Trimalleolar Fractures with Impaction of the Posteromedial Tibial Plafond: Implications for Talar Stability

Weber, Martin

doi:10.1177/107110070402501005

Cited by 134 publications

(137 citation statements)

References 11 publications

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“…Switaj et al [69] and Klammer et al [41] termed the medial extension type of a fracture of the posterior rim (Haraguchi´s type II, Bartoníček´s and Rammelt´s type 3) a "posterior pilon fracture". Weber [77] considers this type as a part of trimalleolar fractures of the ankle. In order to distinguish between trimalleolar fractures and fractures of the tibial pilon, Bartoníček and Rammelt [9] set the line connecting the center of the fibular notch and the intercollicular groove as the conventional criterion.…”

Section: Classificationmentioning

confidence: 99%

“…This technique allows simultaneous fixation of the fracture of the posterior tibial rim and the medial malleolus from single incision [2,10,77]. It is especially useful in Bartoníček and Rammelt type 3 PM fractures with a posteromedial fragment involving the medial malleolus [9].…”

Section: Direct Reduction and Fixation From The Posteromedial Approachmentioning

confidence: 99%

“…After anatomic reduction and stable fixation of the posterior tibial fragment(s) and any accompanying lateral and medial malleolar fractures, syndesmotic stability is tested with an interoperative external rotation or hook test. In many cases, fixation of the avulsed posterior tibiofibular ligament together with malleolar fracture fixation will restore syndesmotic stability thus obviating the need for an additional transsyndesmotic screw [23,53,65,77].…”

Section: Authors' Preferred Treatmentmentioning

confidence: 99%

“…9 Fracture of the ankle from: a, b radiographs before surgery; c, d radiographs after surgery of PM fractures even with fragments carrying 25 % of the articular surface [17,27,36]. The results of non-anatomical reduction and internal fixation of PM are inferior than those obtained by non-operative treatment [24,30,77]. Both the clinical results and the degree of post-traumatic arthritis are reported to correspond to the size of the avulsed PM fragment [37,47].…”

Section: Prognosis and Complicationsmentioning

confidence: 99%

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Posterior malleolar fractures of the ankle

Bartoníček

Rammelt

Tuček

et al. 2015

Eur J Trauma Emerg Surg

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Despite an increasing awareness of injuries to PM in ankle fracture-dislocations, there are still many open questions. The mere presence of a posterior fragment leads to significantly poorer outcomes. Adequate diagnosis, classification and treatment require preoperative CT examination, preferably with 3D reconstructions. The indication for surgical treatment is made individually on the basis of comprehensive assessment of the three-dimensional outline of the PM fracture and all associated injuries to the ankle including syndesmotic instability. Anatomic fixation of the avulsed posterior tibiofibular ligament will contribute to syndesmotic stability and restore the integrity of the incisura tibiae thus facilitating anatomic reduction of the distal fibula. A necessary prerequisite is mastering of posterolateral and posteromedial approaches and the technique of direct reduction and internal fixation. Further clinical studies with higher numbers of patients treated by similar methods and evaluation of pre- and postoperative CT scans will be necessary to determine reliable prognostic factors associated with certain types of PM fractures and associated injuries to the ankle.

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Section: Classificationmentioning

confidence: 99%

Section: Direct Reduction and Fixation From The Posteromedial Approachmentioning

confidence: 99%

Section: Authors' Preferred Treatmentmentioning

confidence: 99%

Section: Prognosis and Complicationsmentioning

confidence: 99%

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Posterior malleolar fractures of the ankle

Bartoníček

Rammelt

Tuček

et al. 2015

Eur J Trauma Emerg Surg

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“…1) • If there is posterolateral translation, we will find a ruptured deltoid ligament and fractures of the lateral malleolus and Volkmann's triangle [9] • If there is posteromedial translation, we will find fracture of the lateral malleolus, rupture of the anterior tibiofibular ligament, and fracture of the posteromedial corner [10] Of course, other fracture patterns can occur that cause similar conditions.…”

Section: Introductionmentioning

confidence: 99%

Treatment of malunion in ankle fractures

Weber

Borisch²,

Weber

2010

Eur J Trauma Emerg Surg

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Malunions are fractured bones that have healed in pathological positions. This leads to nonphysiological load transfer. Clinical symptoms at the ankle may include swelling, pain and impaired function. Lateral, posterolateral or posteromedial subluxation of the talus will be visible on the radiographs. Surgical correction may be indicated if the malunion is symptomatic. Different osteotomies have been described, but the goal of surgery will always be the reduction and retention of the subluxed talus in an effort to recreate stable conditions. Eighty percent of patients show good results with significant pain reduction in mid-term follow-up studies. Ankle arthrodesis after corrective osteotomy is rarely necessary.

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Direct medial approach in surgical fixation of fractures in the posterior aspect of the medial malleolus

et al. 2017

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Fractures in the posterior aspect of the medial malleolus form an important subset of ankle fractures and the indications for fixation include involvement of > 25% of the articular surface or an articular step off by > 2 mm. Several approaches have been described but there has been no recent study on the direct medial approach. Five fresh frozen cadaveric ankles were dissected using the direct medial approach. A longitudinal incision of 10 cm was centered directly over the medial malleolus and deepened straight down to the bone. The periosteum was identified over the distal tibia and careful subperiosteal dissection yielded access to the posterior aspect of the medial malleolus. We investigated the relationship of the neurovascular bundle to the incision by measuring the distance from the center of the medial malleolus to the closest aspect of the bundle. The mean distance from the center of the medial malleolus to the neurovascular bundle was only 2.64 cm (95% CI: 2.06 to 3.22 cm). We found that the neurovascular bundle could be avoided if a periosteal sheath was developed during the dissection and elevated off the posterior aspect of the medial malleolus. The direct medial approach can be performed safely by creating a periosteal sheath through subperiosteal dissection, and the distance of the neurovascular bundle from the incision allows for a good margin of safety during surgery. This approach can be extended proximally and distally and the medial malleolus can be fixed concurrently. Clin. Anat. 31:605-607, 2018. © 2017 Wiley Periodicals, Inc.

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Trimalleolar Fractures with Impaction of the Posteromedial Tibial Plafond: Implications for Talar Stability

Cited by 134 publications

References 11 publications

Posterior malleolar fractures of the ankle

Posterior malleolar fractures of the ankle

Treatment of malunion in ankle fractures

Direct medial approach in surgical fixation of fractures in the posterior aspect of the medial malleolus

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