Pathoanatomy of Posterior Malleolar Fractures of the Ankle

A retrospective study of posterior malleolus fractures

“…Moreover, the articular surface at the distal end of the tibia is a curve surface rather than a flat surface; thus, estimation of fragment size using only the proportion of the distance between the two points can also cause error. Magid et al [26] and Haraguchi et al [27] proposed that the calculation method for fragment size based on CT images is more accurate.…”

Advances in the Surgical Management of Ankle Fractures

“…22,44,57 A recent survey of orthopedic surgeons found that the most frequently reported indication for operative fixation of posterior malleolus fractures was not fragment size but rather ankle stability, highlighting that current indications for fixation are much less clear-cut than the previous "25% rule." 16 Haraguchi et al 19 classified posterior malleolus fractures as posterolateral oblique type, medial extension type, and small shell type based on CT imaging. Along with several other authors, they advocate for routine CT imaging for any ankle fracture involving the posterior malleolus to aid in operative decision making.…”

“…Along with several other authors, they advocate for routine CT imaging for any ankle fracture involving the posterior malleolus to aid in operative decision making. 5,6,19 When associated injuries are identified or articular congruity is compromised, literature suggests that a more aggressive approach to ORIF of posterior malleolar fractures involving as little as 10% of the articular surface may improve long-term outcomes. 1,36,44 We routinely obtain a CT scan of all posterior malleolus fractures to determine size, orientation, comminution, and articular impaction.…”

Cómo sintetizar el maléolo posterior. ¿La mejor opción es la síntesis directa?

“…La clasificación de Haraguchi (13) (Tabla 1), publicada en 2006, ha sido la primera clasificación basada en imágenes de TC, diferenciando 3 tipos: la fractura posterolateral oblicua, la fractura con extensión medial y la pequeña fractura cortical del MP. La limitación de esta clasificación es que usa únicamente secciones transversales de TC, sin reconstrucciones bi-o tridimensionales.…”