Skip to main content

Advertisement

SpringerLink
Log in

The treatment options for posterior malleolar fractures in tibial spiral fractures

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The posterior malleolar fracture (PMF) in tibial spiral fractures are a common type of complication that occurs in tibial fractures. However, the indication of fixation for posterior fractures is still under debate and varies between different surgeons’. It is not unusual to find the smaller PMF (<25%), which could be treated conservatively within guidelines, treated with internal fixation in clinic. The aim of this study is to evaluate the clinical outcomes of tibial spiral fractures with PMF and provide proper guidance for the treatment of this special fracture.

Methods

A total of 284 cases of spiral fractures combined with PMF were collected and analyzed. Demographic data, fragment size (classified by 25% involvement of ankle joint), time to weight-bearing and functional scores post-operatively were recorded. The ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS), a visual analogue scale (VAS) pain score, assessment of dorsiflexion restriction and arthritis scale were used as the main evaluations.

Results

Forty patients with a larger PMF (≥25%) and 72 with smaller ones (<25%) were fixed and categorized as the fixation group (FG). In the nonfixation group (NG), the corresponding numbers were four and 168 patients respectively. A total of 279 PMF were classified as large posterolateral triangular fragment carrying the posterior half of the fibular notch and intra-incisural posterolateral fragment involving one-fourth to one-third of the fibular notch. However, no obvious differences were observed in terms of the clinical outcomes in PMF involving one-fourth to one-third of the fibular notch. In the treatment of smaller PMF (<25%) of this type, there were no obvious differences in the functional outcomes between fixed (SF) and nonfixed PMF (SN).

Conclusions

Many patients with smaller PMFs were fixated, but functional outcomes of SF were not better than those of SN. There is no need to emphasize other factors guiding the treatment of PMF involving one-fourth to one-third of the fibular notch in spiral fractures. The traditional size of PMF may be only enough to guide the treatment of spiral fracture with PMF. But other types of PMF should still be treated considering morphology and fragment simultaneously.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Larsen P, Elsoe R, Hansen SH, Graven-Nielsen T, Laessoe U, Rasmussen S (2015) Incidence and epidemiology of tibial shaft fractures. Injury 46(4):746–750

    Article  PubMed  Google Scholar 

  2. Hou Z, Zhang Q, Zhang Y, Li S, Pan J, Wu H (2009) A occult and regular combination injury: the posterior malleolar fracture associated with spiral tibial shaft fracture. J Trauma 66(5):1385–1390

    Article  PubMed  Google Scholar 

  3. Hou Z, Zhang L, Zhang Q, Yao S, Pan J, Irgit K, Zhang Y (2012) The “communication line” suggests occult posterior malleolar fracture associated with a spiral tibial shaft fracture. Eur J Radiol 81(3):594–597

    Article  PubMed  Google Scholar 

  4. Langenhuijsen JF, Heetveld MJ, Ultee JM, Steller EP, Butzelaar RM (2002) Results of ankle fractures with involvement of the posterior tibial margin. J Trauma 53(1):55–60

    Article  PubMed  Google Scholar 

  5. Erdem MN, Erken HY, Burc H, Saka G, Korkmaz MF, Aydogan M (2014) Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures. Foot Ankle Int 35(10):1022–1030

    Article  PubMed  Google Scholar 

  6. Raasch W, Larkin J, Draganich L (1992) Assessment of the posterior malleolus as a restraint toposterior subluxation of the ankle. J Bone Joint Surg Am 74(8):1201–1206

    Article  CAS  PubMed  Google Scholar 

  7. Evers J, Barz L, Wähnert D, Grüneweller N, Raschke MJ, Ochman S (2015) Size matters: the influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures. Injury 46:S109–S113

    Article  PubMed  Google Scholar 

  8. Rammelt S, Heim D, Hofbauer L, Grass R, Zwipp H (2011) Problems and controversies in the treatment of ankle fractures. Unfallchirurg 114(10):847–860

    Article  CAS  PubMed  Google Scholar 

  9. Büchler L, Tannast M, Bonel HM, Weber M (2009) Reliability of radiologic assessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures. J Orthop Trauma 23(3):208–212

    Article  PubMed  Google Scholar 

  10. Gardner MJ, Streubel PN, McCormick JJ, Klein SE, Johnson JE, Ricci WM (2011) Surgeon practices regarding operative treatment of posterior malleolus fractures. Foot Ankle Int 32(4):385–393

    Article  PubMed  Google Scholar 

  11. Irwin TA, Lien J, Kadakia AR (2013) Posterior malleolus fracture. J Am Acad Orthop Surg 21(1):32–40

    Article  PubMed  Google Scholar 

  12. Xu H-l, Li X, Zhang D-Y, Fu Z-G, Wang T-B, Zhang P-X, Jiang B-G, Shen H-l, Wang G, Wang G-l (2012) A retrospective study of posterior malleolus fractures. Int Orthop 36(9):1929–1936

