Management of Posterior Malleolar Fractures: A Systematic Review

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

“…Currently, the recommended indication for posterior malleolar fixation is when the fracture affecting over 25% of the articular surface, displacement over 2 mm, ankle instability, and persistent subluxation of the talus [4]. In our study, we included the patients with a posterior malleolar fragment involving over 25% of the articular surface measured in preoperative lateral view radiographs or sagittal reconstruction of CT images (Figs.…”

“…The debate continues whether the fragment less than 25% should be anatomically reduced and fixed. Some authors reported negative relationships between the fixation of small posterior malleolar fragment and the functional outcome, while others believed that the fixation of small posterior malleolar fragment would contribute to the stability of syndesmosis [2, 4, 21, 22]. Recent anatomical and clinical studies provide evidence that the morphology of the fracture fragment might be more important than the fragment size [1, 23].…”

“…Despite of the evidence provided by anatomical and biomechanical studies that the posterior malleolus serves as an important contributor to the stability of ankle mortise and syndesmosis, the indication of surgical reduction and fixation of PMF remains controversial [2–4]. Fragment size is frequently used as a reference for surgical intervention, and the posterior malleolar fracture involves more than 25% of articular surface is generally recommended to be reduced and fixed to prevent instability and reduce the risk of post-traumatic degenerative changes [1].…”

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

“…3 Outcomes are related to the degree of restoration of the articular surface itself and any remaining tibiotalar subluxation following surgical intervention. 49 Reduction of the posterior malleolus in an injury with concurrent syndesmotic instability may lead to improved syndesmotic reduction as malreduction of the syndesmosis is common. 18 This is likely because the congruity of the tibial articular surface is restored and the syndesmosis is likely reduced through an intact PITFL; fibular length may also be obtained.…”

Akut ve kronik sindesmoz yaralanmaları

“…[79] Posterior malleol kırıkları sonrası klinik sonuçlar, kırığın büyüklüğünden ziyade kırığın deplasmanı, tibiotalar eklem uyumu ve eklem yüzünün düzgünlüğü ile ilişkilidir. [80] Posterior malleolun rijid tespit edilmediği olgularda posterolateral subluksasyonu önlemek için, sindesmozun internal tespiti gerekir. Anatomik tespit sonrasında mediyal boşlukta açıklığı devam eden lateral malleol kırıkla-rında, derin deltoid bağ hasarı ya da anstabil sindesmoz yaralanması mevcuttur.…”