Haraguchi, J Bone Joint Surg Am 2006 - Pathoanatomy of Posterior Malleolar Fractures of the Ankle

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Pathoanatomy of Posterior Malleolar Fractures of the Ankle

Haraguchi, Kato, et al.·J Bone Joint Surg Am·2006·412 citations·Retrospective cohort

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Background

The functional outcome following ankle fractures that involve a posterior malleolar fragment is often not satisfactory, and treatment of this type of fracture remains controversial. Thorough knowledge of the pathologic anatomy of the posterior malleolar fracture is essential for planning appropriate treatment. Thus, we conducted a computed tomographic study to clarify the pathologic anatomy of the posterior malleolar fracture.

Methods

Between 1999 and 2003, 57 consecutive patients with a unilateral ankle fracture with one or more posterior fragments were managed at our hospital.
We reviewed the patients' preoperative computed tomographic scans to determine (1) the ratio of the posterior fragment area to the total cross-sectional area of the tibial plafond and (2) the angle between the bimalleolar axis and the major fracture line of the posterior malleolus.
Each fracture was categorized according to the location of the major fracture line on the computed tomographic image at the level of the tibial plafond.

Results

The 57 fractures were categorized into 3 types: (1) the posterolateral-oblique type (38 fractures; 67%), (2) the medial-extension type (11 fractures; 19%), and (3) the small-shell type (8 fractures; 14%).
2 of the 11 medial-extension fractures extended to the anterior part of the medial malleolus, and the other 9 actually consisted of 2 fragments.
The average area of the fragment comprised 11.7% of the cross-sectional area of the tibial plafond for posterolateral-oblique fractures and 29.8% for medial-extension fractures.
In the cases of 7 of the 9 fractures that comprised >25% of the tibial plafond, the fracture line extended to the medial malleolus.
The angles between the bimalleolar axis and the major fracture line of the posterior malleolus varied.

Conclusions

The fracture lines associated with posterior malleolar fractures appear to be highly variable. A large fragment extending to the medial malleolus existed in almost 20% of the posterior malleolar fractures in the current study, and some fragments involved almost the entire medial malleolus. Because of the great variation in fracture configurations, preoperative use of computed tomography may be justified. The information obtained from this study will be helpful for conducting basic research of this condition and for determining appropriate surgical approaches.

Copyright remains with the authors and publisher.

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Pathoanatomy of Posterior Malleolar Fractures of the Ankle

Haraguchi, Kato, et al.·J Bone Joint Surg Am·2006·412 citations·Retrospective cohort

|

Background

The functional outcome following ankle fractures that involve a posterior malleolar fragment is often not satisfactory, and treatment of this type of fracture remains controversial. Thorough knowledge of the pathologic anatomy of the posterior malleolar fracture is essential for planning appropriate treatment. Thus, we conducted a computed tomographic study to clarify the pathologic anatomy of the posterior malleolar fracture.

Methods

Between 1999 and 2003, 57 consecutive patients with a unilateral ankle fracture with one or more posterior fragments were managed at our hospital.
We reviewed the patients' preoperative computed tomographic scans to determine (1) the ratio of the posterior fragment area to the total cross-sectional area of the tibial plafond and (2) the angle between the bimalleolar axis and the major fracture line of the posterior malleolus.
Each fracture was categorized according to the location of the major fracture line on the computed tomographic image at the level of the tibial plafond.

Results

The 57 fractures were categorized into 3 types: (1) the posterolateral-oblique type (38 fractures; 67%), (2) the medial-extension type (11 fractures; 19%), and (3) the small-shell type (8 fractures; 14%).
2 of the 11 medial-extension fractures extended to the anterior part of the medial malleolus, and the other 9 actually consisted of 2 fragments.
The average area of the fragment comprised 11.7% of the cross-sectional area of the tibial plafond for posterolateral-oblique fractures and 29.8% for medial-extension fractures.
In the cases of 7 of the 9 fractures that comprised >25% of the tibial plafond, the fracture line extended to the medial malleolus.
The angles between the bimalleolar axis and the major fracture line of the posterior malleolus varied.

Conclusions

The fracture lines associated with posterior malleolar fractures appear to be highly variable. A large fragment extending to the medial malleolus existed in almost 20% of the posterior malleolar fractures in the current study, and some fragments involved almost the entire medial malleolus. Because of the great variation in fracture configurations, preoperative use of computed tomography may be justified. The information obtained from this study will be helpful for conducting basic research of this condition and for determining appropriate surgical approaches.

Copyright remains with the authors and publisher.

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