Posterior Malleolus Fractures

Tenenbaum, Shay; Shazar, Nachshon; Bruck, Nathan; Bariteau, Jason T.

doi:10.1016/j.ocl.2016.08.004

Cited by 42 publications

(22 citation statements)

References 56 publications

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“…Indeed, they are the fourth most common indication for orthopedic surgery, with an incidence of 187 per 100,000 person-years (1) . Isolated lateral malleolus fracture accounts for 66% of ankle fractures; 25% are bimalleolar, and only 7% are trimalleolar (2)(3)(4) .…”

Section: Introductionmentioning

confidence: 99%

Incidence of early complications in the posterolateral approach to posterior malleolus fractures

et al. 2020

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Introduction: To ascertain the incidence of early complications in the posterolateral approach to open reduction and internal fixation of posterior malleolar fractures and identify possible risk factors related to occurrence of these complications. Methods: Retrospective study carried out in three tertiary hospitals. Patients who underwent open reduction and internal fixation of posterior malleolus fractures via the posterolateral route were divided into two groups: with versus without delayed postoperative healing. To assess risk and protective factors for the outcome of delayed healing, we evaluated the time between trauma and surgery, whether the patient had a fracture-dislocation of the ankle, and whether external fixation was performed before surgery. We also evaluated whether improvement in operative technique led to a reduction in complication rates. Results: A total of 43 individuals who underwent surgical correction of posterior malleolus fractures via the posterolateral route between 2013 and 2018 were included. Of these, 19 (44.2%) had skin complications that led to delayed healing. Skin complications occurred more frequently at the beginning of the learning curve of the surgeons involved; the incidence up to the year 2016 was 56.3%, decreasing significantly to 37% from 2017 onward. Conclusion: Patients who undergo open reduction and internal fixation of posterior malleolus fractures via the posterolateral route at the beginning of the learning curve are a greater risk of developing skin complications, demonstrating the importance of this approach being restricted to more experienced surgeons. Level of Evidence III; Prognostic Studies; Retrospective Study.

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Section: Introductionmentioning

confidence: 99%

Incidence of early complications in the posterolateral approach to posterior malleolus fractures

et al. 2020

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“…Surgeons should focus on restoring ankle joint structural integrity, that is, restoring articular congruity, correcting posterior talar translation, addressing articular impaction, removing osteochondral debris, and achieving syndesmotic stability. Surgeons should familiarize themselves with posterolateral and posteromedial approaches [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study on the Morphology of Posterior Malleolar Fractures Based on a CT Scan: Whether We Ignore the Importance of Fracture Height

Wang

Yuan

Zhu

et al. 2020

BioMed Research International

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Objective. The aim of this study was to investigate the respective correlation between the height (H) of a posterior malleolar fracture (PMF) and the involved area (S) of an articular surface and the presence of “die-punch.” Methods. Patients with closed posterior malleolar fractures admitted to our hospital from January 2015 to December 2017 were selected, with complete X-ray and 3D reconstruction CT imaging data. The gender, age, injured side, and surgical fixation methods of the patients were recorded. A preoperative ankle CT scan was performed, and the images were viewed through the PACS (Picture Archiving and Communication Systems). Simultaneously, the involved joint surface area (S) by the posterior malleolar fracture was measured, as well as the proportion of the fracture area to the total ankle joint area. On the sagittal reconstruction CT images, the height (H) of the posterior malleolar fracture was measured to compare the correlation between the height of the fracture and the area of the fracture, as well as the area ratio. Besides, according to the presence or absence of “die-punch,” patients were divided into two groups: A and B. And each group was further divided into three subgroups according to age (16-39 years old, 40-59 years old, and ≥60 years old). The statistical differences in the height of fracture between the subgroups were compared. Results. A total of 48 patients, aged 16-82 years, with an average age of 48.9 years, were included in this study, including 13 males and 35 females. There were 20 cases of left ankle injury and 28 cases of right ankle injury. The average height of the posterior malleolar fractures was 18.19 mm, the average area of the fracture was 202.28 mm2, and the average ratio of the fracture area to the total articular surface area was 17.84%. Besides, die-punch was seen in 27 cases and not in 21 cases. The average height of fractures was 21.33±5.38 mm in group A1, 14.38±9.01 mm in group B1, 18.30±7.95 mm in group A2, 14.48±5.37 mm in group B2, 26.26±6.73 mm in group A3, and 12.77±3.07 mm in group B3. Conclusion. The height (H) of the posterior malleolar fractures is positively correlated with the fracture area (S) and the fracture area ratio (FAR). The posterior malleolar fractures with “die-punch” tend to have a greater average height than that without “die-punch.” In clinical work, orthopedic surgeons should not only pay attention to the size of the posterior malleolus fracture but also value its height, which hopefully could provide insight into the treatment and prognosis of PMF patients.

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“…Malreduction leads to difficulty reducing the fibula at the next step of the operation, as well as to degenerative changes later. 7,26 It is advisable to fix the posterior malleolus provisionally, and then check that the fibula reduces, before it is fixed definitively. In order to improve the standards of fixation, there is a strong case for pre-and (early) post-operative CT scans to ensure that the goals of the operation have been achieved (Fig.…”

Section: Cite This Articlementioning

confidence: 99%