Posterior malleolar fractures of the ankle

Abstract

Despite an increasing awareness of injuries to PM in ankle fracture-dislocations, there are still many open questions. The mere presence of a posterior fragment leads to significantly poorer outcomes. Adequate diagnosis, classification and treatment require preoperative CT examination, preferably with 3D reconstructions. The indication for surgical treatment is made individually on the basis of comprehensive assessment of the three-dimensional outline of the PM fracture and all associated injuries to the ankle including syndesmotic instability. Anatomic fixation of the avulsed posterior tibiofibular ligament will contribute to syndesmotic stability and restore the integrity of the incisura tibiae thus facilitating anatomic reduction of the distal fibula. A necessary prerequisite is mastering of posterolateral and posteromedial approaches and the technique of direct reduction and internal fixation. Further clinical studies with higher numbers of patients treated by similar methods and evaluation of pre- and postoperative CT scans will be necessary to determine reliable prognostic factors associated with certain types of PM fractures and associated injuries to the ankle.

Advances in the Surgical Management of Ankle Fractures

“…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.…”

Posterior malleolus fractures

“…[7][8][9] This approach remains the most frequently needed, but in complex ankle fractures, axial imaging CT scans are recommended, as one benefit is helping to detect those patterns of posterior malleolus fractures that extend medially. 3,10,11 In orthopaedic practice in the United Kingdom, it is common for surgeons to ignore a posterior malleolus fracture completely.…”

“…Bartoniček et al 3,10,23 used more advanced CT reconstructions to classify posterior malleolus fractures in 141 patients. Their system has four main types.…”

Via Póstero-Interna na Fixação de Fragmento Posterior em Fratura Complexa do Pilão Tibial

“…Além disso, há evidências crescentes do importante papel do maléolo posterior no desenvolvimento da artrose pós-traumática. [9][10][11] Com um maléolo posterior deslocado, o centro do stress muda de forma anterior e interna na superfície articular. 12 Posteriormente, as fraturas maleolares posteriores viciosamen-te consolidadas levam a um desfecho funcional mau e a uma má qualidade de vida.…”