Radiographic Assessment of Posterior Malleolar Ankle Fractures

González, O.; Fleming, Justin J.; Meyr, Andrew J.

doi:10.1053/j.jfas.2014.08.005

Cited by 17 publications

(14 citation statements)

References 16 publications

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“…10,11,24 However, it is obvious in the literature that a CT scan is required to clearly understand the fracture pattern. 5,[12][13][14]22,26 Specifically, because of the anterior curve of the posterior tibia, on a true lateral radiograph, a posterior malleolus fracture can not only be underestimated but also be barely visible (Figure 3). A clearer understanding of the etiology, mechanics, and fracture patterns may allow us to direct our management more successfully.…”

Section: Discussionmentioning

confidence: 99%

“…4,16,20 The evaluation of the characteristics of the posterior malleolus fragment in ankle fractures is poor when undertaken using plain radiographs. 5,[12][13][14]22,26 Computed tomography (CT) has become the gold standard in assessing the posterior malleolar ankle fracture. 30 The Mason and Molloy classification of posterior malleolus fractures based on CT scan 19 described the pathomechanics of the injury pattern.…”

Section: Introductionmentioning

confidence: 99%

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CT Analysis of the Posteromedial Fragment of the Posterior Malleolar Fracture

et al. 2019

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Background: To date, there have been no studies describing the characteristics of posteromedial fragment in the posterior malleolus fracture. The aim was to investigate the variability of posteromedial fracture fragments to enable better surgical planning. Methods: All Mason and Molloy type 2B fractures, defined as fracture of both the posterolateral and the posteromedial fragments of the posterior malleolus, from our database were identified to analyze the preoperative computed tomography scan. The posteromedial fragment was investigated in 47 cases (mean age, 46.6 years; 11 male, 36 female). Results: Morphologically, the fracture could be divided into 2 subtypes: (1) a large pilon intra-articular fragment (mean of X axis: 33.0 mm, Y: 30.7 mm, Z: 31.7 mm) presented in 29 cases with mean interfragmentary angle of 32.1 and back of tibia angle of 32.7 degrees (this was seen in 25 of 27 cases with supination injury pattern); and (2) a small extra-articular avulsion fragment (mean of X axis: 9.6 mm, Y: 13.2 mm, Z: 11.5 mm) present in 18 cases with a mean interfragmentary angle of 11.0 and back of tibia angle of 10.1 degrees. It was seen in 80% of pronation injuries. Conclusion: The avulsion type of the posteromedial fragment of posterior malleolus fracture was more common in pronation injuries, likely the result of traction by the intermalleolar ligament, and the pilon type was more common in supination injuries, likely the result of the rotating talus impaction. Because of the intra-articular involvement, we believe the pilon type should undergo fixation to achieve articular congruity, unlike the avulsion type which may only function as a secondary syndesmotic stabilizer. Level of Evidence: Level III, retrospective comparative series.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CT Analysis of the Posteromedial Fragment of the Posterior Malleolar Fracture

et al. 2019

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“…Recent studies have shown incompatibility between observers in respect of PMF size on lateral ankle radiographs and this dilemma has forced the surgeons to better understand the accurate sizing and morphology of PMF [7,[17][18][19]. In the literature, fragment sizing methods are divided into two sections; the assessment of fragment size from plain radiography measurements and CT-based studies [8,20]. Plain radiography studies have demonstrated poor technique accuracy and interobserver reliability in the visualisation of fragment size.…”

Section: Discussionmentioning

confidence: 99%

Trimalleoller ayak bileği kırıklarında posterior malleol fragmanın ölçümü için 3D temelli ölçüm metodlarıyla ile iki boyutlu radyoragrafi metodunun karşılaştırılması

