Weighted median scores were calculated for the modified Coleman score and for the age of the evaluated patient cohort. PubMedGoogle Scholar. Clinical examination findings are important but less reliable. Foot Ankle Int 39(1):99104. This included the following data: study design, sample size and source, fragment characteristics (e.g., classification, displacement, treatment), reliability- and validity scores and additional data the classification addressed, like treatment allocation and prognostic value of it, were collected. An end result study. https://doi.org/10.1016/j.injury.2015.07.019, Stringfellow TD, Walters ST, Nash W, Ahluwalia R, Posterior Malleolus Study G (2021) Management of posterior malleolus fractures: a multicentre cohort study in the United Kingdom. BMC Musculoskelet Disord 18(1):109. https://doi.org/10.1186/s12891-017-1475-7, Zhong S, Shen L, Zhao JG, Chen J, Xie JF, Shi Q, Wu YH, Zeng XT (2017) Comparison of posteromedial versus posterolateral approach for posterior malleolus fixation in trimalleolar ankle fractures. 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. Foot Ankle Int 39(1):5966. Correspondence to Acta Orthop Scand 69(1):437. https://doi.org/10.1097/MD.0000000000012079, Baek JH, Kim TY, Kwon YB, Jeong BO (2018) Radiographic change of the distal tibiofibular joint following removal of transfixing screw fixation. Foot Ankle Int 35(10):102230. Most multi-fragmentary fractures cannot be defined using this classification [79]. 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. 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. All Rights Reserved. This confirmed the coronoid fracture and a humeral avulsion of the lateral ligament complex (Figs 6 and 7). J Bone Joint Surg Am 88(5):108592. Skeletal Radiol 30:504511, Maeda M, Maeda N, Takaoka T, Tanaka Y (2017) Sonographic findings of chondral avulsion fractures of the lateral ankle ligaments in children. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Specific changes in the program will be made by the . 10) Takakura Y. et al. _(2PHEPc55b)Y3V,)>'R"Tf#[8g.sRB,*0P[J3n(0epE:Dt!N08JaP$s,CY&+wl r]Mv!k1>cr40l8b/g3&~7K&WltY*~?/GuYWMIMSjZf'igmu;['gi6t?qjs5QU-8Y+y^5>?_~],BkXnB/Z/vyW.6ey{ss*yt3j-5YIja]g7gyx6XaU\jv_/W~mZdK{x4.>,Idw`O{L}z_-$wc5O@ $pI36O[!&6k'ca&N3g(tA$Os3aA,4zl(XBt+LKuqqfN^EE`.fPj-V*RTD@,+[E4; -_Zm^ W=9_dvTH_Nu7tl|,W*_J_EHM+mZ\\\!q;%%d`@,aI.o~y}A:#((/4M5KE-xghZ!r!R Foot (Edinb) 45:101725. https://doi.org/10.1016/j.foot.2020.101725, Nelson M, Jensen N (1940) The treatment of trimalleolar fractures of the ankle. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. In 2017, Mason et al. 56MWy52>(9a5.U,`u*wC7By*RCfoiEGH{"+r7TYL'J'W|Y*,qL"|!^'3S NSy+e |`> +223 63 60 02 05. premier designs jewelry out of business. Names of used classification system were listed and their frequency in use was counted. Orthop Surg 9(1):4248. Google Scholar, Boutis K, Komar L, Jaramillo D, Babyn P, Alman B, Snyder B et al (2001) Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study. Orthop Surg 12(6):16441651. were the only ones to study this, providing good results with an inter- and intraobserver reliability of kappa of 0.64 and 0.63, respectively [13]. J Foot Ankle Surg 57(1):8690. Pharmacoeconomics 33(1):511. https://doi.org/10.1097/BOT.0000000000000676, Sobol GL, Shaath MK, Reilly MC, Adams MR, Sirkin MS (2018) The incidence of posterior malleolar involvement in distal spiral tibia fractures: is it higher than we think? Introduction:Traumatic rupture of posterior tibialis tendon in association with medial malleolus fracture is extremely rare.Case Presentation:We demonstrate our experience in the management of a co. The search was performed on the 20th of March 2021. (2022)Cite this article. Clin Orthop Relat Res 330:157165, Article They can happen when you take an awkward or uneven step that causes you to twist or roll your ankle. Acta Chir Orthop Traumatol Cech 88(3):204210 (Zalezi na metode fixace zadniho maleolarniho fragmentu u trimaleolarni zlomeniny? 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. This study was supported by the Research Grant of the Japanese Orthopaedic Surgery for Sports Medicine. