When and how to operate the posterior malleolus fragment in trimalleolar fractures: a systematic literature review

Verhage, Samuël Marinus; Hoogendoorn, J. M.; Krijnen, Pieta; Schipper, Inger B.

doi:10.1007/s00402-018-2949-2

Cited by 57 publications

(59 citation statements)

References 32 publications

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“…Furthermore, the size of the articular fragment was found to be similar between the 2 groups supporting prior evidence suggesting that fragment size is likely not the most important variable leading to posttraumatic osteoarthrosis after these injuries. 23 Additionally, patients undergoing operative treatment of trimalleolar ankle fractures with or without posterior malleolar fixation were compared to a healthy control population as well as literature values of 2 separate cohorts of healthy controls: younger (ages 22-24, Pietraszewski et al 18 ) and elderly (ages 70-74, Hollman et al 10 ). With the exceptions of stance phase time and stride time, all other record spatiotemporal gait parameters were significantly different between the ankle fracture cohort, the healthy controls, and the literature values for younger healthy patients.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…19 Furthermore, a recent systematic review of posterior malleolar fractures was unable to demonstrate that posterior fragment size was an indication for fixation; instead, step-off appears to be a more important indicator for the development of posttraumatic osteoarthritis and worse functional outcomes. 23 Therefore, whether fixation is necessary for these types of fractures remains a source of controversy.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Spatiotemporal Gait Parameters Following Operative Treatment of Trimalleolar Ankle Fractures vs Healthy Controls

Tyler

Rose

Day

et al. 2020

Foot & Ankle Orthopaedics

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Background: Controversy continues regarding appropriate indications for posterior malleolus fracture fixation in unstable rotational trimalleolar ankle injuries, with limited data comparing gait in operatively treated trimalleolar ankle fractures vs control populations. The purpose of this study was to evaluate the effect of trimalleolar ankle fracture fixation on gait parameters in the early postoperative period as compared to a healthy control population. Methods: Adult patients having undergone operative treatment of isolated trimalleolar ankle fractures were eligible for inclusion. A total of 10 patients met the inclusion criteria and participated in the analysis. Patients were evaluated using standard parameters of human gait 6 months after their index procedures, with gait values compared to a population of 17 non–age-matched healthy control subjects in addition to literature values of healthy populations of younger and older subjects. Results: Significant differences were noted between the spatiotemporal gait parameters of healthy control subjects and patients who had undergone operative treatment of trimalleolar ankle fractures. However, within the fracture group itself, no differences were found between patients with or without posterior malleolar fixation for any of the tested gait parameters. When patients were compared to literature values of younger and older healthy control populations, they were found to have gait patterns more similar to older rather than younger individuals. Conclusion: Operative fixation of trimalleolar ankle fracture does not restore normal gait function in the early postoperative period. Fixation of the posterior malleolus in particular also does not appear to improve gait characteristics. Patients who undergo surgery for these injuries demonstrate gait patterns similar to those of healthy older adults. Level of Evidence: Level II, Therapeutic (prospective cohort study).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of Spatiotemporal Gait Parameters Following Operative Treatment of Trimalleolar Ankle Fractures vs Healthy Controls

Tyler

Rose

Day

et al. 2020

Foot & Ankle Orthopaedics

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“…In the past, percutaneous anteroposterior fixation was generally used in the management posterior malleolus fractures 20 . Therefore, after the fixation of lateral and medial malleoli, with the patient in the supine position, the posterior malleolus was addressed by a 3.5/4.0 cannulated screw 21 . This minimally invasive technique aimed to reduce the malleolar fracture through ligamentotaxis.…”

Section: Surgical Approachmentioning

confidence: 99%

“…Furthermore, the anteroposterior partially threated screw may not provide enough interfragmentary compression when the thread of the lag screw partially crosses the fracture line 2,22 . Currently, the posterior approach is the preferred choice when percutaneous antero-posterior fixation is not indicated 21 . The main elements that should be assessed in the decision-making process are: the posterior malleolus fragment shape and size; the presence of loose bodies at the fracture site; the possibility to obtain anatomic fixation of the fracture; the presence of a posterior ankle subluxation; the eventual osteochondral impaction of the tibial plafond and mechanical stability of the joint 21 .…”

Section: Surgical Approachmentioning

confidence: 99%

Malunions and nonunions following tibial malleolar and tibial plafond fractures: current concepts

et al. 2020

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Ankle fractures or fracture-dislocations account for about 4-5% of all body fractures, with approximately 120-180/100,000 affected persons/year. Tibial pilon fractures are relatively infrequent, accounting for 5-7% of all fractures of the tibia. This review aims to summarize the current evidence on malunions and nonunions following tibial malleolar and tibial plafond fractures and to give some tips to avoid such complications. Malunion and nonunion following tibial malleolar and plafond fractures are quite rare but dreadful complications. Accurate evaluation of comorbidities and optimization of the patient's health should be done before surgery. Multiple recent retrospective studies have shown that ankle/ tibial plafond fractures treated within 72 h of surgery have comparable outcomes to staged fixation, the two-stage protocol is the most commonly used approach for the treatment of high-energy intra-articular injuries of the distal tibia. Several surgical approaches have been described for the management of ankle and tibial plafond fractures. Each one of these approaches has its own advantages and disadvantages, hence, it is important to recognize that no one approach is right for all patients. Surgeons managing these complex fractures should be comfortable with the various approaches to the distal tibia and be prepared to use whichever approach is suitable for the individual soft tissues and fracture pattern. Finally, with improvements in surgical techniques and implants, complication rates following ankle and tibial plafond fractures have declined, and outcomes have improved.

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Malleolar Fractures

Axelrod¹,

Sanders²

2021

Evidence‐Based Orthopedics

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When and how to operate the posterior malleolus fragment in trimalleolar fractures: a systematic literature review

Abstract: Therapeutic level II.

Cited by 57 publications

References 32 publications

Comparison of Spatiotemporal Gait Parameters Following Operative Treatment of Trimalleolar Ankle Fractures vs Healthy Controls

Comparison of Spatiotemporal Gait Parameters Following Operative Treatment of Trimalleolar Ankle Fractures vs Healthy Controls

Malunions and nonunions following tibial malleolar and tibial plafond fractures: current concepts

Malleolar Fractures

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