Journal of Musculoskeletal Trauma

Original Articles

Comparison of the Size of the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures Measured Using Lateral Plain Radiography and Three-Dimensional Computed Tomography: Gun-Woo Lee, Dong-Min Jung, Woo Kyoung Kwak, Keun-Bae Lee; J Korean Fract Soc 2022;35(3):91-96. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.91

Abstract PDF: Purpose
This study aimed to evaluate and compare the accuracy of the size of the posterior malleolar fragment measured using lateral plain radiography and three-dimensional computed tomography (3DCT) in patients with ankle trimalleolar fractures.
Materials and Methods
This study enrolled 80 patients (80 ankles) with ankle trimalleolar fractures and analyzed the size of the posterior malleolar fragments using plain radiography and 3D-CT. The articular involvement of the posterior malleolar fragments was measured as a percentage of the articular surface in the sagittal length of the tibial plafond using lateral plain radiography, and the articular surface area was directly measured using 3D-CT. In addition, we classified the patients into three groups based on the morphology of the posterior malleolar fracture, according to the Haraguchi classification method, and evaluated and compared the accuracy of the size of the posterior malleolar fragments.
Results
The mean articular involvement of the posterior malleolar fragments on plain radiography was 27.6% (range, 6.0%-53.1%), which was significantly higher than the mean of 21.9% (range, 4.7%-47.1%) measured using 3D-CT (p=0.004). In the analysis, according to the fracture morphology, the mean difference between the two methods was the largest for type I fractures at 9.1% (range, 1.8%-19.5%) and the smallest for type II fractures at 1.1% (range, –7.7% to 8.8%).
Conclusion
The articular involvement of posterior malleolar fragments measured using plain radiography showed low accuracy and significantly higher values than the actual articular involvement. Therefore, careful evaluation using 3D-CT is crucial for accurate analysis and optimal treatment in patients with ankle trimalleolar fractures.

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Comparing Outcomes of Screw Fixation and Non-Fixation for Small-Sized Posterior Malleolar Fragment in Ankle Trimalleolar Fractures: Jee-Wook Ko, Gun-Woo Lee, Keun-Bae Lee; J Korean Fract Soc 2021;34(1):8-15. Published online January 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.1.8

Abstract PDF: Purpose
This study was undertaken to compare outcomes of screw fixation and non-fixation of a small-sized posterior malleolar fragment involving less than 25% articular surface in ankle trimalleolar fractures. Materials and Methods: A total of 32 consecutive ankles (32 patients), with posterior malleolar fragment involving 15%-25% of the joint surface, were enrolled in the study. Patients were divided into 2 groups according to whether the fragment was fixed or not (fixed: 20 ankles, non-fixed: 12 ankles). The minimum follow-up period was 12 months. Median size of the posterior malleolar fragment in the fixed and non-fixed groups were 24.6% (range, 22.3%-25.0%) and 22.1% (range, 17.4%-24.3%), respectively. Complications as well as clinical and radiographic outcomes were compared and analyzed between the two groups. Results: Clinical outcomes, including American Orthopaedic Foot & Ankle Society (p=0.501), visual analogue scale (p=0.578), and ankle range of motion (p=0.552), showed no difference between groups at the final follow-up. No differences were obtained in the radiographic outcomes, including joint stepoff (p=0.289) and fragment gap (p=0.289). Complications, including 1 case of delayed union and 1 case of wound infection, were reported in the fixed group. Conclusion: Clinical outcomes and radiographic outcomes of the non-fixation group were satisfactory and comparable to the fixation group. Our results indicate that anatomical reduction with small-sized posterior malleolar fragment in ankle trimalleolar fractures is sufficient for satisfactory outcomes, without the need for additional internal fixation.

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Usefulness of Computed Tomography on Distal Tibia Intra-Articular Fracture Associated with Spiral Tibia Shaft Fracture: Seong Eun Byun, Sang June Lee, Uk Kim, Young Rak Choi, Soo Hong Han, Byong Guk Kim; J Korean Fract Soc 2016;29(2):114-120. Published online April 30, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.2.114

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the usefulness of computed tomography (CT) for spiral tibia shaft fracture by analyzing associated distal tibia intra-articular fractures diagnosed by CT only which met the indication of surgical fixation and were fixed.
MATERIALS AND METHODS
Ninety-five spiral tibia shaft fractures with preoperative ankle plain radiographs and CT were analyzed retrospectively. The incidence and type of associated distal tibia articular fractures were evaluated by reviewing ankle plain radiography and CT. The number of fractures diagnosed by CT that correspond with the indication of fixation and that were actually fixed were analyzed.
RESULTS
Among 95 spiral tibia shaft fractures, 62 cases (65.3%) were associated with distal tibia intra-articular fracture. There were 37 cases of posterior malleolar fracture, 5 cases of avulsion fracture of the distal anterior tibiofibular ligament, 5 cases of medial malleolar fracture, and 15 cases of complex fracture. Among 52 posterior malleolar fractures including complex fracture, 20 cases were diagnosed by ankle plain radiograph. Of these 20 cases, 16 posterior malleolar fractures (80.0%) met the indication of surgical fixation, and 14 cases were actually fixed with a screw. Among 32 posterior malleolar fractures diagnosed by CT only, 26 cases (81.3%) met the indication of surgical fixation and 18 cases (56.3%) were fixed by screw.
CONCLUSION
Approximately 50% of associated fractures were diagnosed by CT only and more than 80% of associated posterior malleolar fractures met the indication of surgical fixation and among these fractures, 18 cases (56.3%) were actually fixed by screw. This result suggests that CT is useful in diagnosis and treatment of distal tibia intra-articular fracture associated with spiral tibia shaft fracture.