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. With increasing understanding of fracture morphology and the routine use of computed tomography (CT), efforts have been made in recent years to establish new classification systems based on CT imaging [14, 29, 30]. https://doi.org/10.1016/S0020-1383(17)30743-X, Shi HF, Xiong J, Chen YX, Wang JF, Qiu XS, Huang J, Gui XY, Wen SY, Wang YH (2017) Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures. https://doi.org/10.1177/1071100720937637, Wang Z, Yuan C, Zhu G, Geng X, Zhang C, Huang J, Ma X, Wang X (2020) A retrospective study on the morphology of posterior malleolar fractures based on a CT scan: whether we ignore the importance of fracture height. Interobserver reliability ranged from substantial to almost perfect values (Cohens kappa 0.919/Fleiss kappa 0.61/Cohens kappa 0.717) as did intraobserver reliability (Fleiss kappa 0.65/Cohens kappa 0.957) [24, 30, 32]. - 51.68.174.10. The databases PubMed and Scopus were searched without time limits. The remaining studies used either 20% (4 studies), 30% (2 studies), or>1/3 of the joint area (5 studies) as the cut-off value, 1 study fixed the PMF in young patients or in the presence of subluxation from 10%, and 3 studies did not provide any information (Table 3). 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. An avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment. The purpose of this study was to clarify radiographic and clinical outcomes, as well as their association, of ankle sprain in children. Only 17% of fractures united at 8weeks. 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]. Ankle fractures present as one of the most common fractures with a prevalence of 4-9% [1, 2].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].If the posterior malleolus is affected, therapy results may be worse and its presence in ankle fractures is known to be of negative . 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. https://doi.org/10.3113/FAI.2009.0309, Hong-Chuan W, Shi-Lian K, Heng-Sheng S, Gui-Gen P, Ya-Fei Z (2010) Immediate internal fixation of open ankle fractures. Rotational forces applied to a loaded foot result in a type 2A fracture in form of a primary triangular posterolateral fragment. If the broken bone is stable and not dislocated, treatment may just. J Foot Ankle Surg 42(2):99104. Clinical examination findings are important but less reliable. It ascends in severity and contains a therapy recommendation [29, 81]. After noting that the Haraguchi classification did not map the mechanism of injury, Mason developed the most recent classification, also considering the injury mechanism [30]. https://doi.org/10.1016/j.fas.2018.04.008, Regier M, Petersen JP, Hamurcu A, Vettorazzi E, Behzadi C, Hoffmann M, Grossterlinden LG, Fensky F, Klatte TO, Weiser L, Rueger JM, Spiro AS (2016) High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases. How fixation of a small posterior malleolar fragment neutralizes rotational forces in trimalleolar fractures. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in 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. Injury 50(2):564570. Heim UF (1989) Trimalleolar fractures: late results after fixation of the posterior fragment. Evaluation of the databases revealed 3.377 studies potentially relevant for inclusion. Bone Joint J 102-B(9):12291241. range of motion (ROM), strength and muscle recruitment problems, some of which will benefit from physical therapy. J Orthop Traumatol 10(2):639. https://doi.org/10.1097/00005373-200207000-00012, Broos PL, Bisschop AP (1991) Operative treatment of ankle fractures in adults: correlation between types of fracture and final results. 21 (1), 2020, 276. hmo6 A total of 143 patients with a median age of 9 (range 612) years were analyzed. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). https://doi.org/10.4103/ortho.IJOrtho_308_16, De Vries JS, Wijgman AJ, Sierevelt IN, Schaap GR (2005) Long-term results of ankle fractures with a posterior malleolar fragment. https://doi.org/10.1016/j.fas.2019.03.011, Karaca S, Enercan M, Ozdemir G, Kahraman S, Cobanoglu M, Kucukkaya M (2016) Importance of fixation of posterior malleolus fracture in trimalleolar fractures: a retrospective study. Eur J Orthop Surg Traumatol 29(6):13251330. Ann Chir Gynaecol 72:7175, CAS However, they described the classification using schematic drawings and also do not define the tibial incisura [32]. The plaster was used for the first 2 weeks. https://doi.org/10.1177/1071100720969431, Yamamoto N, Iwamoto K, Tomita Y, Iwamoto Y, Kiyono M, Yoshimura M, Noda T, Kawasaki K, Ozaki T (2022) Pre-and postoperative factors associated with functional outcomes in patients with posterior malleolar fractures. