Repair of syndesmosis injury in ankle fractures

Mak, May; Stern, Richard; Assal, Mathieu

doi:10.1302/2058-5241.3.170017

Cited by 21 publications

(18 citation statements)

References 30 publications

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“…Certain clinicians have opted for cannulated compression screw fixation (from posterior to anterior) and have achieved satisfactory results (2,6). In addition, a plate and screws may be used to fix the posterolateral and posteromedial bone fragments, respectively, depending on the condition of each case (17).…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes of the posterolateral approach of plate fixation for posterior pilon fractures

et al. 2019

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Posterior pilon fracture is a common type of intraarticular fracture encountered in clinical practice. The treatment of this fracture pattern has been increasingly reported. However, methods for minimizing the associated surgical trauma and achieve effective fixation still require to be established. The present study involved 23 patients with posterior pilon fracture treated at the First Affiliated Hospital of Soochow University (Suzhou, China) between March 2013 and October 2017. Klammer's classification system was used to divide the posterior pilon fractures into 3 types. The surgical procedure, reduction of post-operative fracture, peri-operative complications and post-operative functional recovery were reviewed and analyzed. The reduction in post-operative fractures was evaluated by determining the Burwell-Charnley scores at the last follow-up. Anatomical reduction was confirmed in 17 patients, and an acceptable reduction was reported in 6 patients. The American Orthopedic Foot and Ankle Score was used to assess ankle function recovery; the average score was 82.3 points (range, 44-97 points). In conclusion, the posterolateral approach is able to achieve anatomical exposure of the operative field. In addition, the posterior fracture fragment of the tibia may be fully exposed through the fibula fracture gap by retraction. Posterior placement of the plate may serve a definitive role in the fixation of the posterior fracture fragment and maintain stability in the anatomical reduction of the fracture, which is helpful in early functional rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Treatment outcomes of the posterolateral approach of plate fixation for posterior pilon fractures

et al. 2019

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“…[ 4 , 6 – 23 ] Fixation of the posterior tibial tubercle fragment even in cases of Weber type B fracture (to avoid the need for syndesmosis screw fixation) has been recommended. [ 5 , 13 , 14 , 60 ] White [ 61 ] has strongly warned against the trend toward aggressive fixation because clinical studies have failed to show any significant improvement in patient outcomes, and furthermore have also confirmed an inevitable increased rate in complications. Our study results may provide insight into this issue.…”

Section: Discussionmentioning

confidence: 99%

Mechanism of posterior malleolar fracture of the ankle

Haraguchi

Armiger

2020

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: Ankle fracture treatment involves reduction of the bone fragments and stabilization of the joint by reversing the mechanics of injury. For posterior malleolar fracture however, the true mechanism is not understood, leading to a lack of consistent guidance on how to best treat this injury. Methods: Fifteen cadaver ankles were subjected to fracture loading that replicated the Lauge-Hansen pronation-external rotation mechanism. An axial load was applied to each specimen, which was mounted on a materials testing machine, and the foot was rotated externally to failure. Digital video cameras recorded the failure sequence of specific anatomic structures. Results: Posterior malleolar fracture occurred in 7 specimens. Of these, 1 was an intra-articular fracture, another was a fracture involving the entire posterior tibial margin consisting of 2 fragments: that of the posterior tubercle and that of the posteromedial margin of the tibial plafond, with the former judged to be a consequence of avulsion by the posterior inferior tibiofibular ligament and the latter a consequence of axial loading from the talus. In the remaining 5 specimens, the posterior malleolar fracture was a small extra-articular avulsion fracture. Conclusions: Fractures at the posterolateral corner of the distal tibia were shown to be avulsion fractures attributed to the posterior inferior tibiofibular ligament and produced by external rotation of the talus. A fracture involving the entire posterior tibial margin consisting of 2 fragments can be produced by a combination of avulsion by the posterior inferior tibiofibular ligament and axial loading from the talus.

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“…Both posterolateral and posteromedial approaches allow for direct visualization of the posterior malleolus and are extensive enough for hardware application, which is important when considering the current focus of ankle fracture repair is to "directly fix what is broken, and directly repair what is torn." 40 Additionally, both approach incisions are not directly over hardware and avoid the issue of hardware prominence. Recent evidence has shown significant numbers of iatrogenic malreduction of the syndesmosis with the standard lateral approach for fibular repair without direct visualization of the posterior malleolus reduction.…”

Section: Approachesmentioning

confidence: 99%

Anatomy, Classification, and Management of Ankle Fractures Involving the Posterior Malleolar Fragment: A Literature Review

Bergman

Morin

Lawson

2019

Foot & Ankle Orthopaedics

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The posterior malleolar fragment is frequently involved in rotational ankle fractures, but diagnosis and definitive management remains controversial. Ankle fractures with a posterior malleolar component that are not identified and treated in a timely manner may contribute significantly to future comorbidities, including continued pain, instability, and the development of arthritis. This article highlights the anatomic features of posterior malleolar ankle fractures, the classification schemes used, and discusses the various nonsurgical and surgical methods currently used. Level of Evidence: Level V, expert opinion.

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Repair of syndesmosis injury in ankle fractures

Cited by 21 publications

References 30 publications

Treatment outcomes of the posterolateral approach of plate fixation for posterior pilon fractures

Treatment outcomes of the posterolateral approach of plate fixation for posterior pilon fractures

Mechanism of posterior malleolar fracture of the ankle

Anatomy, Classification, and Management of Ankle Fractures Involving the Posterior Malleolar Fragment: A Literature Review

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