Open Reduction Internal Fixation of Posterior Malleolus Fractures and Iatrogenic Injuries

Karbassi, John A.; Braziel, Andrew; Garas, Peter K.; Patel, Abhay

doi:10.1177/1938640016670242

Cited by 3 publications

(1 citation statement)

References 11 publications

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“… 121 , 127 In a cadaveric study, lesions to the tibialis anterior tendon were seen through posterior to anterior K-wires. 128 The posterolateral approach offers advantages over indirect fixation methods involving direct visualization and reduction as well as the possibility to remove small osteochondral fragments. 121 Clinical studies showed a better outcome of direct posterior in comparison to indirect reduction with comparable complication rates.…”

Section: Operative Treatmentmentioning

confidence: 99%

Current management of trimalleolar ankle fractures

et al. 2021

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A trimalleolar ankle fracture is considered unstable and treatment is generally performed operatively. Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus. Trimalleolar ankle fractures have a rising incidence in the last decade with up to 40 per 100,000 people per year. With a growing number of elderly patients, trimalleolar ankle injuries will become more relevant in the form of fragility fractures, posing a particular challenge for trauma surgeons. In patients with osteoporotic trimalleolar ankle fractures and relevant concomitant conditions, further evidence is awaited to specify indications for open reduction and internal fixation or primary transfixation of the ankle joint. In younger, more demanding patients, arthroscopic-assisted surgery might improve the outcome, but future research is required to identify patients who will benefit from assisted surgical care. This review considers current scientific findings regarding all three malleoli to understand the complexity of trimalleolar ankle injuries and provide the reader with an overview of treatment strategies and research, as well as future perspectives. Cite this article: EFORT Open Rev 2021;6:692-703. DOI: 10.1302/2058-5241.6.200138

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Section: Operative Treatmentmentioning

confidence: 99%

Current management of trimalleolar ankle fractures

et al. 2021

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Surgical Treatment of Posterior Malleolus Fractures and Posterior Fixation

Herring

Yoon

2018

Techniques in Foot &Amp; Ankle Surgery

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Posterior malleolar fractures (PMFs) have been demonstrated to result in poorer outcomes than other types of ankle fractures with a higher incidence of posttraumatic arthritis. Accordingly, there has been a recent surge in interest in reduction and fixation of PMFs. Operative criteria for PMFs have been based on size, step-off, ankle joint instability, and syndesmotic injury, though universally accepted criteria have yet to be defined. Anatomically, the posterior malleolus is important as an insertion point of the posterior inferior tibiofibular ligament and thereby may play a role in syndesmotic stability. However, the important lateral ankle ligament complex is also important in governing stability of the talus within the ankle mortise. PMFs have been classified by the Haraguchi system based on morphology and extent. Radiographs, although always appropriate to perform as the initial diagnostic imaging study, are likely insufficient to evaluate the size and displacement; computed tomography scan is recommended for optimal evaluation for preoperative planning. When treating the posterior malleolus by a posterolateral approach, prone and lateral positioning of the patient facilitates exposure, although it can also be performed in the supine position with a large bump and with a leg that can be safely passively internally rotated sufficiently, or externally rotated if a posteromedial approach is used. Fixation can be performed with lag screw fixation alone versus buttress or standard plating techniques. Wound complications and posttraumatic arthritis are relatively common complications encountered in the treatment of PMFs. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

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In defence of the posterior malleolus

White

2018

The Bone & Joint Journal

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The posterior malleolus of the ankle is the object of increasing attention, with considerable enthusiasm for CT scanning and surgical fixation, as expressed in a recent annotation in The Bone & Joint Journal. Undoubtedly, fractures with a large posterior malleolar fragment that allow posterior talar subluxation from the mortise are served better by fixation. However, in all other situations, the existing literature does not support this widespread change in practice. The available biomechanical evidence shows that the posterior malleolus has little part to play in the stability or contact stresses of the ankle joint. Radiographic studies have not shown that CT scanning offers helpful information on pathoanatomical classification, case selection, or prognosis, or that scanning improves the likelihood of an adequate surgical reduction. Clinical studies have not shown any improvement in patient outcome after surgical fixation, and have confirmed that the inevitable consequence of increased intervention is an increased rate of complications. A careful and thoughtful evaluation of indications, risks, and benefits of this fashionable concept is required to ensure that we are deploying valuable resources with efficacy, and that we do no harm. Cite this article: Bone Joint J 2018;100-B:566-9.

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Open Reduction Internal Fixation of Posterior Malleolus Fractures and Iatrogenic Injuries

Abstract: Level IV.

Cited by 3 publications

References 11 publications

Current management of trimalleolar ankle fractures

Current management of trimalleolar ankle fractures

Surgical Treatment of Posterior Malleolus Fractures and Posterior Fixation

In defence of the posterior malleolus

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