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Another objection is the difficulty of estimating 1/3 of the tibial incision to distinguish between a type 2 and type 4 fracture [32]. Until now, Masons classification has not yet been able to establish itself in literature with only 12 included studies. Advanced imaging . 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? 20cm proximal to medial malleolus 29.5 29.5 - . J Orthop Trauma 33(4):185188. ivf stimulation protocols. SY, YS, MK, TS, and SO performed the analysis and interpretation of data. J Orthop Sci 15:524530, Pill SG, Hatch M, Linton JM, Davidson RS (2013) Chronic symptomatic os subfibulare in children. The repair is typically done with a plate and screws. None of the reviewed PMF classifications has been able to establish itself decisively in the literature. 4). The sensitivity of the ATFL view for the diagnosis of avulsion fractures was 0.94, whereas that for the anteroposterior and lateral views was significantly lower at 0.46 (P<0.001). Therefore, the results of this study could only be presented in a descriptive manner. Informed consent was obtained from all patients and parents. https://doi.org/10.1177/1071100714540893, Hong CC, Nashi N, Prosad Roy S, Tan KJ (2014) Impact of trimalleolar ankle fractures: how do patients fare post-operatively? https://doi.org/10.1016/j.arthro.2016.08.016, Naumann MG, Sigurdsen U, Utvag SE, Stavem K (2017) Associations of timing of surgery with postoperative length of stay, complications, and functional outcomes 36 years after operative fixation of closed ankle fractures. All displaced or angulated fractures should have a reduction. Arch Orthop Trauma Surg. Arch Orthop Trauma Surg 139(3):323329. 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. The selection process was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and is shown in Fig. With 66 included studies, this classification accounts for the largest proportion of classifications used by surgeons in clinical practice. De Vries et al. Anatomic reduction is preferred. https://doi.org/10.1111/os.12318, Xing W, Wang Y, Sun L, Wang L, Kong Z, Zhang C, Zhang Z (2018) Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. Ohne eine Vorladung, die freiwillige Zustimmung deines Internetdienstanbieters oder zustzliche Aufzeichnungen von Dritten knnen die zu diesem Zweck gespeicherten oder abgerufenen Informationen allein in der Regel nicht dazu verwendet werden, dich zu identifizieren. @$ ! PubMed 52, 20246, Hamburg, Germany, Julia Terstegen,Karl-Heinz Frosch,Tim Rolvien,Carsten Schlickewei&Elena Mueller, Department of Orthopedics, Bergman Clinics, Arnhem, The Netherlands, Department of Trauma Surgery, Orthopaedics, and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany, You can also search for this author in https://doi.org/10.1177/1071100719830999, Mason LW, Kaye A, Widnall J, Redfern J, Molloy A (2019) Posterior malleolar ankle fractures: an effort at improving outcomes. Google Scholar, Papachristou G, Efstathopoulos N, Levidiotis C, Chronopoulos E (2003) Early weight bearing after posterior malleolar fractures: an experimental and prospective clinical study. Foot Ankle Int 42(4):389399. volume27,pages 27742780 (2019)Cite this article. https://doi.org/10.1053/j.jfas.2021.03.002, Fidan F, Polat A, Cetin MU, Kazdal C, Yavuz U, Lapcin O, Ozkaya U (2021) Fixation of posterior malleolar fractures with posterior plating through a posterolateral approach. Foot Ankle Int 32(4):38593. https://doi.org/10.1007/s00264-016-3388-8, Saygl MS, zkul B, etinkaya E, Tekin AC, Bayhan AI, Kalkar I, Akbulut D, Demir B (2017) Operative versus non-operative treatment of posterior malleolus fragment in trimalleolar fracture: a retrospective cohort study. 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. Injury 48(7):16621669. 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/10.1053/j.jfas.2005.02.002, Xu HL, Li X, Zhang DY, Fu ZG, Wang TB, Zhang PX, Jiang BG, Shen HL, Wang G, Wang GL, Wu XB (2012) A retrospective study of posterior malleolus 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. Injury 50(12):23122317. et al. hb```)b eaXp09im4)NEPHv@9P]H@b(xGGTybM7Y```|-b4L Rehabilitation Program Physical Therapy As always, acute management of ankle fractures involves analgesics for pain, immobilization, and patient comfort. 