Posterior Malleolar Fractures: Changing Concepts and Recent Developments.
Jan Bartoníček1, Stefan Rammelt2, Michal Tuček3
1Department of Orthopaedics, First Faculty of Medicine, Central Military Hospital Prague, Charles University, U Vojenské Nemocnice 1200, Prague 6 169 02, Czech Republic; Department of Anatomy, First Faculty of Medicine, Charles University Prague, U Nemocnice 3, Prague 2 120 00, Czech Republic.
Foot and Ankle Clinics
|February 8, 2017
Summary
Posterior malleolus fractures significantly impact ankle fracture-dislocation prognosis. Fragment shape and involvement of key ankle structures are more critical for treatment than fragment size.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Radiology
Background:
- Posterior malleolus fractures are crucial in ankle fracture-dislocations, affecting patient outcomes.
- Computed tomography (CT) provides detailed 3D assessment of fracture patterns.
Purpose of the Study:
- To evaluate the prognostic and therapeutic relevance of posterior malleolus fracture characteristics.
- To compare the biomechanical stability of different surgical fixation methods.
Main Methods:
- Analysis of three-dimensional fracture outlines using CT classification.
- Assessment of fibular notch involvement and intercalary fragments.
- Comparison of direct open reduction via posterior approach versus indirect reduction with anteroposterior screw fixation.
Main Results:
- Fragment morphology, fibular notch involvement, and intercalary fragments are more therapeutically relevant than fragment size or articular surface involvement.
- Operative treatment focuses on reconstructing the tibial plafond, fibular notch, and syndesmosis integrity.
Conclusions:
- CT-based classification of posterior malleolus fractures aids in therapeutic decision-making.
- Direct open reduction and posterior fixation offer superior biomechanical stability for these injuries.
