Biomechanical and Clinical Evaluation of Posterior Malleolar Fractures. A Systematic Review of the Literature

Bekerom, Michel P.J. van den; Haverkamp, Daniël; Kloen, Peter

doi:10.1097/ta.0b013e318187eb16

Cited by 122 publications

(116 citation statements)

References 40 publications

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“…Furthermore, in none of these configurations was a tendency for subluxation noted. Fitzpatrick's experimental data are supported and have been confirmed by van Bekerom's systematic review of the literature, including clinical and biomechanical publications [23]. No differences in outcome were found whether Volkmann fragments that were bigger than one-third of the joint surface were reduced and fixed or just left alone.…”

Section: Discussionmentioning

confidence: 67%

See 1 more Smart Citation

The Volkmann dogma: a retrospective, long-term, single-center study

Heim¹,

Niederhauser

Simbrey

2010

Eur J Trauma Emerg Surg

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Introduction There has been (and still is) some controversy about the treatment of malleolar fractures with an additional fracture of the posterior malleolus (Volkmann triangle) in the last few years. Should a posterior malleolus with a fragment that is larger than 25% of the articular surface be fixed? Can long-term results be influenced by the fixation of the Volkmann triangle? Materials and methods In a consecutive series of 43/56 patients with a dislocated malleolar fracture, clinical and radiological results were analyzed after a follow-up of 7.3 years (4-11 years). There were 15 men with an average age of 53 years and 28 women with an average age of 62 years, respectively. Eleven fragments were fixed. At inspection, 16 patients displayed a cartilage lesion at the talar dome.Results No or only slight arthrosis was found on X-rays of 37/43 patients. Six patients showed moderate or severe arthrosis. The Olerud-Molander score was 95.5 in patients without a Volkmann triangle, 98.5 in the presence of a small, unfixed fragment, and 90.6 with a large fixed fragment. Patients with no cartilage damage on perioperative inspection presented less severe arthrosis in the long-term results, while those with documented cartilage damage during the operation had more severe arthrosis. The Olerud-Molander score was 97.2 without cartilage damage and 94.5 with cartilage damage. Conclusion In conclusion, the presence of a Volkmann triangle impairs prognosis; fixation, even with anatomic results, does not return the score to ''normal.'' Cartilage damage seems to play a crucial role in the long-term outcome.

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Section: Discussionmentioning

confidence: 67%

“…Among the fractures followed, 9 were bi-and 34 were trimalleolar fractures. There were 23 Weber type B fractures and 20 type C fractures. Four fractures were open fractures, 3 were grade 1 and 1 was grade 2 according to the Gustilo-Anderson classification [12].…”

Section: Resultsmentioning

confidence: 99%

The Volkmann dogma: a retrospective, long-term, single-center study

Heim¹,

Niederhauser

Simbrey

2010

Eur J Trauma Emerg Surg

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“…However, fractures of the posterior malleolus, which usually occur in combination with lateral malleolus fractures [20,21], may alter treatment decisions even when there is minimal displacement of the fragments. Although there is still debate whether the primary role of the posterior malleolus is related to peak stress distribution or to tibiotalar stability [7,19], indications for operative intervention in cases of posterior malleolus fractures are frequently based on fragment size [7,8,10]. Accordingly, 97 % of surgeons preferred operative management for posterior malleolus fractures in one study when >50 % of the articular surface was involved [8].…”

Section: Introductionmentioning

confidence: 99%

“…Yet, common combinations of minimally displaced lateral malleolus fractures with minimally displaced posterior malleolus fractures that involve <50 % of the articular surface increase the uncertainty regarding preferred treatment. Accordingly, in a recent review, no consensus was found as to which posterior malleolus fragment size should be internally fixed [19].…”

Section: Introductionmentioning

confidence: 99%

The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures

Palmanovich

Brin

Laver

et al. 2013

International Orthopaedics (SICOT)

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Purpose Despite the high incidence of cases of minimally displaced lateral or posterior malleolus ankle fractures, treatment guidelines are still an issue of controversy. The purpose of this study was to delineate treatment preferences among orthopaedic surgeons in these fractures with and without concomitant posterior malleolus fractures. We hypothesized that concomitant minimally displaced fractures of the posterior malleolus can shift treatment preference towards operative intervention. Methods A questionnaire-based study was conducted among orthopaedic surgeons attending the 2012 European Federation of National Associations of Orthopaedics and Traumatology Conference (EFORT) in Berlin, Germany. Treatment preferences were reported for minimally displaced lateral malleolus fractures seen on radiographs and were then compared with treatment preferences when computed tomography (CT) was added revealing a concomitant minimally displaced posterolateral fracture of the posterior malleolus. Results The cohort comprised 177 surgeons from all six continents. When radiographs showing a minimally displaced lateral malleolus fracture were presented, nonoperative management was indicated by 35 % (62) of participants, whereas 65 % (115) preferred operative intervention. After CT views were added showing an accompanying minimally displaced posterolateral posterior malleolus fracture, 79 % (140) suggested operative intervention and only 21 % (37) advocated nonoperative management (p =0.03). ConclusionsMost surgeons prefer open reduction with internal fixation for minimally displaced lateral malleolar fractures. The presence of concomitant posterior malleolus fractures in these cases shifts treatment preference further towards open reduction with internal fixation. Because the posterior malleolus fragment might not be well delineated on standard ankle radiographs, a high index of suspicion is warranted, and the use of CT should be considered in these cases.

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“…But studying their paper, we will discover that their arguments are based on just a limited number of personal observations and that the Volkmann dogma is grounded on very weak and thin ice-a good reason to review critically the role of the Volkmann triangle and formulate some serious doubts and provocative ideas about how to deal with these fractures today. If the recent literature [8] (and our small, personal series) is right, the Volkmann dogma might fall.…”

mentioning

confidence: 85%

Focus on malleolar fractures

Heim¹

2010

Eur J Trauma Emerg Surg

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Biomechanical and Clinical Evaluation of Posterior Malleolar Fractures. A Systematic Review of the Literature

Cited by 122 publications

References 40 publications

The Volkmann dogma: a retrospective, long-term, single-center study

The Volkmann dogma: a retrospective, long-term, single-center study

The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures

Focus on malleolar fractures

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