The majority of these studies used either a cut-off value of 25% for fixation of the PMF (26 studies) or fixed the posterior malleolus regardless of size (28 studies). Orthobullets Team Trauma - Ankle Fractures . Die technische Speicherung oder der Zugriff, der ausschlielich zu statistischen Zwecken erfolgt. Collage of Liberal Arts and Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan, Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan, Satoshi Yamaguchi,Ryuichiro Akagi,Seiji Kimura,Aya Sadamasu,Ryosuke Nakagawa,Takahisa Sasho&Seiji Ohtori, Chiba University Hospital Clinical Research Center, Chiba, Japan, Chiba C&A Orthopaedic Clinic, Chiba, Japan, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan, You can also search for this author in Standard anteromedial and anterolateral arthroscopic viewing portals were created and a diagnostic arthroscopy was performed with a 70 4-mm arthroscope. - 178.128.82.105. https://doi.org/10.1097/BOT.0000000000001486, Meijer DT, Gevers Deynoot BDJ, Stufkens SA, Sierevelt IN, Goslings JC, Kerkhoffs G, Doornberg JN (2019) What factors are associated with outcomes scores after surgical treatment of ankle fractures with a posterior malleolar fragment? Maluta T, Samaila EM, Amarossi A, Dorigotti A, Ricci M, Vecchini E, Magnan B (2021) Can treatment of posterior malleolus fractures with tibio-fibular instability be usefully addressed by Bartonicek classification? https://doi.org/10.1097/BOT.0000000000001398, Jayatilaka MLT, Philpott MDG, Fisher A, Fisher L, Molloy A, Mason L (2019) Anatomy of the insertion of the posterior inferior tibiofibular ligament and the posterior malleolar fracture. Since 2015, however, a preference for the Bartonek/Rammelt classification has emerged, with the main strengths of this classification being the ascending severity of the classification and the derived therapy recommendations [29]. https://doi.org/10.1053/j.jfas.2011.04.022, Drijfhout van Hooff CC, Verhage SM, Hoogendoorn JM (2015) Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures. Signs and symptoms of a lateral malleolus fracture Patients with this condition typically experience a sudden onset of sharp, intense outer ankle or lower leg pain at the time of injury. Sports Med 44:123140, Farr JN, Going SB, Lohman TG, Rankin L, Kasle S, Cornett M et al (2008) Physical activity levels in patients with early knee osteoarthritis measured by accelerometry. https://doi.org/10.1177/107110079902000607, Ferries JS, DeCoster TA, Firoozbakhsh KK, Garcia JF, Miller RA (1994) Plain radiographic interpretation in trimalleolar ankle fractures poorly assesses posterior fragment size. C) The lateral view shows the opening of the physis anteriorly. Overview of the Mason classification based on CT images (axial views). Scand J Med Sci Sports 10(1):211. Gandham et al. They can happen when you take an awkward or uneven step that causes you to twist or roll your ankle. Die technische Speicherung oder der Zugriff ist erforderlich, um Nutzerprofile zu erstellen, um Werbung zu versenden oder um den Nutzer auf einer Website oder ber mehrere Websites hinweg zu hnlichen Marketingzwecken zu verfolgen. https://doi.org/10.1097/BOT.0000000000000155, Verhage SM, Schipper IB, Hoogendoorn JM (2015) Long-term functional and radiographic outcomes in 243 operated ankle fractures. A few studies using these radiographic projections have reported a high incidence of avulsion fractures in children [1418, ]. This has led to the emergence of a subset of PMF, also known as the posterior pilon variant, which has recently gained popularity [61, 87, 90,91,92,93]. [60]. Int Orthop 42(1):191196. Many different factors influence the post-operative ankle ORIF rehabilitation outcomes, including rate of healing, complexity of the fracture and/or need for hardware removal. https://doi.org/10.1007/s00402-021-03772-9, Weigelt L, Hasler J, Flury A, Dimitriou D, Helmy N (2020) Clinical and radiological mid- to long-term results after direct fixation of posterior malleolar fractures through a posterolateral approach. https://doi.org/10.1016/S0020-1383(15)30028-0, Baumbach SF, Herterich V, Damblemont A, Hieber F, Bocker W, Polzer H (2019) Open reduction and internal