Quadrimalleolar Fractures of the Ankle: Think 360°—A Step-by-step Guide on Evaluation and Fixation

Joannas, German; Arrondo, Guillermo; Rammelt, Stefan; Casola, Leandro; Mizdraji, Luciano

doi:10.5005/jp-journals-10040-1199

Cited by 6 publications

(1 citation statement)

References 43 publications

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“…[5][6][7][8][9][10] Intraoperatively, great care should be taken to anatomically align the ankle in terms of osseous and ligamentous structures. 11,12 Marmot et al showed that up to 30 degrees of rotation could go unnoticed per-operatively when using standard fluoroscopy. 13 A postoperative computed tomography (CT) scan is advised in cases of doubt regarding the quality of reduction.…”

Section: Introductionmentioning

confidence: 99%

Measuring external rotation of the fibula and fibular length in bilateral CT scans: how reliable is this method?

Penning,

Molendijk,

Halm

et al. 2024

Journal of Orthopaedic Trauma

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Objective. During ankle fracture surgery, goals include accurate reduction and fixation of the tibiofibular joint and fibular length. Bilateral postoperative computed tomography (CT) can be performed to assess syndesmotic reduction, the talar dome angle and fibular length.. The study aim is to compare side-to-side differences of the fibular rotation and fibular length using bilateral CT’s of uninjured ankles. Methods. We included patients with bilateral CT scans of uninjured ankles and measured external rotation using the Nault talar dome method and fibular length using the coronal method of Prior et al. The average, difference, and ratio (injured side/healthy side) and inter-observer variability were calculated. Results. There were 83 patients included (166 ankles, mean age 47 years, 77.1% male). A random set of 66 ankles (33 CT scans) were used to measure inter-observer variability. The mean degrees of external rotation ranged from 6.6 to 7.7, mean difference from 1.4 to 3.4 degrees, mean ratio from 1.1 to 1.5, inter-observer variability from 0.27 to 0.65. For fibular length, the mean ranged from 24.6 to 25.8 mm, mean difference in fibular length ranged from 0.5 to 2.1 mm, mean ratio ranged from 1.0 to 1.1 mm and inter-observer variability ranged from 0.45 to 0.73. Conclusion. Using bilateral ankle CTs, mean differences in fibular rotation using the Nault talar dome method were 1.4 to 3.4 degrees. The distal fibular length had a mean difference between both sides of 0.5 to 2.1mm. Even though the ICC’s were low, the inter-leg differences between patients were small, making them useful for clinical practice. Level of evidence. Diagnostic level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Introductionmentioning

confidence: 99%

Measuring external rotation of the fibula and fibular length in bilateral CT scans: how reliable is this method?

Penning,

Molendijk,

Halm

et al. 2024

Journal of Orthopaedic Trauma

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Ankle fractures involving the anterolateral distal tibia: medium-term clinical results of 50 cases

Kroker

Neumann

Beyer

et al. 2022

Eur J Trauma Emerg Surg

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Purpose The anterolateral distal tibial rim (anterior malleolus, AM) is frequently fractured in malleolar fractures. The aim of this study was to evaluate the medium-term outcomes of malleolar fractures involving the AM. Methods Among 100 patients with AM fractures that were treated over a 10-year period, 50 patients were available for follow-up. Outcome was assessed with the Olerud Molander Ankle Score (OMAS), the Foot Function Index (FFI-D), the EuroQol (EQ)-5D-5L Index, the EQ-VAS and the AOFAS Ankle-Hindfoot Score. Type 1 AM fractures (bony syndesmotic avulsions) were fixed surgically with either a suture anchor or a transosseous suture in 11 of 22 cases (50%). Among type 2 AM fractures (with incisura and joint involvement), 68% were treated surgically with screw fixation. All three type 3 AM fractures (anterolateral tibial plafond impaction) were treated surgically with either screw or plate fixation. Results At follow-up, the median OMAS was 75, the FFI-D 19, the EQ-5D-5L-Index 0.88, the EQ-VAS 70, and the AOFAS score 93. Assuming that the fracture severity increases from Supination–External Rotation to Pronation–External Rotation and Pronation–Abduction injuries, the AOFAS score (p < 0.001), OMAS score (p = 0.009), and FFI-D (p = 0.041) all showed a significantly inferior clinical outcome with increasing fracture severity. Patients who required surgical revision (n = 5) showed a significantly inferior outcome with the OMAS (p = 0.019). Conclusions A differentiated treatment protocol tailored to dislocation, size, incisura involvement and joint impaction leads to favourable outcomes in complex malleolar fractures involving the AM. More data are needed on the outcome of AM fractures that are still commonly underestimated and overlooked.

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The concept of ring of injuries: evaluation in ankle trauma

et al. 2022

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Quadrimalleolar Fractures of the Ankle: Think 360°—A Step-by-step Guide on Evaluation and Fixation

Cited by 6 publications

References 43 publications

Measuring external rotation of the fibula and fibular length in bilateral CT scans: how reliable is this method?

Measuring external rotation of the fibula and fibular length in bilateral CT scans: how reliable is this method?

Ankle fractures involving the anterolateral distal tibia: medium-term clinical results of 50 cases

The concept of ring of injuries: evaluation in ankle trauma

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