Missed isolated posterior malleolar fractures

Area of Science:

• Orthopedic Surgery
• Traumatology
• Radiology

Background:

• Isolated posterior malleolar fractures are frequently missed, initially diagnosed as ankle sprains.
• Delayed diagnosis can lead to prolonged symptoms and potentially poorer outcomes.

Purpose of the Study:

• To evaluate the injury mechanism, clinical outcomes, and radiological results of patients with missed isolated posterior malleolar fractures.
• To highlight the importance of considering this fracture in specific injury patterns.

Main Methods:

• Retrospective review of seven patients with missed isolated posterior malleolar fractures.
• Diagnosis confirmed by MRI after initial negative radiographs.
• Treatment involved ankle bracing for three weeks.
• Clinical outcomes assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.
• Radiographic evaluation included a 50° external rotation lateral view.

Main Results:

• Six of seven patients achieved fracture healing by six weeks.
• One patient showed no radiographic healing by six months.
• Mean AOFAS scores improved significantly from 20 at baseline to 86 at three months.
• No instability or degenerative changes were observed at one-year follow-up.

Conclusions:

• Isolated posterior malleolar fractures should be suspected in cases of posterior ankle pain after forced plantar flexion or axial compression.
• A 50° external rotation lateral radiograph is a valuable tool for detecting these fractures.
• Prompt diagnosis and management are crucial for favorable patient outcomes.