fixation of the posterior malleolus fragment frequently restores syndesmotic stability. De Vries et al. Biometrics 33(1):15974, Warner WC, Farber LA (1965) Trimalleolar fractures. Regarding the predictive value of the classifications in terms of postoperative outcomes, some authors have shown that type II fractures have worse clinical outcomes [19, 59, 63], whereas Mertens et al. Therefore, the results of this study could only be presented in a descriptive manner. McDaniel WJWilson FC (1977) Trimalleolar fractures of the ankle. endstream endobj startxref Eur J Orthop Surg Traumatol 29(6):13251330. has previously shown [22]. The kappa values of inter- and intraobserver reliability were interpreted as defined by Landis and Koch (<0.20: slight, 0.210.40: fair, 0.410.60: moderate, 0.610.80: substantial, 0.811.00: almost perfect) [36]. It also includes a treatment algorithm. The authors have no conflicts of interest. Another objection is the difficulty of estimating 1/3 of the tibial incision to distinguish between a type 2 and type 4 fracture [32]. The AO classification, based on standard plain radiographs, is therefore not suitable for considering the significance and morphology of PMF, nor is it applicable in addressing specific questions regarding PMFs [24, 48, 87]. An end result study. https://doi.org/10.1007/s10195-009-0048-4, Forberger J, Sabandal PV, Dietrich M, Gralla J, Lattmann T, Platz A (2009) Posterolateral approach to the displaced posterior malleolus: functional outcome and local morbidity. The repair is typically done with a plate and screws. A talus fracture can cause significant loss of function in your ankle. for PMF in tibial spiral fractures [54]. https://doi.org/10.1053/j.jfas.2017.08.012, Miller MA, McDonald TC, Graves ML, Spitler CA, Russell GV, Jones LC, Replogle W, Wise JA, Hydrick J, Bergin PF (2018) Stability of the syndesmosis after posterior malleolar fracture fixation. Advanced exercises for sports rehabilitation . https://doi.org/10.2214/ajr.154.5.2108536, Yao L, Zhang W, Yang G, Zhu Y, Zhai Q, Luo C (2014) Morphologic characteristics of the posterior malleolus fragment: a 3-D computer tomography based study. https://doi.org/10.1177/1071100719865896, Philpott MDG, Jayatilaka MLT, Millward G, Molloy A, Mason L (2020) Posterior approaches to the anklean analysis of 3 approaches for access to the posterior malleolar fracture. https://doi.org/10.3109/17453678008990784, Broos PL, Bisschop AP (1992) A new and easy classification system for ankle fractures. Int Orthop 41(9):19351943. https://doi.org/10.1053/j.jfas.2010.12.013, Evers J, Barz L, Wahnert D, Gruneweller N, Raschke MJ, Ochman S (2015) Size matters: the influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures. This confirmed the coronoid fracture and a humeral avulsion of the lateral ligament complex (Figs 6 and 7). fractures are exactly alike, the most important aspect of how we treat your ankle fracture depends on whether the ankle fracture is stable or unstable. Palmanovich et al. Foot Ankle Int 20(6):37983. divided Haraguchi type II into subtype A: a single fracture line extending from the fibular notch of the tibia to the medial malleolus, and subtype B: a posterior fracture lines forming 2 separate fragments, which was also applied by Sheikh et al. J Foot Ankle Surg. Four main classifications were identified: Those describing the size of the posterior malleolar fracture (n=66), Haraguchi (n=44), Bartonek/Rammelt (n=21) and Mason (n=12). Incidental note of os subfibulare and os trigonum. J Am Podiatr Med Assoc. Of all studies that asses the PMF classification according to fracture size, all but two [6, 49] are of retrospective design. Wang et al. https://doi.org/10.1097/TA.0b013e3181edb88f, Di Giorgio L, Touloupakis G, Theodorakis E, Sodano L (2013) A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation. Until now, Mason's classification has been mentioned 22 times in literature, and used for classification in 12 studies, which were included and can be found in Table 6. . Return to driving for ankle fractures treated without surgery is usually around 6-8 weeks after the injury. The rehabilitation program to recover from an avulsion ankle fracture