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Objective To study biomechanical effects of cannulated screws at different fixation angles on posterior malleolus fracture based on finite element method, so as to determine the best fixation method of cannulatedscrew. Methods The finite element model of ankle joint, including tibia, fibula, astragalus, corresponding cartilage and ligaments was reconstructed using CT images, and 1 / 2 posterior malleolus fracture model was established on the basis of verifying its validity. The biomechanical effects of cannulated screw fixation on posterior malleolus fracture fixation model were analyzed. Results Compared with 0°,5°,10°,20° fixation model, the 15° fixation model had the smallest displacement. The screw stress of 15° fixation model was lower than that of 5°, 10°, 20° fixation model, and higher than that of 0° fixation model. But when the screw fixation angle was 0°, the peak contact pressure of ankle joint was much larger than that of normal ankle joint, which was easy to cause traumatic osteoarthritis. Conclusions Cannulated screw is safe and effective for treating posterior malleolus fracture which is less than 1 / 2 fragment size. The displacement and stress of the model are different at different fixation angles of screws. When the fixation angle of screw is 15°, the biomechanical stability is the best, which can be used to guide clinical operation.
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Objective@#To compare the effects of indirect reduction, percutaneous anterior posterior screw and direct reduction, posterior anterior screw in the treatment of posterior malleolus fracture.@*Methods@#A retrospective analysis was made on 58 patients with posterior malleolus fracture treated by cannulated screw fixation from January 2013 to December 2017 in the Department of Orthopedics, Affiliated Hospital of Guangdong Medical University.They were divided into anterior and posterior screw group (26 cases) and posterior and anterior screw group (32 cases) according to different treatment methods.The incidence of poor screw position and other complications were compared between the two groups.Health status and ankle function at the last follow-up were compared between the two groups.@*Results@#The incidence of screw malposition in the anterior and posterior screw fixation group was 23.08%(6/26), which was significantly higher than that in the posterior screw fixation group was 3.85%(1/32). The difference between the two groups has statistically significant (χ2=5.381, P=0.020); there was no significant difference in other complications such as infection, traumatic arthritis, bone nonunion (all P>0.05). At the last follow-up, the OMA scores of AP group were (80.70±8.16)and PA group were(75.23±9.33), There were significant differences between the two scores(t=2.240, P=0.029), the AOFAS scores of AP group were (80.57±7.25) and PA group were(75.38±10.19), There were significant differences between the two scores(t=2.110, P=0.039).@*Conclusion@#The Indirect reduction and percutaneous anterior and posterior screw treatment have a high incidence of malposition of the screw, which has an impact on ankle function.Direct reduction and posterior and anterior screw fixation can significantly reduce the incidence of malposition of the screw and obtain better functional results.
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Introducción: El manejo terapéutico de las fracturas de maléolo posterior en las fracturas trimaleolares de tobillo continúa en debate. Nuestro objetivo fue realizar una búsqueda de la evidencia científica sobre los aspectos terapéuticos de las fracturas de maléolo posterior en el contexto de las fracturas trimaleolares. Materiales y métodos: Se realizó una revisión de la bibliografía sistematizada por dos revisores, centrados en el manejo terapéutico del maléolo posterior. Resultados: Se obtuvieron 16 artículos clínicos de un total de 1029 pacientes, 8 estudios nivel de evidencia II y 8 de nivel IV. Se sistematizaron las indicaciones quirúrgicas y se analizaron los resultados funcionales y las complicaciones. Conclusiones: La comprensión pato-anatómica de estas fracturas es cada día mayor, principalmente por la utilización habitual de tomografías computarizadas (TC). El tratamiento quirúrgico sobre el maléolo posterior está evidenciando buenos y excelentes resultados funcionales. Para una adecuada decisión terapéutica se debería tener en cuenta ciertos factores: inestabilidad tibiotalar y sindesmótica, congruencia articular y características morfológicas del maléolo posterior. La reducción abierta (RA) y fijación interna con placa de sostén es el tratamiento que ha demostrado mejores resultados a corto y mediano plazo, no encontrando estudios con seguimiento a largo plazo.
