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

Bergman, C. J; Morin, Matthew; Lawson, Kevin A.

doi:10.1177/2473011419887724

Cited by 8 publications

(6 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our follow up, we have not encountered any heterotopic ossification in the interosseous membrane of the affected ankles, or synostosis, in our study. It is recommended that posterior fragments greater than 25% of the size should be fixed, by Christain Bergman et al [31] . In our study also we have fixed 5 cases of posterior malleolus fracture which has more than 25% of its articular size.…”

Section: Discussionmentioning

confidence: 99%

A prospective study on radiological functional outcome of syndesmotic screw fixation in distal tibiofibular syndesmotic injuries associated with ankle injuries

Senthilnathan¹,

Parasuraman²,

Prabhakar³

et al. 2022

Int. J. Orthop. Sci.

View full text Add to dashboard Cite

Introduction and Purpose: Improper alignment, malreduction and neglecting to foresee syndesmotic injuries in ankle trauma led to persistent post operative ankle pain, delay in recovery and early arthritic changes of ankle joint. The treatment of distal tibiofibular syndesmotic injuries is a major concern in ankle injuries. The objectives of this study is to have Preoperative suspicious, assessment of mode of injury, stress x-rays and intraoperative test for all ankle injuries to avoid missing syndesmotic injuries and there by the treatment. Materials and Methods: This is a prospective study of 28 ankle injuries diagnosed to have syndesmotic injury. All cases are due to RTA or fall while walking. Mostly of Weber type b and c. Compound grade I, II & III A were also included. After clinical and radiological investigations, diagnosis was confirmed and intraoperative test done and bimalleolar fracture fixed first then syndesmotic injury fixed with either single or double cortical screws and with 3 or 4 cortex purchase. Postoperative check x rays taken for checking proper reduction of the syndesmotic joint and level of screw placement. Post operative outcome were measured using AOFAS score chart. Results and Discussion: Results of our study shows excellent (AOFAS 90-100) in 17 cases, good (AOFAS 80-89) in 9 cases, fair (AOFAS 70-79) in 1 case and poor (AOFAS less than 70) in 1 case. With this we come to the conclusion that (1) pronation external rotation injury is the common type. (2) Diagnosis of distal syndesmotic injuries and fixing it is very much important for having pain free stable ankle joint, early mobilization and preventing ankle joint arthritis. (3) Three cortical or four cortical purchase of syndesmotic screw is not significant in postoperative maintenance of reduction. (4) There is no definitive disadvantage if the syndesmotic screws were not removed.

show abstract

Section: Discussionmentioning

confidence: 99%

A prospective study on radiological functional outcome of syndesmotic screw fixation in distal tibiofibular syndesmotic injuries associated with ankle injuries

Senthilnathan¹,

Parasuraman²,

Prabhakar³

et al. 2022

Int. J. Orthop. Sci.

View full text Add to dashboard Cite

show abstract

“…Other authors have stipulated a value of 25% of the articular surface as the determinant for the fixation of the posterior fragment to thereby restore ankle congruity[ 8 - 10 ]. PM fixation is currently controversial[ 11 - 14 ], and variable clinical results have been obtained in the treatment of trimalleolar fractures[ 15 ]. The classic recommendation to fix PM fractures with a radiological size ≥ 25% theoretically improves articular congruence and reduces the risk of post-traumatic arthritis[ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Importance of computed tomography in posterior malleolar fractures: Added information to preoperative X-ray studies

De Marchi Neto,

Nesello,

Bergamasco

et al. 2023

World J Orthop

View full text Add to dashboard Cite

BACKGROUND Ankle fractures are common lesions of the lower limbs. Approximately 40% of ankle fractures affect the posterior malleolus (PM). Historically, PM osteosynthesis was recommended when PM size in X-ray images was greater than 25% of the joint. Currently, computed tomography (CT) has been gaining traction in the preoperative evaluation of ankle fractures. AIM To elucidate the similarity in dimensions and to correlate PM size in X-ray images with the articular surface of the affected tibial plafond in the axial view on CT (AXCT) of a PM fracture. METHODS Eighty-one patients (mean age: 39.4 ± 13.5 years) were evaluated (54.3% were male). Two independent examiners measured PM size in profile X-ray images (PMXR) and sagittal CT (SAGCT) slices. The correlation of the measurements between the examiners and the difference in the PM fragment sizes between the two images were compared. Next, the PM size in PMXR was compared with the surface of the tibial plafond involved in the fracture in AXCT according to the Haraguchi classification. RESULTS The correlation rates between the examiners were 0.93 and 0.94 for PMXR and SAGCT, respectively (P < 0.001). Fragments were 2.12% larger in SAGCT than in PMXR (P = 0.018). In PMXR, there were 56 cases < 25% and 25 cases ≥ 25%. When PMXR was < 25%, AXCT corresponded to 10.13% of the tibial plafond. When PMXR was ≥ 25%, AXCT was 24.52% (P < 0.001). According to the Haraguchi classification, fracture types I and II had similar PMXR measurements that were greater than those of type III. When analyzing AXCT, a significant difference was found between the three types, with II > I > III (P < 0.001). CONCLUSION PM fractures show different sizes using X-ray or CT images. CT showed a larger PM in the sagittal plane and allowed the visualization of the real dimensions of the tibial plafond surface.

show abstract

“…Involvement of the posterior malleolus in ankle fractures occurs with rotational ankle injuries. Management of posterior malleolus fractures is classically based on size and displacement of the articular segment 6 . Involvement of the posterior malleolus can alter operative planning and surgical approaches to ORIF of ankle fractures.…”

mentioning

confidence: 99%

Anomalous Posterior Tibial Artery Course—Anatomic Considerations for the Posterolateral Ankle Approach

Perugini

Passias

Pelz

et al. 2023

JBJS Case Connector

View full text Add to dashboard Cite

Case:We report a unique anatomical case of an anomalous course of the posterior tibial artery found on dissection during the posterolateral approach to the ankle. To the best of our knowledge, no such case has been documented.Conclusion:The vascular bundle consistent with that of the posterior tibial artery and vein was encountered in the far lateral aspect of the deep posterior compartment, which suggests physicians should proceed with caution when performing the posterolateral approach to the ankle so as to avoid iatrogenic injury of this named anatomic structure.

show abstract

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

Cited by 8 publications

References 64 publications

A prospective study on radiological functional outcome of syndesmotic screw fixation in distal tibiofibular syndesmotic injuries associated with ankle injuries

A prospective study on radiological functional outcome of syndesmotic screw fixation in distal tibiofibular syndesmotic injuries associated with ankle injuries

Importance of computed tomography in posterior malleolar fractures: Added information to preoperative X-ray studies

Anomalous Posterior Tibial Artery Course—Anatomic Considerations for the Posterolateral Ankle Approach

Contact Info

Product

Resources

About