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

Affiliations
  • 1Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea. sjs0506@ilsanpaik.ac.kr

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).


Cited by  3 articles

The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique
Jae-Sung Lee, Han-Jun Lee, Jae-Hyun Yoo, Hee-Chun Kim
J Korean Fract Soc. 2009;22(1):19-23.    doi: 10.12671/jkfs.2009.22.1.19.

Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle
Jae Sung Lee, Soo Yong Kang, Han Jun Lee, Young Bong Ko
J Korean Fract Soc. 2009;22(2):98-103.    doi: 10.12671/jkfs.2009.22.2.98.

Treatment of the Posterior Malleolar Fracture Using Posterior Approach
Hyun Wook Chung, Dong Hwan Kim, Si Hoon Yoo, Jin Soo Suh
J Korean Fract Soc. 2010;23(1):50-56.    doi: 10.12671/jkfs.2010.23.1.50.


Reference

1. Bauer M, Bergstrom B, Hemborg A, Sandegard J. Malleolar fractures: nonoperative versus operative treatment. A controlled study. Clin Orthop Relat Res. 1985. 199:17–27.
2. Chung MY, Rhi WS, Song WC, Lee SM, Seo SD. Surgical treatment of fractures of the ankle. J Korean Orthop Assoc. 1997. 32:741–748.
Article
3. Day GA, Swanson CE, Hulcombe BG. Operative treatment of ankle fractures: a minimum ten-year follow-up. Foot Ankle Int. 2001. 22:102–106.
Article
4. Egol KA, Tejwani NC, Walsh MG, Capla EL, Koval KJ. Predictors of short-term functional outcome following ankle fracture surgery. J Bone Joint Surg Am. 2006. 88:974–979.
Article
5. Harper MC, Hardin G. Posterior malleolar fractures of the ankle associated with external rotation-abduction injuries. Results with and without internal fixation. J Bone Joint Surg Am. 1988. 70:1348–1356.
Article
6. Hedstrom M, Ahl T, Dalen N. Early postoperative ankle exercise. A study of postoperative lateral malleolar fractures. Clin Orthop Relat Res. 1994. 300:193–196.
7. Jarde O, Vives P, Havet E, Gouron R, Meunier W. Malleolar fractures. Predictive factors for secondary osteoarthritis. Retrospective study of 32 cases. Acta Orthop Belg. 2000. 66:382–388.
8. Katioz H, Bombaci H, Gorgec M. Treatment of trimalleolar fractures. Is osteosynthesis needed in posterior malleolar fractures measuring less than 25% of the joint surface? Acta Orthop Traumatol Turc. 2003. 37:299–303.
9. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957. 16:494–502.
Article
10. Langenhuijsen JF, Heetveld MJ, Ultee JM, Steller EP, Butzelaar RM. Results of ankle fractures with involvement of the posterior tibial margin. J Trauma. 2002. 53:55–60.
Article
11. Mandracchia DM, Mandracchia VJ, Buddecke DE Jr. Malleolar fractures of the ankle. A comprehensive review. Clin Podiatr Med Surg. 1999. 16:679–723.
12. McDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle. An end result study. Clin Orthop Relat Res. 1977. 122:37–45.
13. McLaughlin HS. McLaughlin HL, editor. Injuries of the ankle. Trauma. 1959. Philadelphia: WB Saunder;357–390.
14. Michelson JD. Fractures about the ankle. J Bone Joint Surg Am. 1995. 77:142–152.
Article
15. Scheidt KB, Stiehl JB, Skrade DA, Barnhardt T. Posterior malleolar ankle fractures: an in vitro biomechanical analysis of stability in the loaded and unloaded states. J Orthop Trauma. 1992. 6:96–101.
16. Talbot M, Steenblock TR, Cole PA. Posterolateral approach for open reduction and internal fixation of trimalleolar ankle fractures. Can J Surg. 2005. 48:487–490.
17. Tornetta P, Ostrum RF, Trafton PG. Trimalleolar ankle fracture. J Orthop Trauma. 2001. 15:588–590.
Article
18. Weber M. Trimalleolar fractures with impaction of the posteromedial tibial plafond: implications for talar stability. Foot Ankle Int. 2004. 25:716–727.
Article
19. Wei SY, Okereke E, Winiarsky R, Lotke PA. Nonoperatively treated displaced bimalleolar and trimalleolar fractures: a 20-year follow-up. Foot Ankle Int. 1999. 20:404–407.
Article
20. Wilson FC. Fractures of the ankle: pathogenesis and treatment. J South Orthop Assoc. 2000. 9:105–115.
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