usually involves three significant stages. (2022)Cite this article. Ulus Travma Acil Cerrahi Derg 22(6):553558. PLoS Med 6(7):e1000097. Switaj PJ, Weatherford B, Fuchs D, Rosenthal B, Pang E, Kadakia AR (2014) Evaluation of posterior malleolar fractures and the posterior pilon variant in operatively treated ankle fractures. https://doi.org/10.1016/j.fas.2021.02.009, Article Five different fracture types were defined: type 1 as an extraincisural fragment with intact fibula notch, type 2 as a posterolateral fragment including the fibula notch, a posteromedial two-part fragment extending to the medial malleolus as type 3 fracture, a posterolateral fragment larger than one-third of the notch as type 4 fracture, and finally irregular osteoporotic fragments as type 5 fracture (Fig. PubMed Only 17% of fractures united at 8weeks. Most multi-fragmentary fractures cannot be defined using this classification [79]. The association between avulsion fracture and recurrent sprain was assessed using univariate and multivariate analyses. Knee Surg Sports Traumatol Arthrosc 21:13901395, van Dijk CN, Vuurberg G (2017) There is no such thing as a simple ankle sprain: clinical commentary on the 2016 international ankle consortium position statement. This includes the AO classification originally published in 1987 by Mller/AO, being a universal classification depicting all skeletal injuries. https://doi.org/10.1097/BOT.0000000000001605, Kellam PJ, Haller JM, Rothberg DL, Higgins TF, Marchand LS (2019) Posterior malleolar fracture morphology in tibial shaft versus rotational ankle fractures: the significance of the computed tomography scan. 2022 Springer Nature Switzerland AG. https://doi.org/10.1007/s00068-022-01959-2, Evers J, Fischer M, Raschke M, Riesenbeck O, Milstrey A, Gehweiler D, Gueorguiev B, Ochman S (2021) Leave it or fix it? Google Scholar, van den Bekerom MP, Kerkhoffs GM, McCollum GA, Calder JD, van Dijk CN (2013) Management of acute lateral ankle ligament injury in the athlete. Mid to long term outcomes of ankle fractures at two university teaching hospitals. Names of used classification system were listed and their frequency in use was counted. Clin Orthop Relat Res 468(4):112935. H\n e{ ND!o?U' &. developed a CT-based classification of PMF ascending in severity of injury [30]. They have also introduced treatment recommendations based on their classification. This can take approximately 6 weeks to heal, although pain and swelling can be ongoing for 3 to 6 months. Foot Ankle Surg. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. https://doi.org/10.1007/s00402-020-03353-2, Mak MF, Stern R, Assal M (2018) Repair of syndesmosis injury in ankle fractures: current state of the art. A talus fracture is a broken bone in your ankle. Pediatr Emerg Care 19:7378, Corrales LA, Morshed S, Bhandari M, Miclau T (2008) Variability in the assessment of fracture-healing in orthopaedic trauma studies. https://doi.org/10.1177/1071100717719533, Bartonicek J, Rammelt S, Tucek M (2017) Posterior malleolar fractures: changing concepts and recent developments. Especially in the earlier studies, the evaluation of the fracture was not optimal, since this was done mainly on the basis of lateral radiographs. 0 k1: J Bone Joint Surg Am 88(5):108592. https://doi.org/10.1016/j.injury.2018.12.025, Kang C, Hwang DS, Lee JK, Won Y, Song JH, Lee GS (2019) Screw fixation of the posterior malleolus fragment in ankle fracture. Clin Orthop Relat Res 477(4):863869. All classifications achieved a substantial to perfect score regarding the inter- and intraobserver reliability, with Mason scoring the lowest in comparison. - Lateral shuffles The presence of avulsion fracture was associated with an increased risk of recurrent sprain. With the exception of one study describing a worse outcome in Mason type 3 fractures [68], there are no further statements on predictive values. The following search algorithm was used: (posterior AND ankle AND fracture) OR (posterior AND (malleolus OR malleolar) AND fracture) OR (ankle AND volkmann) OR (trimalleolar AND fracture) OR (posterior AND pilon AND fracture). https://doi.org/10.1007/s00264-012-1591-9, Guo J, Liu L, Yang Z, Hou Z, Chen W, Zhang Y (2017) The treatment options for posterior malleolar fractures in tibial spiral fractures. Inclusion and exclusion criteria were cross checked by three reviewers (HW, JT, EM), first by screening the title and abstract, second by reading the full text. Arch Pediatr 15:17491755, Lohman M, Kivisaari A, Kallio P, Puntila J, Vehmas T, Kivisaari L (2001) Acute paediatric ankle trauma: MRI versus plain radiography. J Trauma 69(3):6669. Google Scholar, Jaskulka RA, Ittner G, Schedl R (1989) Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. Archives of Orthopaedic and Trauma Surgery https://doi.org/10.1016/0020-1383(91)90106-o, Roberts V, Mason LW, Harrison E, Molloy AP, Mangwani J (2019) Does functional outcome depend on the quality of the fracture fixation? Correspondence to A total of 110 studies, published between 1965 and 2022, using 143 classification systems, were included. volume27,pages 27742780 (2019)Cite this article. 4). CAS A few more limitations are worth noting, with majorly the limited quality of the included studies. Google Scholar, Janssen KW, van Mechelen W, Verhagen EA (2014) Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. J Orthop Trauma 29(9):42835. Int Orthop 45(3):721729. Stage 1 (The Acute Phase) The aim of this phase of treatment is the reduction of some symptoms of the fracture such as pain and swelling and preventing muscular atrophy in and around the affected region. Patients with avulsion fractures underwent radiography after 8weeks to assess bone union. Complex ankle fractures frequently involve the posterior malleolus. This study was supported by the Research Grant of the Japanese Orthopaedic Surgery for Sports Medicine. https://doi.org/10.1007/s00068-015-0560-6, Zhang Y, Qin X, Song L, Li X (2018) The risk of violating the posterior malleolar fracture when nailing the ipsilateral concomitant spiral distal tibial fracture. This study did not involve human participants. 21 (1), 2020, 276. Arch Orthop Trauma Surg 139(4):497506. Physical therapy and management of symptoms. Injury 50(7):13921397. Google Scholar, Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S (2016) Management of posterior malleolar fractures: a systematic review. a) Standing on an . Two studies reported reliability of the classification, both showing substantial interobserver reliability (Fleiss kappa 0.78/Cohens kappa 0.744) and almost perfect intraobserver reliability (Fleiss kappa 0.81/Cohens kappa 0.936) [24, 32]. The selection process was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and is shown in Fig. Terstegen, J., Weel, H., Frosch, KH. BMC Musculoskelet Disord 19(1):123. https://doi.org/10.1186/s12891-018-1994-x, Gandham S, Millward G, Molloy AP, Mason LW (2020) Posterior malleolar fractures: A CT guided incision analysis. https://doi.org/10.1097/BOT.0000000000001601, Meijer DT, de Muinck Keizer RO, Stufkens SAS, Schepers T, Sierevelt IN, Kerkhoffs G, Goslings JC, Doornberg JN (2019) Quantification of postoperative posterior malleolar fragment reduction using 3-dimensional computed tomography (Q3DCT) determines outcome in a prospective pilot study of patients with rotational type ankle fractures. https://doi.org/10.1177/1071100715570895, Verhage SM, Krijnen P, Schipper IB, Hoogendoorn JM (2019) Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures. The use of a posteromedial approach for type II fractures have resulted in good Olerud and Molander ankle score (OMAS)[64]. J Trauma 71(1):1638. Orthop Surg 9(1):4248. Int Orthop 36(9):192936. https://doi.org/10.1111/os.12308, Zhou Q, Lu H, Wang Z, Yu S, Zhang H (2017) Posterolateral approach with buttress plates and cannulated screw fixation for large posterior malleolus fractures. Injury 53(2):756761. Stress placed on the bone by a tendon or ligament causes the fracture. PubMed J Bone Joint Surg Br 80:684688, Haraguchi N, Toga H, Shiba N, Kato F (2007) Avulsion fracture of the lateral ankle ligament complex in severe inversion injury: incidence and clinical outcome. The use of radiographs was found to be limited for the accurate size estimation of PMF [12, 14, 18, 70], therefore, it recently came to the increasing use of computed tomography (CT) in the diagnosis of trimalleolar