1/25/2024 0 Comments Bimalleolar fxFinally, when the articular surface of the distal tibia is involved, or the integrity of the syndesmosis is jeopardized, surgical intervention should be considered. In general, if posterior subluxation of the tibiotalar joint is seen in the presence of a posterior malleolus fracture operative fixation is indicated. Another common indication for surgery is a posterior malleolar fracture in combination with lateral malleolar fractures. Other authors support surgical intervention only when the fragment involves more than 50% of the articular surface. Some investigators recommend surgical intervention when the posterior fragment is measured to be one third to one fourth of the antero-posterior curvature of the articular surface of the tibial plafond. Typically, the size of the posterior malleolar fragment is taken into account when considering operative fixation. Indications for surgery in cases of posterior malleolar fractures are subject to ongoing debate. While less than 1% of ankle fractures are isolated posterior malleolar fractures, the majority of this fracture commonly occurs in relation to lateral or medial malleolar fractures. A posterior malleolar fracture constitutes 7 to 44% of all ankle fractures. Seven to 12% of all ankle fractures can be classified as trimalleolar fractures, which involve the posterior malleolus in addition to the medial and lateral malleoli. Sixty to 70% of these injuries are unimalleolar fractures, and 15 to 20% are bimalleolar fractures involving both the medial and lateral malleoli. The incidence of ankle fractures is reported to be 187 fractures per 100,000 people each year. There are 3 distinct anatomic subgroups of posterior malleolar fragments, each with an ideal screw trajectory that needs to be used in order to achieve an optimal reduction and fixation.Īnkle fractures are among the most common types of fractures treated by orthopedic surgeons. The mean trajectory angle was 21° lateral for “postero-lateral” fragments, 7° lateral for “postero-central” fragments, and 28° medial for “postero-medial” fragments ( p 0.05 for all comparisons). Fractures were also categorized according to the Lauge-Hansen system. Mean trajectory angles were calculated for each fracture type. An optimal trajectory angle for a single-lag screw fixation was measured on the CT cut between a central antero-posterior line and the line intersecting the posterior fragment perpendicular to the major fracture line. Fractures were categorized into one of three types, namely “postero-lateral,” “postero-medial,” or “postero-central,” according to the location of the fracture fragment on axial CT image. Eighty-five adult ankle fractures with posterior malleolar fragments were included in this study. Fractures were included if a CT scan was performed within 1 week of the surgery, and the posterior malleolar fragment occupied one third or more of the antero-posterior talar surface or jeopardize the ankle stability. MethodsĪ retrospective review of all ankle fracture operations from January 2014 to December 2016 was performed. Our aim was to assess the value of a modified classification system for posterior malleolar fractures, which is based on computed tomography (CT) images, optimizing screw trajectory during fluoroscopic-guided surgery, and to compare it to the Lauge-Hansen classification system to the CT-based classification. A proper reduction and internal fixation of posterior malleolar fractures can be challenging, as intraoperative fluoroscopy often underestimates the extent of the fracture.
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