Introduction: The therapeutic management of posterior malleolus fractures in trimaleolar ankle fractures continues in debate. Our objective was to conduct a search for scientific evidence on the therapeutic aspects of posterior malleolus fractures in the context of trimaleolar fractures. Materials and methods: A review systematic of the literature was carried out by two reviewers, focusing on the therapeutic management of the posterior malleolus. Results: 16 clinical articles were obtained with a total of 1029 patients, 8 studies level of evidence II and 8 studies level IV. The surgical indications were systematized, and the functional results and complications were analyzed. Conclusions: The patho-anatomical understanding of these fractures is increasing every day, mainly due to the usual use of CT scans. Surgical treatment on the posterior malleolus shows good and excellent functional results. For an adequate therapeutic decision certain factors should be taken into account: tibiotalar and syndesmotic instability, joint congruence and morphological characteristics of the posterior malleolus. Open reduction and internal fixation with support plate is the treatment that has shown better results in the short and medium term, not finding studies with long-term follow-up.
Introdução: O tratamento terapêutico das fraturas do maléolo posterior nas fraturas do tornozelo trimaleolar continua em debate. Nosso objetivo foi realizar uma pesquisa de evidências científicas sobre os aspectos terapêuticos das fraturas do maléolo posterior no contexto das fraturas trimaleolares. Materiais e métodos : Uma revisão sistemática da literatura foi realizada por dois revisores, com foco no manejo terapêutico do maléolo posterior. Resultados: foram obtidos 16 artigos clínicos com um total de 1029 pacientes, 8 estudos com nível de evidência II e 8 estudos com nível IV. As indicações cirúrgicas foram sistematizadas e os resultados e complicações funcionais foram analisados. Conclusões: O entendimento anatomopatológico dessas fraturas está aumentando a cada dia, principalmente devido ao uso habitual de tomografias computadorizadas. O tratamento cirúrgico do maléolo posterior mostra bons e excelentes resultados funcionais. Para uma decisão terapêutica adequada, certos fatores devem ser levados em consideração: instabilidade tibiotalar e sindesmótica, congruência articular e características morfológicas do maléolo posterior. A redução aberta e a fixação interna com placa de suporte é o tratamento que apresenta melhores resultados no curto e médio prazo, não encontrando estudos com acompanhamento a longo prazo.
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Humans , Ankle Fractures/surgery , Open Fracture Reduction , Fracture Fixation, InternalABSTRACT
Objective To evaluate the treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.Methods From January 2014 to January 2017,26 patients were operatively treated at Department of Orthopaedics,Tongji Hospital for posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.They were 10 men and 16 women,aged from 53 to 67 years(average,61.5 years).The surgery was conducted in prone position via the posterolateral and posteromedial approaches to expose simultaneously the fractures ends at medial,lateral and posterior malleoli for open reduction.The lateral malleolar fractures were fixated with plate,the medial malleolar fractures with screws and posterior malleolar fractures with plate or cannulated screws depending on the size of the fracture blocks.The outcomes were assessed using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society(AOFAS) and the visual analogue scale(VAS).Results Of this cohort,22 were followed up for 30 months on average(range,from 18 to 48 months).All the cases healed by the first intension without any infection.Their postoperative X-ray showed bone union after an average of 12.5 weeks(range,from 10 to 15 weeks).No nonunion,loosening or breakage of implants was found.The mean time for walking with full weight-bearing was 13 weeks(range,from 11 to 16 weeks).Their AOFAS ankle-hindfoot scores at the final follow-ups were 85.4(range,from 80 to 92),yielding 13 excellent and 9 good cases with a good to excellent rate of 100%.Their mean VAS scores were decreased significantly from preoperative 8.6±0.6 to postoperative 1.7±0.3(f=153.000,P=0.000).Conclusion In treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures,a combination of posterolateral and posteromedial approaches in prone position can expose and reduce simultaneously the fractures ends at medial,lateral and posterior malleoli,leading to satisfactory clinical outcomes.
