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High Association of Posterior Malleolus Fractures with Spiral Distal Tibial Fractures

  • Original Article
  • Fractures
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Associations between fracture patterns are important and can ensure proper diagnosis and guide treatment. Occult posterior malleolus fractures associated with distal spiral tibia fractures often are underrecognized and the morbidity of a missed posterior malleolus injury can be substantial. We determined the association between the two injuries and evaluated the ability of a new protocol to improve management of these associated fractures. Of 62 consecutive patients with fractures of the distal third of the tibia, we retrospectively evaluated the first 39 patients and prospectively used a diagnostic protocol including computed tomography of the ankle in the subsequent 23 patients. The minimum followup was 3 months (mean, 25 months; range, 3–68 months). Twenty-four patients (39%) had fractures of the posterior malleolus. Before initiation of the protocol, intraarticular fractures were recognized in 33% (with one delayed diagnosis and one missed diagnosis), and after institution of the protocol, the detection rate was 48% with no known missed injuries and complete followup; however, with the limited power the detection rates were similar without and with the protocol. A spiral distal tibial shaft fracture with a proximal fibula fracture should alert the surgeon to investigate an occult ankle injury, particularly of the posterior malleolus. A protocol including computed tomography of the ankle may detect more injuries in a larger study.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Sreevathsa Boraiah MD, David L. Helfet MD & Dean G. Lorich MD

  2. Department of Orthopaedic Surgery, New York Presbyterian Hospital, 520 East 70th Street, New York, NY, 10021, USA

    Sreevathsa Boraiah MD

  3. Harborview Medical Center, Seattle, WA, USA

    Michael J. Gardner MD

Authors
  1. Sreevathsa Boraiah MD
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  2. Michael J. Gardner MD
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  3. David L. Helfet MD
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  4. Dean G. Lorich MD
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Correspondence to Sreevathsa Boraiah MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has waived or does not require informed consent from the patients given the retrospective nature of this study.

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Boraiah, S., Gardner, M.J., Helfet, D.L. et al. High Association of Posterior Malleolus Fractures with Spiral Distal Tibial Fractures. Clin Orthop Relat Res 466, 1692–1698 (2008). https://doi.org/10.1007/s11999-008-0224-5

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  • DOI: https://doi.org/10.1007/s11999-008-0224-5

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