Missed isolated posterior malleolar fractures

Abstract

Isolated posterior malleolar fracture should be kept in mind in patients who present with pain at the posterior part of the ankle following a forced plantar flexion and/or axial compression injury. A 50° external rotation lateral radiograph can be useful in detecting the fracture.

Fracture of the posterior malleolus: an underdiagnosed condition

“…[3][4][5][6] This case report highlights the upmost importance of a comprehensive history taking and detailed clinical examination. In this sense, the most common mechanism of injury is plantar flexion associated to axial load since in these conditions the impact is transferred to the posterolateral tibial lip, 4 to 8-fold superior than in any other position.…”

“…7 These injuries may occur isolated or in combination with other injuries, such as, trimalleolar fractures, proximal fibular fractures, syndesmotic injuries or low-energy tibial shaft spiral-type fractures. 3,4,8 In this line, Kukkonen and colleagues reported that a fourth of the tibial shaft spiral-type fractures were associated with posterior malleolus fractures. 8 Usually, these fractures are related to a specific injury mechanism comprising, plantar flexion in axial load at the moment of ground impact, supination or external rotation of the talus in axial load, or progressive external rotation of the talus.…”

“…2 Less frequently, the isolated fracture of the posterior malleolus, also known as "parachute injury", it is a difficult condition to diagnose and many times forgotten. [3][4][5][6] When compared to other ankle injuries, the isolated fractures of the posterior malleolus occur less frequently. In this sense, 25 cases of isolated fractures of the posterior malleolus were found in a cohort of 2500 patients with ankle injuries.…”

“…[11][12][13] However, the decision model shows to be ineffective in the diagnose of posterior malleolus fractures since these patients frequently report nonspecific complaints of an usual ankle sprain, without any sensibility in the parameters described by the Ottawa rules. 3,14 Additionally, it has been reported that these injuries are difficult to diagnose through conventional radiograph views, justifying other methods of diagnosis. 6,14 Due to its low incidence, the unspecific symptomatology and incorrect diagnosis, the isolated injuries of the posterior malleolus represent a clinico-radiological challenge.…”

The isolated posterior malleolar fracture and syndesmotic instability: A case report and review of the literature

“…An isolated posterior malleolar fracture is also known as a Volkmann’s fracture or an Earle’s fracture [7] , [8] . This injury is easily missed on plain radiographs and requires awareness of the treating physician [9] . In the present study, we describe a patient with an isolated posterior malleolar fracture including the long-term follow-up, which has been reported in line with the SCARE statement [10] .…”