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Two-staged management of ankle fracture-dislocations with a posterior fragment: computer-tomography-based classification, treatment and its outcome

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value. Current computed-tomography (CT)-based fracture classifications led to an increase in fixation of the posterior malleolus. The aim of this study was to describe the functional outcome after a two-stage stabilisation with direct fixation of the posterior fragment in trimalleolar dislocation fractures.

Materials and methods

In a retrospective study, all patients presenting with a trimalleolar dislocation fracture, an available CT scan, and a two-stage operative stabilisation including the posterior malleolus by a posterior approach were included. All fractures were treated with initial external fixator and delayed definitive stabilisation including fixation of the posterior malleolus. Next to clinical and radiological follow-up, outcome measures (Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS), Activity of Daily Living (ADL), Hulsmans implant removal score) and complications were analysed.

Results

Between 2008 and 2019, of 320 trimalleolar dislocation fractures, 39 patients were included. Mean follow-up was 49 months (standard deviation (SD) 29.7, range 16–148). Mean age was 60 years (SD 15.3, 17–84) with 69% female patients. The mean FAOS was 93/100 (SD 9.7, 57–100), NRS 2 (interquartile range (IQR) 0–3) and ADL 2 (IQR 1–2). Four patients showed a postoperative infection, three re-operations had to be performed and implants were removed in 24 individuals.

Conclusion

A two-stage procedure of trimalleolar dislocation fractures with in-direct reduction and fixation of the posterior tibial fragment through a posterior approach leads to good functional outcome scores with a low rate of complications.

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Funding

No funding was received. Each author certifies that he has no commercial associations that might pose a conflict of interest in connection with the submitted article.

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Authors and Affiliations

  1. Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland

    Nina Kabelitz, Philipp Florian Stillhard, Christoph Sommer & Christian Michelitsch

  2. Clinic of Orthopedics, Hand and Trauma Surgery, City Hospital Zurich, Tièchestrasse 99, 8037, Zurich, Switzerland

    Method Kabelitz

  3. Department of Trauma Surgery, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, Netherlands

    Herman Frima

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  1. Method Kabelitz
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  2. Nina Kabelitz
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by NK, MK, CM, HF, PFS and CS. The first draft of the manuscript was written by NK, MK, HF and CM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Method Kabelitz.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclosure.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local ethics committee (Cantonal Ethics Committee Zurich, ref. 2020-01854).

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Prior to patient enrolment a signed informed consent was obtained from each patient.

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Kabelitz, M., Kabelitz, N., Frima, H. et al. Two-staged management of ankle fracture-dislocations with a posterior fragment: computer-tomography-based classification, treatment and its outcome. Arch Orthop Trauma Surg 143, 6193–6200 (2023). https://doi.org/10.1007/s00402-023-04949-0

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