Citations

Citations to this article as recorded by

Treatment of Distal Tibial Spiral Fractures Combined with Posterior Malleolar Fractures
Young Sung Kim, Ho Min Lee, Jong Pil Kim, Phil Hyun Chung, Soon Young Park
Journal of the Korean Orthopaedic Association.2021; 56(4): 317. CrossRef

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The role of posterior malleolar fragments in ankle pain after trimalleolar fractures: Su Young Bae, Dong Hoon Sihn; J Korean Soc Fract 2003;16(1):59-66. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.59

Abstract PDF

PURPOSE
There are some criticisms of indication for internal fixation of the posterior malleolar fragments in trimalleolar fractures. We tried to find out clinical and radiologic factors which affect on a clinical outcome of trimalleolar fractures.
MATERIALS AND METHODS
Thirty three patients who were treated for trimalleolar fractures and given anatomical reduction of lateral and medial malleolus were included. We divided patients into two groups, a group without the pain and the other group with the pain. Preoperative and postoperative lateral plain radiographic films were used to estimate fragment size, post-reduction gap and step off. By reviewing the medical records, other factors such as the time of ankle motion, weight loading and whether posterior malleolus was fixed. or not were stucdied. A clinical outcome was evaluated by AOFAS(American Orthopaedic Foot and Ankle Society) scaling system. We performed statistical analysis using Logistic regression analysis and Chi-square test on each factors.
RESULTS
There was no definite difference between two groups on the functional outcome. There was one case showing limited ankle motion. Seven patients were involved in the group with the pain and 23 in the group without the pain. The remnant fracture gap and step off of joint surface statistically showed the meaningful corellation with the pain but a fragment size and a surgical fixation, time of motion and weight loading did not show any significances.
CONCLUSION
We doubt the significance of the size of posterior malleolar fragment. We concluded that anatomical reduction of posterior malleolus is the most significant factor of a clinical outcome regardless of the size or internal fixation, especially the pain after trimalleolar injuries.

Citations

Citations to this article as recorded by

Treatment of Isolated Posterior Malleolus Fracture in the Ankle
Ji Hoon Kim, Seong Mu Cha, Dae Yeon Jo, Jin Soo Suh
Journal of the Korean Orthopaedic Association.2014; 49(1): 29. CrossRef
Treatment of the Posterior Malleolar Fracture Using Posterior Approach
Hyun Wook Chung, Dong Hwan Kim, Si Hoon Yoo, Jin Soo Suh
Journal of the Korean Fracture Society.2010; 23(1): 50. CrossRef
Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle
Jae Sung Lee, Soo Yong Kang, Han Jun Lee, Young Bong Ko
Journal of the Korean Fracture Society.2009; 22(2): 98. CrossRef

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Treatment of the Posterior Malleolar Fracture: Hwa Jae Jeong, Kyung Chul Kim, Seoung Woo Chung; J Korean Soc Fract 1998;11(4):924-931. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.924

Abstract PDF

Posterior malleolar fractures are usually caused by an abduction or external rotation injury. indications for open reduction of the posterior malleolar fracture depend on its size and the amount of displacement. If the fragment of the posterior malleolus involves more than 25% to 30% of the articular surface, it should be treated by anatomical reduction and internal fixation. Authors analysed twenty-three patients of ankle fractures with the posterior malleolar fractures who were treated in Kangbuk Samsung Hospital between March 1993 and March 1997. Thirteen patients whose posterior malleolar fracture involved less than 30% of articular surface were treated conservatively (Group 1), while ten patients with involvement of more than 30% of articular surface were treated by open reduction and internal fixation. Among the ten patients treateed by open reduction, the five patients were indirectly fixed through anterior approach (Group 2), another five patients were directly fixed through posterior approach (Group 3). In group 1, the patients whose opsterior malleolus involved more than 25% of articular surface have unsatisfactory results compared to patients whose posterior malleolus involved less than 25% of articular surface(P<0.04). The results of the treatment were better in those directly fixed through posterior appproach than in those indirectly fixed through anterior approach regardless of size of the fragment(P<0.05).

Citations

Citations to this article as recorded by

Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results
Gwang Chul Lee, Jun-Young Lee, Sang-Ho Ha, Jae-Won You, Sang-Hong Lee, Hong-Moon Sohn, Ki-Young Nam, Kwang-Hyo Seo
Journal of the Korean Fracture Society.2011; 24(4): 328. CrossRef
The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique
Jae-Sung Lee, Han-Jun Lee, Jae-Hyun Yoo, Hee-Chun Kim
Journal of the Korean Fracture Society.2009; 22(1): 19. CrossRef
Treatment of the Posterior Malleolar Fragment of Trimalleolar Fracture Using Posterolateral Approach - Preliminary Report -
Jun-Young Lee, Sang-Ho Ha, Kyung-Hwan Noh, Sang-Jun Lee
The Journal of the Korean Orthopaedic Association.2009; 44(4): 422. CrossRef
Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle
Jae Sung Lee, Soo Yong Kang, Han Jun Lee, Young Bong Ko
Journal of the Korean Fracture Society.2009; 22(2): 98. CrossRef

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