    Article  PubMed  PubMed Central  Google Scholar 

  13. Haraguchi N, Haruyama H, Toga H, Kato F (2006) Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg Am 88(5):1085–1092. doi:10.2106/jbjs.e.00856

    PubMed  Google Scholar 

  14. Bartoníček J, Rammelt S, Kostlivý K, Vaněček V, Klika D, Trešl I (2015) Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg 135(4):505–516. doi:10.1007/s00402-015-2171-4

    Article  PubMed  Google Scholar 

  15. Meijer DT, de Muinck Keizer R-JO, Doornberg JN, Sierevelt IN, Stufkens SA, Kerkhoffs GM, van Dijk CN (2015) Diagnostic accuracy of 2-dimensional computed tomography for articular involvement and fracture pattern of posterior malleolar fractures. Foot Ankle Int 37(1):75–82

  16. Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S (2016) Management of posterior malleolar fractures: a systematic review. J Foot Ankle Surg 55(1):140–145

    Article  PubMed  Google Scholar 

  17. Mangnus L, Meijer DT, Stufkens SA, Mellema JJ, Steller EP, Kerkhoffs GM, Doornberg JN (2015) Posterior malleolar fracture patterns. J Orthop Trauma 29(9):428–435

    Article  PubMed  Google Scholar 

  18. De Vries J, Wijgman A, Sierevelt I, Schaap G (2005) Long-term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg 44(3):211–217

    Article  PubMed  Google Scholar 

  19. Mingo-Robinet J, López-Durán L, Galeote JE, Martinez-Cervell C (2011) Ankle fractures with posterior malleolar fragment: management and results. J Foot Ankle Surg 50(2):141–145

    Article  PubMed  Google Scholar 

  20. Simanski CJ, Maegele MG, Lefering R, Lehnen DM, Kawel N, Riess P, Yücel N, Tiling T, Bouillon B (2006) Functional treatment and early weightbearing after an ankle fracture: a prospective study. J Orthop Trauma 20(2):108–114

    Article  PubMed  Google Scholar 

  21. Gul A, Batra S, Mehmood S, Gillham N (2007) Immediate unprotected weight-bearing of operatively treated ankle fractures. Acta Orthop Belg 73(3):360

    PubMed  Google Scholar 

  22. Dehghan N, McKee MD, Jenkinson RJ, Schemitsch EH, Stas V, Nauth A, Hall JA, Stephen DJ, Kreder HJ (2016) Early weightbearing and range of motion versus non-weightbearing and immobilization after open reduction and internal fixation of unstable ankle fractures: a randomized controlled trial. J Orthop Trauma 30(7):345–352

    Article  PubMed  Google Scholar 

  23. Piątkowski K, Piekarczyk P, Kwiatkowski K, Przybycień M, Chwedczuk B (2015) Comparison of different locking plate fixation methods in distal tibia fractures. Int Orthop 39(11):2245–51. doi:10.1007/s00264-015-2906-4

    Article  PubMed  Google Scholar 

  24. Zhou Y, Wang Y, Liu L, Zhou Z, Cao X (2015) Locking compression plate as an external fixator in the treatment of closed distal tibial fractures. Int Orthop 39(11):2227–37. doi:10.1007/s00264-015-2903-7

    Article  PubMed  Google Scholar 

  25. Palmanovich E, Brin YS, Laver L, Kish B, Nyska M, Hetsroni I (2014) The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures. Int Orthop 38(5):1051–6. doi:10.1007/s00264-013-2224-7

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

JLG searched the literature and wrote the manuscript. YZZ designed the study. LL collected the data. ZYY analyzed the data. ZYH and WC interpreted the data. This study has not been presented in any meeting.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People’s Republic of China

    Jialiang Guo, Lei Liu, Zongyou Yang, Zhiyong Hou, Wei Chen & Yingze Zhang

  2. Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, People’s Republic of China

    Jialiang Guo, Lei Liu, Zongyou Yang, Wei Chen & Yingze Zhang

Authors
  1. Jialiang Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zongyou Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhiyong Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yingze Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yingze Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

This article is a retrospective study containing human participants performed by the authors. Ethical approval is uploaded separately.

Informed consent

Informed and verbal consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guo, J., Liu, L., Yang, Z. et al. The treatment options for posterior malleolar fractures in tibial spiral fractures. International Orthopaedics (SICOT) 41, 1935–1943 (2017). https://doi.org/10.1007/s00264-016-3388-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-016-3388-8

Keywords

Search

Navigation