic Structures at Risk During Posterior to Anterior Percutaneous Screw Fixation of Posterior Malleolar Fractures: A Cadaveric Study

Czerwonka

¹

,

Momenzadeh

²

,

Stenquist

³

et al. 2020

Foot & Ankle Specialist

View full text Add to dashboard Cite

Background. There are no established guidelines for fixation of posterior malleolus fractures (PMFs). However, fixation of PMFs appears to be increasing with growing evidence demonstrating benefits for stability, alignment, and early functional outcomes. The purpose of this study was to determine the risk to anatomic structures utilizing a percutaneous technique for posterior to anterior (PA) screw fixation of PMFs. Methods. Percutaneous PA screw placement was carried out on 10 fresh frozen cadaveric ankles followed by dissection to identify soft tissue and neurovascular structures at risk. The distance from the guidewire to each anatomic structure of interest was measured. The correlation between the mean distances from the guidewire to each structure was calculated. Results. The sural nerve was directly transected in 1/10 specimens (10%) and in contact with the wire in a second specimen (10%). There was a significant correlation between the proximity of the guidewire to the apex of Volkmann’s tubercle and its proximity to the sural nerve. The flexor hallucis longus (FHL) muscle belly was perforated by the guidewire 40% of the time but was not tethered or entrapped by the screw. Conclusions. Percutaneous PA screw placement is a safe technique which can be improved with several modifications. A mini-open technique is recommended to protect the sural nerve. There may be potential for tethering of the FHL with use of a washer or large screw head. Risk to the anterior and posterior neurovascular bundles is minimal. Levels of Evidence: Level V

show abstract

Posteroanterior Lag Screws Versus Posterior Buttress Plate Fixation of Posterior Malleolar Fragments in Spiral Tibial Shaft Fracture

Cited by 12 publications

References 27 publications

Incidence and Predictive Factors of Tibial Fracture with Occult Posterior Ankle Fractures

Incidence and Predictive Factors of Tibial Fracture with Occult Posterior Ankle Fractures

Incidence and missed diagnosis risk of occult posterior malleolar fractures associated with the tibial shaft fractures: a systematic review

Anatomic Structures at Risk During Posterior to Anterior Percutaneous Screw Fixation of Posterior Malleolar Fractures: A Cadaveric Study

Contact Info

Product

Resources

About