The role of a small posterior malleolar fragment in trimalleolar fractures

Evers, Julia; Fischer, Maren; Zderic, Ivan; Wähnert, Dirk; Richards, R. Geoff; Gueorguiev, Boyko; Raschke, Michael J.; Ochman, Sabine

doi:10.1302/0301-620x.100b1.bjj-2017-0435.r1

Cited by 29 publications

(28 citation statements)

References 26 publications

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“…Posterior pilon fractures are frequently associated with injury of the lower syndesmosis ligament. This ligament originates from the posterior malleolus, attaches to the posterior portion of the lateral malleolus and is an important structure for maintaining ankle stability (11,12). In addition, posterior pilon fractures may be accompanied by the dislocation of the talus or comminuted lateral (medial) malleolus fractures.…”

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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“…15,20 Studies have shown that smaller posterior malleolar fragments do not affect ankle joint stability, and fragment size likely represents a confounding variable in patient outcomes. 5…”

Section: Discussionmentioning

confidence: 99%

Comparison of Spatiotemporal Gait Parameters Following Operative Treatment of Trimalleolar Ankle Fractures vs Healthy Controls

Tyler

Rose

Day

et al. 2020

Foot & Ankle Orthopaedics

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Background: Controversy continues regarding appropriate indications for posterior malleolus fracture fixation in unstable rotational trimalleolar ankle injuries, with limited data comparing gait in operatively treated trimalleolar ankle fractures vs control populations. The purpose of this study was to evaluate the effect of trimalleolar ankle fracture fixation on gait parameters in the early postoperative period as compared to a healthy control population. Methods: Adult patients having undergone operative treatment of isolated trimalleolar ankle fractures were eligible for inclusion. A total of 10 patients met the inclusion criteria and participated in the analysis. Patients were evaluated using standard parameters of human gait 6 months after their index procedures, with gait values compared to a population of 17 non–age-matched healthy control subjects in addition to literature values of healthy populations of younger and older subjects. Results: Significant differences were noted between the spatiotemporal gait parameters of healthy control subjects and patients who had undergone operative treatment of trimalleolar ankle fractures. However, within the fracture group itself, no differences were found between patients with or without posterior malleolar fixation for any of the tested gait parameters. When patients were compared to literature values of younger and older healthy control populations, they were found to have gait patterns more similar to older rather than younger individuals. Conclusion: Operative fixation of trimalleolar ankle fracture does not restore normal gait function in the early postoperative period. Fixation of the posterior malleolus in particular also does not appear to improve gait characteristics. Patients who undergo surgery for these injuries demonstrate gait patterns similar to those of healthy older adults. Level of Evidence: Level II, Therapeutic (prospective cohort study).

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“…Up to now, controversy still remains on the operative indication for posterior malleolar fractures [6], and various indications were proposed which were based on a specific percentage measured by plain radiographs [7][8][9][10][11][12][13][14]. However, the operative indications will have no reference value if the measurement method itself is not reliable or reproducible.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, many scholars recommended anatomical reduction and internal fixation for treatment of ankle fractures [3][4][5]. But still no consensus was achieved on the operative indication for posterior malleolar fractures [6].…”

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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The role of a small posterior malleolar fragment in trimalleolar fractures

Abstract: Surgical reduction of a small PMF with less than 25% ankle joint surface improves pressure distribution but does not affect ankle joint stability. Cite this article: 2018;100-B:95-100.

Cited by 29 publications

References 26 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

Comparison of Spatiotemporal Gait Parameters Following Operative Treatment of Trimalleolar Ankle Fractures vs Healthy Controls

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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