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Objective@#To explore the morphological characteristics and differences of posterior malleolus fracture fragments in ankle fracture combined with posterior malleolus fracture and spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture, and to analyze the relationship between the posterior malleolus fracture fragments and the above two types of fracture injury.@*Methods@#A retrospective analysis was performed. One hundred patients with ankle fracture were admitted to Beijing Jishuitan Hospital from January 2011 to December 2011, including 59 males and 41 females, aged (42.0±14.1) years, with an age range of 17-73 years. Among them, 57 patients who were ankle fracture combined with posterior malleolus fracture were in Group A. Meanwhile, 90 patients with spiral fracture of middle and lower third of tibial were admitted to Beijing Jishuitan Hospital from January 2013 to December 2013, including 42 males and 48 females, aged (45.2±13.0) years, with an age range of 18-77 years. Among them, 35 patients who were spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture were in group B. A total of 92 patients in the two groups were examined by CT before operation. The patient′s fracture classification was determined according to Haraguchi classification. On axial plane, the angle between posterior malleolus fracture line and medial and lateral malleolus axis was defined as Ⅰa in Haraguchi Ⅰ, angles between posterior malleolus fracture line and medial and lateral malleolus axis were defined as Ⅱa and Ⅱb in Haraguchi Ⅱ, and angle Ⅰc and Ⅱc were angles between posterior malleolus fracture line and tibial axis on sagittal CT. Measurement data were expressed as mean±standard deviation (Mean±SD). Mann-whitney and Chi-square test were used to compare the differences of different angles in type I and type Ⅱ, and whether there were statistical differences in different angles between the two groups.@*Results@#In the 92 cases, 75 were type Ⅰ, 12 were type Ⅱ and 5 were type Ⅲ. The angle of Ⅰa was (26.6±5.6)°, the angle of Ⅰc was (15.4±4.1)°, the angle of type Ⅱa was (22.1±3.3)°, and the angle of Ⅱc was (16.4±5.4)°. The difference between Ⅰa and Ⅱa data was statistically significant (P=0.003), but there was no significant difference between Ⅰc and Ⅱc(P=0.667). In group A and group B, the angle of Ⅰa was (26.6±5.9)°and (26.6±5.1)°, the angle of Ⅰc was (15.7±4.2)°and (14.9±3.9)°, the angle of Ⅱa was (22.0±3.0)°and (22.2±4.3)°, the angle of Ⅱb was (45.4±9.0)°and (46.5±10.0)°, the angle of Ⅱc was (17.0±5.4)°and (15.3±6.2)°, respectively. There were no significant differences in the angles of Ⅰa, Ⅰc, Ⅱa, Ⅱb and Ⅱc between the two groups (P values were 0.862, 0.387, 1.000, 0.932 and 0.444, respectively).@*Conclusion@#The posterior malleolar fragments is not associated with fracture type of ankle fracture combined with posterior malleolus frature and the spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture.
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Objective To explore the morphological characteristics and differences of posterior malleolus fracture fragments in ankle fracture combined with posterior malleolus fracture and spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture,and to analyze the relationship between the posterior malleolus fracture fragments and the above two types of fracture injury.Methods A retrospective analysis was performed.One hundred patients with ankle fracture were admitted to Beijing Jishuitan Hospital from January 2011 to December 2011,including 59 males and 41 females,aged (42.0 ± 14.1) years,with an age range of 17-73 years.Among them,57 patients who were ankle fracture combined with posterior malleolus fracture were in Group A.Meanwhile,90 patients with spiral fracture of middle and lower third of tibial were admitted to Beijing Jishuitan Hospital from January 2013 to December 2013,including 42 males and 48 females,aged (45.2 ± 13.0) years,with an age range of 18-77 years.Among them,35 patients who were spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture were in group B.A total of 92 patients in the two groups were examined by CT before operation.The patient's fracture classification was determined according to Haraguchi classification.On axial plane,the angle between posterior malleolus fracture line and medial and lateral malleolus axis was defined as Ⅰ a in Haraguchi Ⅰ,angles between posterior malleolus fracture line and medial and lateral malleolus axis were defined as Ⅱ a and H b in Haraguchi Ⅱ,and angle Ⅰ c and Ⅱ c were angles between posterior malleolus fracture line and tibial axis on sagittal CT.Measurement data were expressed as mean ± standard deviation (Mean ± SD).Mann-whitney and Chi-square test were used to compare the differences of different angles in type Ⅰ and type Ⅱ,and whether there were statistical differences in different angles between the two groups.Results In the 92 cases,75 were type Ⅰ,12 were type Ⅱ and 5 were type Ⅲ.The angle of Ⅰ a was (26.6 ± 5.6)°,the angle of Ⅰ c was (15.4 ±4.1)°,the angle of type Ⅱa was (22.1 ±3.3)°,and the angle of Ⅱc was (16.4 ±5.4)°.The difference between Ⅰ a and Ⅱa data was statistically significant (P=0.003),but there was no significant difference between Ⅰ c and Ⅱ c (P =0.667).In group A and group B,the angle of Ⅰ a was (26.6 ± 5.9)°and (26.6±5.1)°,the angle of Ⅰcwas (15.7 ±4.2)°and (14.9±3.9)°,the angle of Ⅱa was (22.0± 3.0)°and (22.2±4.3)°,the angle of Ⅱb was (45.4 ±9.0)°and (46.5 ± 10.0)°,the angle of Ⅱc was (17.0 ±5.4)°and (15.3 ±6.2)°,respectively.There were no significant differences in the angles of Ⅰ a,Ⅰ c,Ⅱ a,Ⅱ b and Ⅱ c between the two groups (P values were 0.862,0.387,1.000,0.932 and 0.444,respectively).Conclusion The posterior malleolar fragments is not associated with fracture type of ankle fracture combined with posterior malleolus frature and the spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture.
