Prognostic value of the Haraguchi classification in posterior malleolar fractures in A0 44-C type ankle fractures

Ræder, Benedikte Wendt; Andersen, Mette Renate; Madsen, Jan Erik; Jacobsen, Silje Berild; Frihagen, Frede; Figved, Wender

doi:10.1016/j.injury.2021.07.038

Cited by 7 publications

(18 citation statements)

References 36 publications

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“…The analysis showed that multifragmentary trans-syndesmotic and supra-syndesmotic trimalleolar ankle fractures (AO/OTA type 44B3.3 and 44C) were more likely to receive external fixation. Interpreting this result as an expression of higher instability and therefore higher severity, this finding corresponds to the current literature, reporting a larger number of intraarticular lesions, involvement of the posterior malleolus and worse outcomes in high-grade unstable ankle fractures [ 14 , 18 , 19 ].…”

Section: Discussionsupporting

confidence: 88%

“…Nowadays, treatment recommendations for trimalleolar ankle fractures focus on the configuration of the posterior malleolus; therefore, the results of this study advocate the use of the Bartoníček classification as a reliable tool to guide treatment. To our knowledge, the presented study includes the largest number of patients to evaluate the reliability of classification systems in ankle fractures [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The importance of the posterior malleolus has gained enormous scientific attention, since studies have demonstrated a significant influence in functional patient-related outcomes [ 7 , 21 ]. However, there are only two studies assessing the interobserver reliability of the Haraguchi classification in a representative patient population [ 9 , 14 ]. In this study, the Haraguchi classification showed substantial interobserver reliability, comparable with the study by Raeder et al [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are only two studies assessing the interobserver reliability of the Haraguchi classification in a representative patient population [ 9 , 14 ]. In this study, the Haraguchi classification showed substantial interobserver reliability, comparable with the study by Raeder et al [ 14 ]. Mason et al even reported almost perfect interobserver reliability with the Haraguchi classification in their analysis of 121 cases of posterior malleolus fractures [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The reliability of ankle classification systems in trimalleolar ankle fractures has not been investigated before. Only a few studies exist either investigating the reliability of the Herscovici or Haraguchi classification systems in the current literature [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of ankle fracture classification systems in 193 trimalleolar ankle fractures

Pflüger

Harder

Müller

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Different classification systems have been developed for ankle fractures. In recent years, the posterior malleolus has gained in importance and led to computed tomography (CT)-based classification systems. The aim of the study was to analyse their reliability, fracture patterns and influence on treatment strategy. Methods Patients with a trimalleolar ankle fracture treated between 2011 and 2020 with preoperative radiographs and CT images were included. The blinded images were independently classified by three reviewers according to the AO/OTA, Herscovici, Bartoníček, Mason and Haraguchi classifications. The interobserver reliability was calculated by Fleiss' kappa (κ). CT images were analysed to determine the dimensions of the posterior malleolus fragments. Patient registries were reviewed regarding the treatment data. Results A total of 193 patients were included. The AO/OTA classification showed almost perfect inter- and intraobserver reliability (Fleiss’ κ = 0.86, 95% CI 0.82–0.90). Regarding the posterior malleolus, the Bartoníček classification demonstrated the highest reliability (Fleiss’ κ = 0.78, 95% CI 0.73–0.83). The Herscovici classification only reached moderate reliability for medial malleolus fractures (Fleiss' κ = 0.59, 95% CI 0.54–0.65). There was a trend towards direct fixation of the posterior malleolus in the last 3 years of the observation period (OR: 2.49, 95% CI 1.03–5.99). Conclusion In trimalleolar ankle fractures, the AO/OTA classification is a reliable system to characterize the type of fracture, but it fails to provide solid information about the posterior malleolus. Nowadays, treatment recommendations for trimalleolar ankle fractures focus on the configuration of the posterior malleolus; therefore, the results of this study advocate the use of the Bartoníček classification as a reliable tool to guide treatment.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Evaluation of ankle fracture classification systems in 193 trimalleolar ankle fractures

Pflüger

Harder

Müller

et al. 2022

Eur J Trauma Emerg Surg

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Classifications of posterior malleolar fractures: a systematic literature review

Terstegen

Weel

Frosch

et al. 2022

Arch Orthop Trauma Surg

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Introduction Complex ankle fractures frequently involve the posterior malleolus. Many classifications describing posterior malleolar fractures (PMF) exist. The aim of this study was to provide a systematic literature review to outline existing PMF classifications and estimate their accuracy. Methods The databases PubMed and Scopus were searched without time limits. Only specific PMF classifications were included; general ankle and/or pilon fracture classifications were excluded. Selection and data extraction was performed by three independent observers. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The methodological quality of the included studies was quantified using the modified Coleman score. Results A total of 110 studies with a total of 12.614 patients were included. Four main classifications were identified: Those describing the size of the posterior malleolar fracture (n = 66), Haraguchi (n = 44), Bartoníček/Rammelt (n = 21) and Mason (n = 12). The quality of the studies was moderate to good with a median Coleman-score of 43.5 (14–79) and a weighted median Coleman-score of 42.5 points. All classifications achieved a substantial to perfect score regarding the inter- and intraobserver reliability, with Mason scoring the lowest in comparison. Conclusions None of the reviewed PMF classifications has been able to establish itself decisively in the literature. Most of the classifications are insufficient in terms of a derivable treatment algorithm or a prognosis with regard to outcome. However, as the Bartoníček/Rammelt classification has the greatest potential due to its treatment algorithm, its reliability in combination with consistent predictive values, its usage in clinical practice and research appears advisable.

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Reproducibility of Bartoníček and Haraguchi classifications of the posterior malleolus fractures

Sugrañes

Lopez-Hervas

Álvarez

et al. 2023

Arch Orthop Trauma Surg

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Prognostic value of the Haraguchi classification in posterior malleolar fractures in A0 44-C type ankle fractures

Abstract: Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial.

Cited by 7 publications

References 36 publications

Evaluation of ankle fracture classification systems in 193 trimalleolar ankle fractures

Evaluation of ankle fracture classification systems in 193 trimalleolar ankle fractures

Classifications of posterior malleolar fractures: a systematic literature review

Reproducibility of Bartoníček and Haraguchi classifications of the posterior malleolus fractures

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