Altun

Reis

Bayram

et al. 2020

Archives of Clinical and Experimental Medicine

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The aim of this study is, to compare the posterior malleolar fragment (PMF) sizing between lateral ankle radiography measurement and computer assistted 3D modelling (CA3DM) methods Methods: Fifty-one patients between january 2015 and november 2018 with posterior malleolar fractured were included in this study. The rate of PMF to the articular surface at the distal end of the tibia was calculated by two different imaging methods by two surgeons. According to posterior fragment size, patients were separated into two groups. Group 1 was consisted of posterior fragment size smaller than 15% and group 2 was bigger than 15% due to CA3DM. Results: The interobserver correlation (IOC) between two observers and CA3DM was 44.3%. Also the IOC between first observer and CA3DM was 35.7% (p<0.05), second observer and CA3DM were 46.6% (p<0.01) and observers was 51.6% (p<0.01). For group 1, IOC between two observers and CA3DM was 41.2% (p<0.05), first observer and CA3DM was 30.6% (p>0.05), second observer and CA3DM was 51.6% (p<0.05) and two observers were 45.8% (p<0.05). For group 2, IOC between two observers and CA3DM was 27.9% (p>0.05), first and CA3DM was 18.6% (p>0.05), second observer and CA3DM was 7.1% (p>0.05) and two observers was 49% (p<0.05). Conclusion: Our study shows that posterior malleolar fragment size measuring on plain radiography is not a safe method for bigger fragments and CA3DM method may be a more reliable to assess correct fragment size and also to analyze fracture morphology. But for fragments ≤15% CA3DM and plain radiographic measures are not statistically different.

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“…However, radiographs may be restricted by the orientation of the foot because of pain and swelling in the acute injury. Surgeons frequently failed to identify posterior malleolar fractures and precisely estimate the size of posterior malleolar fragments when interpreting plain radiographs [15][16][17][18][19]. Axial CT was also used to measure the percentage of posterior malleolar fractures [16,20].…”

Section: Introductionmentioning

confidence: 99%

Quantitative Evaluation of Articular Involvement of Posterior Malleolus Associated with Operative Indication: A Comparative Study of Six Methods Based on Radiography and CT

Kun

Jia

Qiang

et al. 2020

BioMed Research International

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The aim of this study was to compare the values of six methods in measuring the involvement of posterior malleolus and to demonstrate the reliability and reproducibility of each method. Three independent orthopaedic surgeons, retrospectively, measured 106 cases. The difference between the six methods was analyzed using Bonferroni-corrected paired t-tests after one-way ANOVA. The agreement between the six methods was analyzed using Bland–Altman analysis. The intraclass correlation coefficient (ICC) was used to assess intraobserver reproducibility and interobserver reliability. Significant differences were observed between values of any two of the six measurement methods (P<0.0033), except between any two of the plane radiograph linear, axial CT linear, sagittal CT linear, and 3D CT linear. The Bland–Altman plots demonstrated poor agreement between values of any two of the six methods. The lowest intraobserver reproducibility was 0.46 (moderate) for resident surgeon using plain radiographs. The intraobserver reproducibility for three surgeons using two-dimensional (2D) and 3D images was almost perfect (ICC, 0.82–0.96). The lowest interobserver reliability was 0.41 (moderate) between chief and attending surgeon using plain radiographs, and it improved to almost perfect (ICC, 0.81–0.95) with the use of 3D CT images. The standard error of measurement showed almost the same results as ICC values. The existing operative indications which were determined based on plain radiography are neither reliable nor suitable for other measurement methods. Both 3D linear and 3D surface measurement methods are reliable and reproducible in measuring posterior fragment involvement, and experience is not so crucial. Operative indications for posterior malleolar fractures need to be redefined based on the 3D measurement method.

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Radiographic Assessment of Posterior Malleolar Ankle Fractures

Cited by 17 publications

References 16 publications

CT Analysis of the Posteromedial Fragment of the Posterior Malleolar Fracture

CT Analysis of the Posteromedial Fragment of the Posterior Malleolar Fracture

Trimalleoller ayak bileği kırıklarında posterior malleol fragmanın ölçümü için 3D temelli ölçüm metodlarıyla ile iki boyutlu radyoragrafi metodunun karşılaştırılması

Quantitative Evaluation of Articular Involvement of Posterior Malleolus Associated with Operative Indication: A Comparative Study of Six Methods Based on Radiography and CT

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