For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
12
views
23
references
 Top references
cited by
9
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      567
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Posterior Malleolar Ankle Fractures : An Effort at Improving Outcomes

      research-article
      Author(s): , MBBCh, MRCS(Eng), FRCS(Tr&Orth) 1 , , , MBChB, MRCS(Eng) 1 , , MBChB, MRCS(Eng), FRCS(Tr&Orth) 1 , , MBChB 1 , , MBChB, MRCS(Ed), FRCS(Tr&Orth) 1
      Publication date (Electronic):
      Journal: JBJS Open Access
      Publisher: Wolters Kluwer

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background:

          There is increasing acceptance that the clinical outcomes following posterior malleolar fractures are less than satisfactory. We report our results of posterior malleolar fracture management based on the classification by Mason and Molloy.

          Methods:

          All fractures were classified on the basis of computed tomographic (CT) scans obtained preoperatively. This dictated the treatment algorithm. Type-1 fractures underwent syndesmotic fixation. Type-2A fractures underwent open reduction and internal fixation through a posterolateral incision, type-2B fractures underwent open reduction and internal fixation through either a posteromedial incision or a combination of a posterolateral with a medial-posteromedial incision, and type-3 fractures underwent open reduction and internal fixation through a posteromedial incision.

          Results:

          Patient-related outcome measures were obtained in 50 patients with at least 1-year follow-up. According to the Mason and Molloy classification, there were 17 type-1 fractures, 12 type-2A fractures, 10 type-2B fractures, and 11 type-3 fractures. The mean Olerud-Molander Ankle Score was 75.9 points (95% confidence interval [CI], 66.4 to 85.3 points) for patients with type-1 fractures, 75.0 points (95% CI, 61.5 to 88.5 points) for patients with type-2A fractures, 74.0 points (95% CI, 64.2 to 83.8 points) for patients with type-2B fractures, and 70.5 points (95% CI, 59.0 to 81.9 points) for patients with type-3 fractures.

          Conclusions:

          We have been able to demonstrate an improvement in the Olerud-Molander Ankle Score for all posterior malleolar fractures with the treatment algorithm applied using the Mason and Molloy classification. Mason classification type-3 fractures have marginally poorer outcomes, which correlates with a more severe injury; however, this did not reach significance.

          Level of Evidence:

          Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

          Related collections

          Most cited references23

          • Record: found
          • Abstract: found
          • Article: not found

          Pathoanatomy of posterior malleolar fractures of the ankle.

          Naoki Haraguchi, Hiroki Haruyama, Hidekazu Toga … (2006)
          The functional outcome following ankle fractures that involve a posterior malleolar fragment is often not satisfactory, and treatment of this type of fracture remains controversial. Thorough knowledge of the pathologic anatomy of the posterior malleolar fracture is essential for planning appropriate treatment. Thus, we conducted a computed tomographic study to clarify the pathologic anatomy of the posterior malleolar fracture. Between 1999 and 2003, fifty-seven consecutive patients with a unilateral ankle fracture with one or more posterior fragments were managed at our hospital. We reviewed the patients' preoperative computed tomographic scans to determine (1) the ratio of the posterior fragment area to the total cross-sectional area of the tibial plafond and (2) the angle between the bimalleolar axis and the major fracture line of the posterior malleolus. Each fracture was categorized according to the location of the major fracture line on the computed tomographic image at the level of the tibial plafond. The fifty-seven fractures were categorized into three types: (1) the posterolateral-oblique type (thirty-eight fractures; 67%), (2) the medial-extension type (eleven fractures; 19%), and (3) the small-shell type (eight fractures; 14%). Two of the eleven medial-extension fractures extended to the anterior part of the medial malleolus. A total of nine of the eleven medial-extension fractures actually consisted of two fragments [corrected] The conditions are not exclusive of one another; for example, in the case of one of the fractures exhibiting two fragments, the fracture also extended to the anterior part of the medial malleolus [corrected] The average area of the fragment comprised 11.7% of the cross-sectional area of the tibial plafond for posterolateral-oblique fractures and 29.8% for medial-extension fractures. In the cases of seven of the nine fractures that comprised >25% of the tibial plafond, the fracture line extended to the medial malleolus. The angles between the bimalleolar axis and the major fracture line of the posterior malleolus varied. The fracture lines associated with posterior malleolar fractures appear to be highly variable. A large fragment extending to the medial malleolus existed in almost 20% of the posterior malleolar fractures in the current study, and some fragments involved almost the entire medial malleolus. Because of the great variation in fracture configurations, preoperative use of computed tomography may be justified. The information obtained from this study will be helpful for conducting basic research of this condition and for determining appropriate surgical approaches.
          Article 0 comments Cited 72 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Fixation of posterior malleolar fractures provides greater syndesmotic stability.

