Posterior Malleolar Fracture Patterns

Mangnus, L.; Meijer, Dennie; Stufkens, Sjoerd A. S.; Mellema, Jos J.; Steller, E. Ph.; Kerkhoffs, Gino M. M. J.; Doornberg, Job N.

doi:10.1097/bot.0000000000000330

Cited by 84 publications

(59 citation statements)

References 40 publications

(75 reference statements)

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“…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]. A thorough study of the morphology of the fracture fragment in reconstructed CT images might provide information about the injury mechanisms, and hence guided different way of reduction and fixation [9, 24].…”

Section: Discussionmentioning

confidence: 99%

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

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis.MethodsPatients with a PMF involving over 25% of the articular surface were recruited and assigned to the direct reduction (DR) group or the indirect reduction (IR) group. Following reduction and fixation of the fracture, the quality of fracture reduction was evaluated in post-operative CT images. Clinical and radiological follow-ups were performed at 6 weeks, 3 months, 6 months, 12 months, and then at 6 month-intervals postoperatively. Functional outcome (AOFAS score), ankle range of motion, and Visual Analog Scale (VAS) were evaluated at the last follow-up. Statistical differences were compared between the DR and IR groups considering the patient demographics, quality of fracture reduction, AOFAS score, and VAS.ResultsTotally 116 patients were included, wherein 64 cases were assigned to the DR group and 52 cases were assigned to the IR group. The quality of fracture reduction was significant higher in the DR group (P = 0.038). In the patients who completed a minimum of 12 months’ follow-up, a median AOFAS score of 87 was recorded in the DR group, which was significantly higher than that recorded in the IR group (a median score of 80). The ankle range of motion was slightly better in the DR group, with the mean dorsiflexion restriction recorded to be 5.2° and 6.1° in the DR and IR group respectively (P = 0.331). Similar VAS score was observed in the two groups (P = 0.419).ConclusionsThe direct reduction technique through a posterolateral approach provide better quality of fracture reduction and functional outcome in the management of PMF over 25% of articular surface, as compared with the indirect reduction technique using ligamentotaxis.Trial registration NCT02801474 (retrospectively registered, June 2016, ClinicalTrails.gov).

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Section: Discussionmentioning

confidence: 99%

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

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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“…[5][6][7] Subject CTs identified as malreductions were uploaded to OsiriX Dicom (Geneva, Switzerland) software and 3-dimensional reformats were created. [5][6][7] Subject CTs identified as malreductions were uploaded to OsiriX Dicom (Geneva, Switzerland) software and 3-dimensional reformats were created.…”

Section: Mapping Of Malreductionsmentioning

confidence: 99%

Incidence, Risk Factors, and Location of Articular Malreductions of the Tibial Plateau

Meulenkamp

Martin

Desy

et al. 2017

Journal of Orthopaedic Trauma

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“…Some studies suggested that morphology of the posterior malleolar fragment might be more important than size for clinical decision making [21,31]. Haraguchi type II fracture was also considered to be posterior pilon fracture, which has more complex mechanism and more special morphological characteristics [32].…”

Section: Discussionmentioning

confidence: 99%

“…e selection of the observation plane was also affected by the position of the ankle and the experience of observers. A study tried to use three-dimensional (3D) CT to assess the articular involvement of posterior malleolar fractures [21]. But the method adopted, which needs to integrate several sets of software, was complex and time-consuming.…”

Section: Introductionmentioning

confidence: 99%

Quantitative Evaluation of Articular Involvement of Posterior Malleolus Associated with Operative Indication: A Comparative Study of Six Methods Based on Radiography and CT

Kun

Jia

Qiang

et al. 2020

BioMed Research International

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The aim of this study was to compare the values of six methods in measuring the involvement of posterior malleolus and to demonstrate the reliability and reproducibility of each method. Three independent orthopaedic surgeons, retrospectively, measured 106 cases. The difference between the six methods was analyzed using Bonferroni-corrected paired t-tests after one-way ANOVA. The agreement between the six methods was analyzed using Bland–Altman analysis. The intraclass correlation coefficient (ICC) was used to assess intraobserver reproducibility and interobserver reliability. Significant differences were observed between values of any two of the six measurement methods (P<0.0033), except between any two of the plane radiograph linear, axial CT linear, sagittal CT linear, and 3D CT linear. The Bland–Altman plots demonstrated poor agreement between values of any two of the six methods. The lowest intraobserver reproducibility was 0.46 (moderate) for resident surgeon using plain radiographs. The intraobserver reproducibility for three surgeons using two-dimensional (2D) and 3D images was almost perfect (ICC, 0.82–0.96). The lowest interobserver reliability was 0.41 (moderate) between chief and attending surgeon using plain radiographs, and it improved to almost perfect (ICC, 0.81–0.95) with the use of 3D CT images. The standard error of measurement showed almost the same results as ICC values. The existing operative indications which were determined based on plain radiography are neither reliable nor suitable for other measurement methods. Both 3D linear and 3D surface measurement methods are reliable and reproducible in measuring posterior fragment involvement, and experience is not so crucial. Operative indications for posterior malleolar fractures need to be redefined based on the 3D measurement method.

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Posterior Malleolar Fracture Patterns

Cited by 84 publications

References 40 publications

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

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

Incidence, Risk Factors, and Location of Articular Malreductions of the Tibial Plateau

Quantitative Evaluation of Articular Involvement of Posterior Malleolus Associated with Operative Indication: A Comparative Study of Six Methods Based on Radiography and CT

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