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Objective To investigate the incidence and surgical fixation-related factors of posterior malleolus fracture in the treatment of ankle fractures.Methods A retrospective study was conducted of the 703 inpatients with ankle fracture at Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital from June 1,2017 to May 31,2018.Of them,464 suffered posterior malleolus fracture.The incidence and surgical fixation rate of posterior malleolar fracture were calculated.Of the patients with posterior malleolus fracture,the gender,age,injury energy,Lauge-Hanse classification,Bartonícek classification,talar backward subluxation,fragment area ratio (FAR) of posterior malleolus fracture on X-ray film and CT cross section,fragmental dislocation,and Die-punch fragment were analyzed to screen out the risk factors related to surgical internal fixation for posterior malleolus fracture.Results In this study,the incidence of posterior malleolus fracture was 66.00％ (464/703) and the surgical fixation rate 43.97％ (204/464).The gender,age,injury energy,Lauge-Hanse classification,direction of talar subluxation and displacement of Die-punch fragments were not the risk factors related to the surgical internal fixation for posterior malleolus fracture (P ＞ 0.05) while the Bartonícek classification,talar backward subluxation,FAR of posterior malleolus fracture on X-ray film and CT cross section,lateral fragmental displacement and Die-punch fragment were the risk factors related to the surgical internal fixation for posterior malleolus fracture (P ＜ 0.05).Logistic regression analysis indicated that the talar backward subluxation (OR =5.580,95％ CI:1.623 ～ 19.181,P =0.006) and the FAR ≥ 15％ on CT cross section (OR =9.103,95％ CI:3.342 ～ 24.800,P =0.000) were independent risk factors for surgical internal fixation of posterior malleolus fracture.Conclusions The incidence and surgical fixation rate of posterior malleolar fracture are very high.The talar backward subluxation and the fragment area ratio ≥ 15％ on CT cross-section are independent risk factors for surgical internal fixation of posterior malleolus fracture.
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Objective To compare the clinical outcomes of percutaneous cannulated lag screws versus posterior buttress plate in the fixation for posterior malleolar fractures.Methods We reviewed the 167 patients who had been treated between January 2010 and December 2014 for ankle fracture involving larger than 25％ of the articular surface of the posterior malleolus.They received posterior malleolus fixation with percutaneous cannulated lag screws or with a buttress plate.In the cannulated screw group (84 patients),there were 47 males and 37 females,aged from 23 to 72 years (average,49.7 ±9.1 years),and 39 cases of type B and 45 ones of type C according to the Dennis-Webber classification.In the buttress plate group (83 patients),there were 38 males and 45 females,aged from 31 to 69 years (average,52.3 ± 8.3 years),and 45 cases of type B and 38 ones of type C according to the Dennis-Webber classification.At 6 and 12 months postoperation and the final follow-up,the ankle motion was evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score and range of motion (ROM).Results The average operation time for the cannulated screw group was significantly shorter than for the buttress plate group (Z =-9.145,P ＜ 0.001).No fracture nonunion,reduction loss or incision infection happened in either group.In the cannulated screw group,we detected malunion with a step-off beyond 2 mm in 5 patients,and penetration of one cannulated lag screw into the tibiofibular syndesmosis in 3 patients.In the buttress plate group,we detected toe flexion contracture in 4 patients,and uncomfortable feeling in ankle motion in 7 patients.At the final follow-up,X-rays and CT scans in the 2 groups showed no obvious post-traumatic osteoarthritis of the ankle.There were no significant differences between the 2 groups regarding the AOFAS scores at 6 and 12 months postoperation and the final follow-up(P ＞ 0.05);the AOFAS scores at the final follow-up for all the patients were significantly different from those at 6 and 12 months postoperation (P ＜ 0.05).At the final follow-up,there were no significant differences between the 2 groups regarding ROMs of dorsal flexion,plantar flexion,varus or valgus (P ＞ 0.05).Conclusions As there are no significant differences between the percutaneous cannulated lag screws and posterior buttress plate in AOFAS score and ROM of the ankle after fixation for posterior malleolar fractures,the 2 fixation methods can both achieve good clinical outcomes.Fixation with cannulated lag screws has advantages of indirect reduction and minimal invasion but also a disadvantage of uncertain quality of reduction;fixation with buttress plates has an advantage of anatomical reduction under direct vision but also shortcomings of relatively large invasion and high cost.