            M. Gardner, Jason H. Nielson, Geoffrey S. Briggs … (2006)
            Syndesmotic injuries are common in ankle fractures. Traditional syndesmosis fixation may be associated with a secondary procedure. When the posterior malleolus is fractured, the posterior syndesmotic ligaments may remain intact and attached to the fragment. Our goals were to establish the incidence of syndesmotic ligament ruptures in pronation-external rotation type ankle injuries associated with posterior malleolar fractures, and to assess syndesmotic stability after fixation of the posterior malleolus compared with using a syndesmotic screw. Fifteen patients who sustained pronation-external rotation Stage 4 ankle fractures that involved the posterior malleolus were evaluated using radiographs and magnetic resonance imaging. No complete tears of the posterior-inferior tibiofibular ligament occurred. A pronation-external rotation fracture pattern with a posterior malleolar fragment was created in 10 lower extremity cadaver specimens with random fixation of the posterior malleolus or the syndesmosis. Compared with the intact specimens, stiffness was restored to 70% after fixation of the posterior malleolus, and to 40% after syndesmosis stabilization. Syndesmotic stability may be obtained more effectively by fixation of the posterior malleolus rather than by using a syndesmotic screw. Although additional clinical investigation is warranted, these concepts may be useful in eliminating syndesmotic screw fixation in select patients.
            Article 0 comments Cited 57 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Anatomy and classification of the posterior tibial fragment in ankle fractures.

              Daniel Klika, Ivo Trešl, Jan Bartonícek … (2015)
              The aim of this study was to analyze the pathoanatomy of the posterior fragment on the basis of a comprehensive CT examination, including 3D reconstructions, in a large patient cohort.
              Article 0 comments Cited 53 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): JB JS Open Access
                Journal ID (iso-abbrev): JB JS Open Access
                Journal ID (coden): JBJSOA
                Journal ID (pmc): JBJSOA
                Journal ID (publisher-id): JBJSOA
                Title: JBJS Open Access
                Publisher: Wolters Kluwer (Philadelphia, PA )
                ISSN (Electronic): 2472-7245
                Publication date Collection: Apr-Jun 2019
                Publication date (Electronic): 07 June 2019
                Volume: 4
                Issue: 2
                Electronic Location Identifier: e0058
                Affiliations
                [1 ]Trauma and Orthopaedic Department, Aintree University Hospital, Liverpool, United Kingdom
                Author notes
                E-mail address for L. Mason: lyndon.mason@ 123456aintree.nhs.uk
                Article
                Publisher ID: JBJSOA-D-18-00058 Accession ID: 00007
                DOI: 10.2106/JBJS.OA.18.00058
                PMC ID: 6613847
                PubMed ID: 31334465
                SO-VID: df1e2a2c-ba20-487d-98ec-4230ff91c586
                Copyright © Copyright © 2019 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                Categories
                Subject: 0050
                Subject: Scientific Articles
                Custom metadata
                OPEN-ACCESS TRUE

                Data availability:

                Comments

                Comment on this article

                scite_

                Similar content567

                See all similar

                Cited by9

                See all cited by

                Most referenced authors280

                See all reference authors