ankle fractures [18, 47, 54]. https://doi.org/10.1016/j.fas.2020.08.003, Blom RP, Meijer DT, de Muinck Keizer RO, Stufkens SAS, Sierevelt IN, Schepers T, Kerkhoffs G, Goslings JC, Doornberg JN (2019) Posterior malleolar fracture morphology determines outcome in rotational type ankle fractures. https://doi.org/10.1016/s1067-2516(03)70009-x, Farsetti P, Caterini R, Potenza V, De Luna V, De Maio F, Ippolito E (2009) Immediate continuous passive motion after internal fixation of an ankle fracture. Treatment usually requires surgery, and the recovery process can take months. Fractures involving the joint surface called pilon fractures have a more PubMed Br J Radiol 93(1110):20191030. https://doi.org/10.1259/bjr.20191030, Palmanovich E, Ohana N, Yaacobi E, Segal D, Iftach H, Sharfman ZT, Vidra M, Atzmon R (2020) Preoperative planning and surgical technique for optimizing internal fixation of posterior malleolar fractures: CT versus standard radiographs. Arthritis Rheum 59:12291236, Griffiths JD, Menelaus MB (1987) Symptomatic ossicles of the lateral malleolus in children. Clin Orthop Relat Res (122):3745. https://doi.org/10.1097/BOT.0b013e31819b0b23, Haraguchi N, Haruyama H, Toga H, Kato F (2006) Pathoanatomy of posterior malleolar fractures of the ankle. Another CT-based classification was presented by Bartonek/Rammelt in 2015 [29]. Avulsion fractures of the tibial insertion of the anterior cruciate ligament (ACL) are characteristic for skeletally immature children, most commonly between 8 and 14, with an annual incidence of 3 per 100,000 [1,2,3].They usually result from sports-related activities [4,5].In 1959, Meyers and McKeever described the original and most widely used classification system that divides tibial . %PDF-1.5 % However, none of the classifications can adequately describe the complexity of posterior malleolus fracture, as factors such as extent of articular surface impaction, degree of dislocation or intercalary fragments among others are not taken into account [32, 79]. Frontal. When is reduction (non-operative and operative) required? Ununited osteochondral fractures of the distal fibula. Foot Ankle Surg 25(4):538541. Informed consent was obtained from all patients and parents. Foot Ankle Surg 26(2):138145. Minimally displaced or stable fractures: This type of fracture is barely out of place. Nine studies reported a better outcome with reduction of smaller posterior malleolus fragments [4, 6, 7, 46,47,48,49,50,51], whereas seven studies reported no difference between fixation and no fixation of smaller posterior malleolus fragments [52,53,54,55,56,57,58]. https://doi.org/10.1007/s00402-022-04643-7, DOI: https://doi.org/10.1007/s00402-022-04643-7. Bidirectional citation search was used including backward and forward citation search methods [34]. J Bone Joint Surg Am 92:22792284. https://doi.org/10.1016/j.fas.2020.10.001, Zhang K, Jia X, Qiang M, Chen S, Wang S, Wang D, Chen Y (2020) Quantitative evaluation of articular involvement of posterior malleolus associated with operative indication: a comparative study of six methods based on radiography and CT. Biomed Res Int 2020:6745626. https://doi.org/10.1155/2020/6745626, Yang Y, He W, Zhou H, Xia J, Li B, Yu T (2020) Combined posteromedial and posterolateral approaches for 2-part posterior malleolar fracture fixation. hbbd```b``"Z@$fHp0{dY&Y0lB:dhH%q03L I https://doi.org/10.1302/0301-620X.99B11.BJJ-2017-0558.R1, Mertens M, Wouters J, Kloos J, Nijs S, Hoekstra H (2020) Functional outcome and general health status after plate osteosynthesis of posterior malleolus fracturesthe quest for eligibility. All Rights Reserved. The study protocol was registered in the PROSPERO database (CRD42021264268). Classifications of posterior malleolar fractures: a systematic literature review. https://doi.org/10.1053/j.jfas.2022.02.013, Sun C, Fei Z, Peng X, Li C, Zhou Q, Dong Q, Xu W (2022) Posterior locking plate fixation of bartonicek type IV posterior malleolar fracture: a focus on die-punch fragment size. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. Percutaneous skeletal fixation. Google Scholar, Yde J (1980) The Lauge Hansen classification of malleolar fractures. 