J Korean Orthop Assoc.  2007 Aug;42(4):470-474. 10.4055/jkoa.2007.42.4.470.

Comparative Study for the Results of Ankle Fracture Depending onthe Extension of the Posterior Malleolus Fracture

• Lee CS
• Suh JS
• Yi JW

• KMID: 2186508
• DOI: http://doi.org/10.4055/jkoa.2007.42.4.470

Abstract

PURPOSE: Posterior malleolus fractures of the ankle involve the articular surface of the distal tibia, and are related to the axis of weight bearing, which often causes difficulty in reduction and fixation. It was assumed that patients with ankle fractures combined with posterior malleolus fractures would be more prone to arthritis than those without such fractures. The main aim of this article was to define the relationship between early arthritis and an ankle fracture with a concomitant trimalleolar fracture or bimalleolar fracture.
MATERIALS AND METHODS
Among the patients who had undergone an open reduction and internal fixation of the ankle joint between Nov. 2000 and Sep. 2005, 52 patients had a bimalleolar fracture or a trimalleolar fracture, and underwent metal removal. A retrospective clinical and radiological analysis was performed on the 52 patients. The mean follow up period was 25 months. Thirty-six patients had a bimalleolar fracture without a posterior malleolus fracture, and 16 patients had a trimalleolar fracture with internal fixation. The mean ages of the two groups were 36 and 43 years of age, and there were no significant differences in the gender distribution, route of trauma, and smoking between the two groups. The post operational rehabilitation treatment was applied equally to both groups.
RESULTS
The VAS score of thebimalleolar fracture and trimalleolar fracture was 8.8 and 8.6, respectively. The AOFAS score of the bimalleolar fracture and trimalleolar fracture was 84.0 and 83.5, respectively, showing no significant difference. Only the patients who underwent metal removal were included because of the radiological analysis. The Kellgren-Lawrence scale of the bimalleolar fracture and trimalleolar fracture was 1.00 and 1.31, respectively, showing no significant difference.
CONCLUSION
This study showed that patients with ankle fractures concomitant with posterior malleolus fractures had equally favorable outcomes to those patients with ankle fractures without a concomitant posterior malleolus fracture. Studies with more cases, a longer follow up, and prospective approaches will be needed to confirm these results.

Keyword

Ankle joint; Bimalleolar fracture; Trimalleolar fracture; Comparison of results

MeSH Terms

Ankle Fractures*
Ankle Joint
Ankle*
Arthritis
Axis, Cervical Vertebra
Follow-Up Studies
Humans
Rehabilitation
Retrospective Studies
Smoke
Smoking
Tibia
Weight-Bearing
Smoke

Figure

• 

  Fig. 1 A 32-year-old woman had a bimalleolar fracture of the ankle joint (A). The medial malleolus was fixed with a cannulated screw and K-wire, and the lateral malleolus was fixed with a plate and screws (B).

• 

  Fig. 2 A 49-year-old man had a trimalleolar fracture of the ankle joint (A). The posterior malleolar fragment was fixed with two cannulated screws (B). The plain radiograph after metal removal shows a well preserved articular surface and a remnant of the broken screw (C).

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