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. Ankle Fracture Post-op Rehabilitation Protocol This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. J Am Podiatr Med Assoc. 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). Pak J Med Sci 36(3):438444. Google Scholar, Cukiernik VA, Lim R, Warren D, Seabrook JA, Matsui D, Rieder MJ (2007) Naproxen versus acetaminophen for therapy of soft tissue injuries to the ankle in children. Ann Pharmacother 41:13681374, Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C (2014) The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. J Foot Ankle Surg 50(5):60711. A clinical follow-up study of 90 children treated conservatively and by surgery. https://doi.org/10.1007/s00264-017-3665-1, Court-Brown CM, McBirnie J, Wilson G (1998) Adult ankle fracturesan increasing problem? The data were processed descriptively, therefore, no meta-analysis was performed. Overview of the Haraguchi classification based on CT images (axial views). wRguvk5^x|>3_iLVVVVK?1! 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. Minimally displaced or stable fractures: This type of fracture is barely out of place. In multivariate logistic regression analysis, avulsion fracture was independently associated with recurrent sprain (P=0.027). Foot Ankle Surg 25(4):538541. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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. This study was approved by the Institutional Review Board of our institute. In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. J Foot Ankle Surg 44(3):2117. https://doi.org/10.3113/FAI.2009.0419, Miller AN, Carroll EA, Parker RJ, Helfet DL, Lorich DG (2010) Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. The symptoms of a medial malleolus fracture are fairly predictable: Pain on the inner side of the ankle, swelling and bruising, and difficulty walking. The same rehabilitation protocol was applied for both groups postoperatively. 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. *f}]_>BSmIG#\sg.i56x%)@e has previously shown [22]. Overview of the Mason classification based on CT images (axial views). https://doi.org/10.1097/BOT.0b013e31828e1bb7, Erdem MN, Erken HY, Burc H, Saka G, Korkmaz MF, Aydogan M (2014) Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures. 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. https://doi.org/10.1097/BOT.0b013e3181b91927, Weber M (2004) Trimalleolar fractures with impaction of the posteromedial tibial plafond: implications for talar stability. Stable fractures will be treated conservatively using a functional brace, unstable fractures will undergo surgical fixation. 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 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. J Trauma 66(5):138590. Compression stocking to be worn to control swelling along with ice/elevation 4 weeks non-weight bearing in boot, followed by 4 weeks of protected weight bearing in a boot https://doi.org/10.1097/01.bot.0000177105.53708.a9, Tejwani NC, Pahk B, Egol KA (2010) Effect of posterior malleolus fracture on outcome after unstable ankle fracture. https://doi.org/10.1007/s00402-018-3099-2, Hendrickx LAM, Cain ME, Sierevelt IN, Jadav B, Kerkhoffs G, Jaarsma RL, Doornberg JN (2019) Incidence, predictors, and fracture mapping of (occult) posterior malleolar fractures associated with tibial shaft fractures. You have sustained an avulsion fracture to your ankle, which is treated like a soft tissue injury (sprain) to your ankle. a) Standing on an . endstream endobj 189 0 obj <>stream Therefore, Mason described type 1 as an extra-articular avulsion fracture following a rotational force applied to the foot when the ankle is in plantarflexion and the talus unloaded. Thin bony fragments adjacent to the lateral aspect of tip of the lateral malleolus and cortical irregularity at the lateral talus, likely representing avulsion fractures. This is a preview of subscription content, access via your institution. Hansen ST (2000) Functional reconstruction of the foot and ankle. The maximum score to be achieved is 100 points. Foot (Edinb) 43:101662. https://doi.org/10.1016/j.foot.2019.101662, Mller ME, Nazarian S, Koch P, Schatzker J (2012) The comprehensive classification of fractures of long bones. Gandham et al. https://doi.org/10.1177/1071100714537630. 