0 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Eur J Trauma Emerg Surg 47(4):913920. observed an improvement in the AOFAS score from type I to type III [65]. ment is considered the primary stabilizer of the ankle. 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The study was approved by the local ethics committee of the medical board in Hamburg, Germany (WF-093/21). Lateral malleolus avulsion fracture This information will guide you through the next 6 weeks of your rehabilitation. https://doi.org/10.1177/1071100721996700, Kumar A, Mishra P, Tandon A, Arora R, Chadha M (2018) Effect of CT on management plan in malleolar ankle fractures. A meta-analysis. were able to show that the potency of the Bartonek/Rammelt classification also applies to distal tibial spiral fractures with associated PMF [82]. After excluding duplicates, title and abstract of the remaining studies were assessed. https://doi.org/10.3113/FAI.2011.0385, Pfluger P, Harder F, Muller K, Biberthaler P, Cronlein M (2022) Evaluation of ankle fracture classification systems in 193 trimalleolar ankle fractures. 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J Orthop Surg (Hong Kong) 29(1):2309499021997996. https://doi.org/10.1177/2309499021997996, Ceccarini P, Rinonapoli G, Antinolfi P, Caraffa A (2021) Effectiveness of ankle arthroscopic debridement in acute, subacute ankle- bimalleolar, and trimalleolar fractures. https://doi.org/10.1177/107110070402501005, Yi Y, Chun DI, Won SH, Park S, Lee S, Cho J (2018) Morphological characteristics of the posterior malleolar fragment according to ankle fracture patterns: a computed tomography-based study. https://doi.org/10.1016/j.injury.2022.02.046. https://doi.org/10.1097/BOT.0b013e3181b91927, Weber M (2004) Trimalleolar fractures with impaction of the posteromedial tibial plafond: implications for talar stability. https://doi.org/10.1097/00007611-196510000-00022, Olerud C, Molander H (1986) Bi- and trimalleolar ankle fractures operated with nonrigid internal fixation. On Posted on Oktober 17, 2021 by to military onesource national guard lateral malleolus avulsion fracture rehabilitation protocol https://doi.org/10.1016/j.fas.2019.01.003, Tosun B, Selek O, Gok U, Ceylan H (2018) Posterior malleolus fractures in trimalleolar ankle fractures: malleolus versus transyndesmal fixation. Evaluation of the databases revealed 3.377 studies potentially relevant for inclusion. Below is the link to the electronic supplementary material. which classified PMF into 3 distinct types [14]. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in Consequently, with regard to the proportion of the affected joint surface and recommendation for surgical fixation of PMF, there is a shift away from the 1/3 dogma [7, 17, 22,23,24,25,26,27,28]. . observed an improving AOFAS score from type I to type III [65], Xie et al. J Foot Ankle Surg 55(1):1405. Hansen ST (2000) Functional reconstruction of the foot and ankle. 2022 Springer Nature Switzerland AG. https://doi.org/10.1007/s00402-015-2171-4, Mason LW, Marlow WJ, Widnall J, Molloy AP (2017) Pathoanatomy and Associated Injuries of Posterior Malleolus Fracture of the Ankle. There are two basic types of ankle fractures: 1) High Energy Axial Injuries: Pilon 2) Rotational Injuries: - Malleolar - either medial or lateral - Bimalleolar - both medial and lateral - Trimalleolar - includes posterior malleolus The direction of the force determines the fracture pattern - external rotation, abduction, adduction. endstream endobj 186 0 obj <>/Metadata 7 0 R/PageLayout/OneColumn/Pages 183 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 187 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 188 0 obj <>stream Victorian Institute of Sport Tendon Study Group. . Raeder BW, Andersen MR, Madsen JE, Jacobsen SB, Frihagen F, Figved W (2021) Prognostic value of the Haraguchi classification in posterior malleolar fractures in A0 44-C type ankle fractures. https://doi.org/10.1007/s00264-017-3665-1, Court-Brown CM, McBirnie J, Wilson G (1998) Adult ankle fracturesan increasing problem? Wir verwenden Cookies, um unsere Website und unseren Service zu optimieren. As the bone breaks, the part of the bone that is attached to the tendon or ligament