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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.
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Ankle , Ankle Fractures , Diagnosis , Incidence , Intra-Articular Fractures , Ligaments , Radiography , Retrospective Studies , TibiaABSTRACT
Objective To evaluate the effect of various reduction degrees of large posterior malleolus fracture on contact condition of the tibiotalar joint using biomechanical and finite element methods.Methods Six fresh adult cadaveric calf-foot were tested with different loadings in neutral position,10 degree of dorsiflexion,and 15 degree of plantar flexion.Models included the intact ankle and posterior malleolus fracture (not fixed,fixed with 1 mm step-off,fixed with 2 mm step-off,fixed with 1 mm gap,or fixed with 2 mm gap).Tibiotalar joint contact area,contact pressure,and peak pressure were measured using the Tek-Scan pressure sensor.In addition,a three-dimensional finite element model of the ankle joint was established and tested under the simulated biomechanical conditions.Results Mter a 500 N axial loading in the intact ankle,contact area of the tibiotalar joint was (4.94 ± 0.67) cm2 and loading strength of the tibiotalar joint was (83.4 ± 2.7) ％ of total loading strength.Contact area of the tibiotalar joint in the fracture model fixed with 1 mm gap demonstrated no significant difference in all loading conditions compared with the intact model.In 15 degree of plantar flexion,contact area of the tibiotalar joint differed between the fracture model fixed with 1 mm step-off and the intact model (P ＜ 0.05).In multiple loading conditions,contact area of the tibiotalar joint differed between the fracture models fixed with 2 mm step-off or 2 mm gap and the intact model (P ＜ 0.05).Results of finite element analysis were conformed to the related biomechanical study.Conclusions Anatomic reduction should be pursued for large posterior malleolus fracture.If difficulty exists,fracture displacement should be within 1 mm step-off and 2 mm gap so as to restore the inter-joint congruity.
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PURPOSE: The purpose of this study is to compare the radiologic and clinical results of syndesmotic screw fixation and posterior malleolar fixation for syndesmotic injury in Lauge-Hansen classification pronation-external rotation (PER) stage IV ankle fractures with posterior malleolus fracture. MATERIALS AND METHODS: We designed a retrospective study that included patients with Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture. Of 723 patients who underwent ankle fracture surgery from March 2005 to November 2012, 29 were included in this study. In this study, syndesmotic injury was treated with syndesmotic screw fixation or posterior malleolus fixation. There were 15 cases of syndesmotic screw fixation and 14 cases of posterior malleolar fixation. We compared the radiologic and clinical results at one year postoperatively. Posterior malleolus fragment size on a pre-operative computed tomographic image, and tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, and Takakura classification on a postoperative one year followup radiograph were used for comparison of the radiologic results. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society score, visual analogue scale score, and patient subjective satisfaction score. RESULTS: Posterior malleolar fragment size was 12.62%+/-3.01% of the joint space in the syndesmotic screw fixation group and 27.04%+/-4.34% in the posterior malleolar fixation group. A statistical difference was observed between the two groups. However, other results, including tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, Takakura classification, and clinical scores showed no statistical difference. CONCLUSION: In the Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture, if the posterior malleolus fracture can be reduced anatomically and fixated rigidly, syndesmotic screw fixation, which can cause several complications, is usually not required for achievement of a satisfactory syndesmotic stability; this would be a recommendable option for treatment of syndesmotic injury.
