The Volkmann dogma: a retrospective, long-term, single-center study

Area of Science:

• Orthopedic surgery
• Traumatology
• Radiology

Background:

• Controversy exists regarding the surgical fixation of posterior malleolus (Volkmann triangle) fractures in malleolar fractures.
• The critical fragment size for fixation and its impact on long-term outcomes remain debated.

Purpose of the Study:

• To evaluate the clinical and radiological outcomes of malleolar fractures with Volkmann triangle involvement.
• To determine the influence of Volkmann triangle fixation and cartilage damage on long-term prognosis.

Main Methods:

• A consecutive series of 43 patients with dislocated malleolar fractures and Volkmann triangle involvement were analyzed.
• Clinical and radiological results were assessed after an average follow-up of 7.3 years.
• 11 fragments were surgically fixed; 16 patients had intraoperative cartilage lesions noted.

Main Results:

• 37/43 patients showed no or mild arthrosis; 6 had moderate/severe arthrosis.
• The Olerud-Molander score was lower in patients with large, fixed Volkmann triangle fragments (90.6) compared to unfixed (98.5) or absent fragments (95.5).
• Pre-existing cartilage damage correlated with more severe long-term arthrosis and lower Olerud-Molander scores.

Conclusions:

• The presence of a Volkmann triangle negatively affects prognosis in malleolar fractures.
• Surgical fixation of Volkmann triangle fragments, even with anatomical reduction, does not normalize long-term outcomes.
• Intraoperative cartilage damage is a critical factor influencing long-term results in these fractures.