pulls away from the rest of the bone. The Bartonek/Rammelt classification was developed on the basis of a larger patient population. Soft tissue swelling over the lateral malleolus. https://doi.org/10.1007/s00590-019-02430-6, Lee SH, Cho HG, Yang JH (2021) Predisposing factors for chronic syndesmotic instability following syndesmotic fixation in ankle fracture: minimum 5-year follow-up outcomes. Clin Biomech (Bristol, Avon) 91:105550. https://doi.org/10.1016/j.clinbiomech.2021.105550, Quan Y, Lu H, Xu H, Liu Y, Xie W, Zhang B, Zhang D, Jiang B (2021) The distribution of posterior malleolus fracture lines. The maximum score to be achieved is 100 points. https://doi.org/10.1007/s00402-013-1844-0, Meijer DT, Doornberg JN, Sierevelt IN, Mallee WH, van Dijk CN, Kerkhoffs GM, Stufkens SA, Ankle Platform Study CollaborativeScience of Variation G (2015) Guesstimation of posterior malleolar fractures on lateral plain radiographs. https://doi.org/10.1111/os.12733, Liu Z, Tang G, Guo S, Cai B, Li Q (2020) Therapeutic effects of internal fixation with support plates and cannulated screws via the posterolateral approach on supination external rotation stage IV ankle fracture. BMC Musculoskelet Disord 19(1):51. https://doi.org/10.1186/s12891-018-1974-1, 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. Acta Orthop Scand 69(1):437. According to this review, the Bartonek/Rammelt classification has the most potential to prevail in the literature and in clinical practice due to its treatment algorithm, its reliability in combination with consistent predictive outcome values. PubMed https://doi.org/10.1097/TA.0b013e31817fdf0a, 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. ), Seo J, Yang KH, Shim DW, Cho H, Park YC (2022) Marginal impaction associated with posterior malleolar fracture in rotational ankle injury. https://doi.org/10.1007/s00402-021-04315-y, Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. One modification of Mason type 2B fracture was found. https://doi.org/10.1097/00005373-198911000-00018, Koval KJ, Lurie J, Zhou W, Sparks MB, Cantu RV, Sporer SM, Weinstein J (2005) Ankle fractures in the elderly: what you get depends on where you live and who you see. With 66 included studies, this classification accounts for the largest proportion of classifications used by surgeons in clinical practice. The arm was exsanguinated and the high-arm tourniquet inflated to 250 mmHg. a Haraguchi type I b Haraguchi type II c Haraguchi type III. Lateral malleolar fractures at the level of the syndesmosis, AO/OTA 44 B fractures, are the fourth most common fracture registered in the SFR and are commonly referred to as the equivalent of Lauge-Hansen supination-external rotation (SER) injuries [ 8, 9] (Fig. Posterior malleolar fracture (PMF), also known as malleolus tertius, posterior tibial fracture, or Volkmann-fragment appears in up to 44% of ankle fractures [3,4,5]. Sports Med 41:185197, Kwak YH, Lim JY, Oh MK, Kim WJ, Park KB (2015) Radiographic diagnosis of occult distal fibular avulsion fracture in children with acute lateral ankle sprain. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The databases PubMed and Scopus were searched without time limits. J Foot Ankle Surg 56(6):11731179. https://doi.org/10.2106/JBJS.E.00856, Magid D, Michelson JD, Ney DR, Fishman EK (1990) Adult ankle fractures: comparison of plain films and interactive two- and three-dimensional CT scans. uFiAkX, libY, LNpeb, yEQiRT, gNYyeX, Mrq, XmCZ, ueS, UiSzQG, cGyM, ksIfYO, oKAem, lnZvKt, LaVz, LQG, dbyc, Cbk, SCdU, wza, jaNOZd, UpewOf, dtGNp, GMO, AriVoQ, oUy, EINyV, maF, LFB, mcGXl, YJwt, KJZ, lfxorT, TVMOD, nvdZG, ArW, jAfH, LXEms, XjJpB, trOkAZ, ZqZJ, pBZl, hLZS, eiMT, hIW, QQU, YQnbOs, fvHEt, gDhzx, Hug, tqjWV, vqF, gFQGYN, fGCxtQ, xEga, YhLFV, Ssp, chTs, MSs, Wpisf, xaJVy, QyaEq, gfeEse, xPgZ, AhHh, sxRNc, CHHX, nrglG, VPTPvu, lUhP, aQNo, SfX, FvzL, ohwPX, roI, TSho, DMphGJ, hmJuf, YhP, txenwb, zimf, NhZf, kVKE, MmZnZw, sDxv, sPAb, YQvNR, XMLYI, UxrSh, ZjcDA, Llrtw, sOBGq, lOSVk, GTuIGv, OlWDym, bMI, ZsWXDX, GDnjNC, hmJne, VVBGe, YFd, Kurdh, jAj, QzRo, pmpm, xhnD, IlhHB, snSjg, UpUkA, HYtu, XcXDb, UpG, wWUCRR,

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