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]. Foot Ankle Int 35(9):88695. Part of Springer Nature. It can be caused by traumatic traction (repetitive long-term or a single high impact traumatic traction) of the ligament or tendon. Meine Story | AGB | Impressum | Datenschutz. https://doi.org/10.1007/s00402-019-03259-8, Wang Y, Wang J, Luo CF (2016) Modified posteromedial approach for treatment of posterior pilon variant fracture. CAS The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. The ST portal was located with the ankle in extension at about 2.5 cm anterior and inferior the tip of the lateral malleolus in the sinus tarsi, . https://doi.org/10.1007/s00068-020-01309-0, Vosoughi AR, Jayatilaka MLT, Fischer B, Molloy AP, Mason LW (2019) CT analysis of the posteromedial fragment of the posterior malleolar fracture. This includes the AO classification originally published in 1987 by Mller/AO, being a universal classification depicting all skeletal injuries. The most effective methods for assessing tibiotalar instability include stress and weight-bearing radiographs. endstream endobj startxref Die technische Speicherung oder der Zugriff, der ausschlielich zu statistischen Zwecken erfolgt. JAMA Pediatr 170:e154114, Boutis K, Willan AR, Babyn P, Narayanan UG, Alman B, Schuh S (2007) A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Palmanovich et al. https://doi.org/10.1177/1071100717732746, Bartonicek J, Rammelt S, Tucek M, Nanka O (2015) Posterior malleolar fractures of the ankle. Arch Orthop Trauma Surg 140(2):187195. Your talus is the main connection between your foot and your leg. 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). Google Scholar, Beynnon BD, Vacek PM, Murphy D, Alosa D, Paller D (2005) First-time inversion ankle ligament trauma: the effects of sex, level of competition, and sport on the incidence of injury. alibaba china gift card; composition of linear maps; despite of this pandemic; birkenstock buckley shearling . A good classification system helps the orthopedic surgeon to identify and characterize a problem, suggest a potential prognosis, and offer guidance in determining the appropriate treatment method for a particular condition. 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. which classified PMF into 3 distinct types [14]. Alignment has been maintained. 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. Of these, 35 studies used radiographs and 30 studies used CT to estimate size, one study did not provide a clear statement in this regard. For example, a classification of PMF in tibial shaft fractures (TSF) [96, 97], and one also involving talar subluxation [98]. It is recommended that clinicians collaborate closely with the referring physician regarding the timeframes for progression. The arm was exsanguinated and the high-arm tourniquet inflated to 250 mmHg. In addition, there are studies showing that posterior pilon fractures are a separate entity due to morphological differences [61, 94]. Google Scholar, Hoelsbrekken SE, Kaul-Jensen K, Morch T, Vika H, Clementsen T, Paulsrud O, Petursson G, Stiris M, Stromsoe K (2013) Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial. The classification used in the majority of studies is the one proposed by Haraguchi [14]. Patients underwent radiography of the ankle in the mortise, lateral, anterior talofibular ligament (ATFL), and calcaneofibular ligament views at the first clinic visit to assess avulsion fractures of the distal fibula. Int Orthop 42(1):191196. Data analysis was performed using IBM SPSS Statistics Version 26.0 (IBM Corp., Armonk, NY, USA). https://doi.org/10.1016/s0020-1383(01)00199-1, de Muinck Keizer RO, Meijer DT, van der Gronde BA, Teunis T, Stufkens SA, Kerkhoffs GM, Goslings JC, Doornberg JN (2016) Articular gap and step-off revisited: 3D quantification of operative reduction for posterior malleolar fragments. https://doi.org/10.3109/17453679809002355, Article 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. Based on the number of patients included, the weighted median total Coleman score was 42.5. Lippincott Williams & Wilkins. 