Size matters: The influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures

Evers, Julia; Barz, Linda; Wähnert, Dirk; Grüneweller, Niklas; Raschke, Michael J.; Ochman, Sabine

doi:10.1016/s0020-1383(15)30028-0

Cited by 68 publications

(37 citation statements)

References 24 publications

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“…The pilon-type PMFs were generally believed to lead to inferior functional outcomes than regular ankle fractures [31–33]. Evers and Drijfhout van Hooff reported mean AOFAS scores of 70.9 and 81 in their studies respectively, wherein the PMFs greater than 25% of the joint surface were fixed [9, 20]. These results were similar with our study, while detailed techniques of fracture reduction and fixation, unfortunately, were not described in these two studies.…”

Section: Discussionsupporting

confidence: 87%

“…In Huber’s study, the rate of anatomical reduction of PMF was reported to be 27% via indirect reduction, while 83% of the patients achieved anatomical reduction using direct posterior approach [6]. A possible reason for the remarkable lower rate of anatomical reduction observed in our study compared with that in Huber’s study was that CT scan might provide more precise determination of residual fracture gap and articular step-off of posterior malleolus [9] (Fig. 6).…”

Section: Discussionmentioning

confidence: 56%

“…Recent anatomical and clinical studies provide evidence that the morphology of the fracture fragment might be more important than the fragment size [1, 23]. A thorough study of the morphology of the fracture fragment in reconstructed CT images might provide information about the injury mechanisms, and hence guided different way of reduction and fixation [9, 24].

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Section: Discussionmentioning

confidence: 99%

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Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis.MethodsPatients with a PMF involving over 25% of the articular surface were recruited and assigned to the direct reduction (DR) group or the indirect reduction (IR) group. Following reduction and fixation of the fracture, the quality of fracture reduction was evaluated in post-operative CT images. Clinical and radiological follow-ups were performed at 6 weeks, 3 months, 6 months, 12 months, and then at 6 month-intervals postoperatively. Functional outcome (AOFAS score), ankle range of motion, and Visual Analog Scale (VAS) were evaluated at the last follow-up. Statistical differences were compared between the DR and IR groups considering the patient demographics, quality of fracture reduction, AOFAS score, and VAS.ResultsTotally 116 patients were included, wherein 64 cases were assigned to the DR group and 52 cases were assigned to the IR group. The quality of fracture reduction was significant higher in the DR group (P = 0.038). In the patients who completed a minimum of 12 months’ follow-up, a median AOFAS score of 87 was recorded in the DR group, which was significantly higher than that recorded in the IR group (a median score of 80). The ankle range of motion was slightly better in the DR group, with the mean dorsiflexion restriction recorded to be 5.2° and 6.1° in the DR and IR group respectively (P = 0.331). Similar VAS score was observed in the two groups (P = 0.419).ConclusionsThe direct reduction technique through a posterolateral approach provide better quality of fracture reduction and functional outcome in the management of PMF over 25% of articular surface, as compared with the indirect reduction technique using ligamentotaxis.Trial registration NCT02801474 (retrospectively registered, June 2016, ClinicalTrails.gov).

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 56%

Fig.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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“…This classification system cannot only describe the severity of posterior pilon fractures but also guide the selection of an appropriate surgical approach and internal fixation strategy. The current classification system is based on CT images, which are required for the diagnosis of posterior pilon fractures (9,10).…”

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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“…There was also a shorter follow-up of 2.5 years. 57 The Curriculum for Training in Trauma and Orthopaedic Surgery in the United Kingdom continues to evolve. 11 In the early years, trainees are encouraged to gain experience in the operative treatment of common fractures.…”

Section: Cite This Articlementioning

confidence: 99%

Posterior malleolus fractures

Solan

Sakellariou

2017

The Bone & Joint Journal

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The posterior malleolus component of a fracture of the ankle is important, yet often overlooked. Pre-operative CT scans to identify and classify the pattern of the fracture are not used enough. Posterior malleolus fractures are not difficult to fix. After reduction and fixation of the posterior malleolus, the articular surface of the tibia is restored; the fibula is out to length; the syndesmosis is more stable and the patient can rehabilitate faster. There is therefore considerable merit in fixing most posterior malleolus fractures. An early postoperative CT scan to ensure that accurate reduction has been achieved should also be considered. Cite this article:

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Size matters: The influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures

Cited by 68 publications

References 24 publications

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

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

Posterior malleolus fractures

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