Posterior Malleolar Fracture Patterns.

Area of Science:

• Orthopedic surgery
• Radiology
• Biomechanical engineering

Background:

• Posterior malleolar fractures are complex ankle injuries.
• Accurate characterization of fracture morphology and fragment involvement is crucial for treatment planning.
• Existing classification systems may not fully capture the spectrum of these fractures.

Purpose of the Study:

• To characterize posterior malleolar fracture morphology using Cole fracture mapping.
• To assess the reliability of 3D CT modeling for quantifying fragment size and articular involvement.
• To correlate fracture morphology with clinical decision-making.

Main Methods:

• Reconstruction of 3D CT scans from 45 patients with posterior malleolar fractures.
• Calculation of fracture maps, fragment volume, and articular surface involvement using 3D CT modeling.
• Evaluation of inter-observer reliability for measurements by 3 independent observers.

Main Results:

• Fracture mapping demonstrated a continuous spectrum of posterolateral to posteromedial fracture lines.
• Reliability of 3D CT measurements for fragment volume and articular surface was almost perfect (ICC range: 0.978-1.000).
• A distinct pattern for Haraguchi type II fractures was identified.

Conclusions:

• Cole fracture mapping reveals a continuous spectrum of posterior malleolar fractures, including a distinct Haraguchi type II pattern.
• 3D CT modeling provides reliable quantification of posterior malleolar fracture characteristics.
• Fracture morphology, as assessed by 3D CT, may be more critical than fragment size alone in guiding treatment decisions.