J Korean Orthop Assoc.  2023 Feb;58(1):45-53. 10.4055/jkoa.2023.58.1.45 .

Morphological Comparison of Posterior Malleolar Fractures in Tibial Spiral Fractures and Ankle Fractures

  • 1Department of Orthopedic Surgery, Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea


This study morphologically compared and analyzed various measurements from initial radiograph and computed tomography scans of posterior malleolar fractures (PMFs) in tibial spiral fractures and ankle fractures.
Materials and Methods
The measurements of PMFs in 31 TSFs and 53 AFs were analyzed. PMFs were classified using Bartoníček’s classification. The initial displacement (ID), cross angle (CA), fragment length ratio (FLR), fragment width ratio (FWR), fragment height ratio (FHR), fragment height (FH), sagittal angle (SA), articular step-off (AS), and inter-fragment distance (IFD) were measured. The presence of intercalary fragments and articular incongruity were identified.
Bartoníček types 2 and 3 in the AF group, type 3 in the supination-external rotation (SER) group, type 2 in the pronation-external rotation (PER) group, and type 4 in the TSF group accounted for the largest proportion. In the TSF group, the mean ID, FWR, SA, AS, and IFD were significantly smaller than in the AF group (p<0.001, p=0.003, p<0.001, p<0.001, and p<0.001, respectively). The CA, FLR, FH, and FHR were significantly larger than the AF group (p<0.001, p=0.019, p<0.001, and p<0.001, respectively).
In TSFs, posterior malleolar fragments tend to have longer anteroposterior lengths and heights, but shorter horizontal lengths than AFs. Most have minimal displacement, congruous joint, and no intercalary fragments. Understanding these morphological differences is necessary for the clinical approach to PMFs in TSFs and AFs.


tibia; distal spiral fracture; ankle fracture; posterior malleolar fracture; morphology
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