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Humans , Ankle Fractures , Ankle Injuries , Ankle , Classification , Follow-Up Studies , Foot , Joints , Pronation , Retrospective StudiesABSTRACT
PURPOSE: We evaluate clinical manifestations and radiologic features of ankle fracture & dislocation, as well as the usefulness of computed tomography on posterior ankle fracture & dislocation to study factors contributing to ankle fracture & dislocation. MATERIAL AND METHODS: Ankle dislocation was defined as the center of talar body being translated over the cortex of tibia on AP or lateral view on simple X-ray. Surgical treatments of 30 patients from January 2007 to March 2012 were categorized according to the injury mechanism, the direction of dislocation and fracture site. Joint involvement of posterior malleoalr fracture was evaluated through simple x-ray and computed tomography. We treated surgically if posterior malleolus fracture involves more than 25% of dital tibial articular surface. Thereafter, clinical outcomes were identified through radiographs and by using the AOFAS score. RESULTS: The mean age was 42(13-78) years old, and slip down was the most common injury mechanism (13 cases). Car accident (6 cases) and fall accident (4 cases) were the next frequently found injury mechanisms. As for the types of ankle fracture, posterior fracture and dislocation (21 cases, 43.3%) was most commonly found. Out of these 21 cases, 15 cases involved trimalleolar fracture, and 19 cases were associated with posterior malleolar fracture. Danis-weber type B and C patients were 11 cases and 10 cases respectively. Articular involvement of posterior malleolar fracture turned out to be average 27.9%(5.1%~49.1%) on simple x-ray. The rate was evaluated as average 31.7%(12.6%~55.3%) on computed tomography which was conducted 15 times, and led us to more meaningful data. CONCLUSION: Anterolateral fracture and dislocation often accompanied open dislocation. Posterior fracture dislocation was most commonly found. Posterior malleolus was an important factor that ensures posterior stability of the ankle joint. Computed tomograph is useful to evaluate the articular involvement of posterior malleolar fracture.
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Animals , Humans , Ankle , Ankle Joint , Joint Dislocations , Joints , TibiaABSTRACT
Objective To evaluate the clinical significance of anatomic reduction and internal fixation of posterior malleolar fracture in ankle fracture surgical treatment. Methods Fifty-four patients with posterior malleolar fracture were treated with anatomic reduction and internal fixation from March 2005 to June 2010. The patients groups consisted of 36 males and 18 females. According to CT scan classification,the group was made up of 36 type Ⅰ cases, 10 type Ⅱ and 8 type Ⅲ cases. All patients were evaluated with modified Baird-Jackson scoring system. The relationship between final result and fracture pattern , fixation methods, the time of exercise initiation fitted operation were analyzed respectively. Results The followedup period varied from 6 months to 36 months, with an average of 18 months. The number of patients whose result was excellent, good, fair and poor was respective 29,18 ,5 and 2. The total percent age of good to excellent clinical result was 87. 03%. There were 4 patients who had only slight pain after long time walking ,the remainder patients were completed with no pain. Conclusion Operative treatment may provide satisfactory fracture anatomic reduction and internal fixation for posterior malleolar fracture. Correct fracture pattern estimation and proper internal fixation are important to achieve and improve reduction quality, and to ameliorate better long term results.
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[Objective]To classify fractures of posterior malleolus by computed tomography and guide its clinical treatment.[Method]From January 2003 to October 2006,eighty-eight patients who had been treated surgically for the posterior malleolar fractures were reviewed.There were 53 males and 35 females.The mean age was 42.3 years(ranged,18～75 years).All the patients' preoperative radiograph and computed tomographic scans were reviewed,and each fracture was categorized according to the size,location and fracture line of the major fragment and the stable state of mortise.The classification was applied to treat 88 patients.[Result]On the basis of the computed tomographic images,the posterior malleolar fractures were categorized into four types.There were type Ⅰ(stable) in 23 cases,type Ⅱ(borderline) in 26 cases,type Ⅲ(big unstable posterolateral oblique) in 18 cases and type Ⅳ(medial-extension) in 21 cases.Type Ⅰ included type Ⅰ1(small shell)in 5 cases and type I2(small posterolateral oblique) in 18 cases.Type Ⅱ included type Ⅱ1(moderate posterolateral oblique without lateral-posterior dislocation of talus)in 15 cases and type Ⅱ2(moedrate postero-lateral oblique with lateral-posterior dislocation of talus)in 11 cases.All patients were followed up for an average of 31months(ranged from 12 to 48 months).According to the Baird-Jackson scoring system,the results were rated as being excellent in 62 cases,good in 13 cases,moderate in 8 cases,and poor in 5 cases,with the good-excellent rate being 85.2%.[Conclusion]Computed tomographic scans can demonstrate the pathoanatomy of the posterior malleolar fracture and provided guidance for clinical treatment.