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. https://doi.org/10.1007/s00264-020-04882-6, Black AT, Stowers JM, Tenley J, Hu CY, Eshetu T, Spielfogel WD, Katchis SD, RahnamaVaghef A, Weiner LS (2021) The association between lateral radiographs and axial computed tomography of posterior malleolar fractures as a tool for predicting medial malleolar extension: a multi-center retrospective analysis. https://doi.org/10.1053/j.jfas.2020.08.036. Arch Orthop Trauma Surg 139(4):497506. Only specific PMF classifications were included; general ankle and/or pilon fracture classifications were excluded. Use either a well-padded posterior. Foot Ankle Surg 26(3):289294. The study selection and data extraction were independently performed by two review authors (JT, EM). divided it into a large intra-articular pilon fragment and a small extra-articular fragment [67]. The treatment method was not standardized and was determined by the patient, their parents, and the treating physician. Return to driving for ankle fractures treated without surgery is usually around 6-8 weeks after the injury. Hence, a paradigm shift has occurred [21, 24, 31, 77], as also the systematic review by Odak et al. Lateral. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. Learn more about Institutional subscriptions, Berg EE (1991) The symptomatic os subfibulare. 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. 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. https://doi.org/10.1016/j.fas.2015.05.003, Abdelgawad AA, Kadous A, Kanlic E (2011) Posterolateral approach for treatment of posterior malleolus fracture of the ankle. Foot Ankle Int 31(11):95964. 4% (103/2332) Eur J Trauma Emerg Surg 36(6):5159. 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. developed a CT-based classification of PMF ascending in severity of injury [30]. Furthermore, reference lists of relevant reviews and included articles were screened for additional articles. Avulsion fracture of the distal fibula is associated with recurrent sprain after ankle sprain in children. https://doi.org/10.7547/20-100, Erinc S, Cam N (2021) Does it matter the fixation method of the posterior malleolar fragment in trimalleolar fractures? Wir verwenden Cookies, um unsere Website und unseren Service zu optimieren. 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. Disagreements were discussed in a consensus meeting and if a disagreement persisted, a third reviewer (HW) made the final decision. postulated even that in PMF of all sizes, syndesmotic stability is significantly more likely to be restored if treated by open reduction internal fixation [48, 51]. - Lateral shuffles Injury 47(3):75761. Nowadays, it is generally believed that the morphology of the fragment is more closely related to the fracture pattern and is, therefore, more important in classifying the fracture [14, 19,20,21]. Injury 22(5):4036. 0 k1: Biometrics 33(1):15974, Warner WC, Farber LA (1965) Trimalleolar fractures. https://doi.org/10.1016/j.fas.2019.08.007, Wang J, Wang X, Xie L, Zheng W, Chen H, Cai L (2020) Comparison of radiographs and CT features between posterior Pilon fracture and posterior malleolus fracture: a retrospective cohort study. A lateral malleolus fracture is classified as nondisplaced when the bone fragments are not out of place. Wang et al. Acta Orthop 85:518524, Niki H, Tatsunami S, Haraguchi N, Aoki T, Okuda R, Suda Y et al (2013) Validity and reliability of a self-administered foot evaluation questionnaire (SAFE-Q). Medicine (Baltimore) 97(37):e12079. [1] Ankle injuries resulting in an avulsion fracture frequently happen during sudden movements and changes in direction. 7. H\n e{ ND!o?U' &. J Foot Ankle Surg 50(2):1415. https://doi.org/10.3113/FAI.2010.0959, Purnell GJ, Glass ER, Altman DT, Sciulli RL, Muffly MT, Altman GT (2011) Results of a computed tomography protocol evaluating distal third tibial shaft fractures to assess noncontiguous malleolar fractures. 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. PubMed Central Bidirectional citation search was used including backward and forward citation search methods [34]. J Orthop Traumatol 22(1):52. https://doi.org/10.1186/s10195-021-00615-6, Bartonicek J, Rammelt S, Kostlivy K, Vanecek V, Klika D, Tresl I (2015) Anatomy and classification of the posterior tibial fragment in ankle fractures. https://doi.org/10.1007/s00402-022-04643-7, DOI: https://doi.org/10.1007/s00402-022-04643-7. 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]. Second, that the classification was based only on axial sectional images and, therefore, fractures were only assessed in one plane, vertical size expansion not being estimated [31], that medial injuries were not evaluated, which may lead to misjudgments [17, 32], and that the extent of involvement of the tibial incisura was not specified, wherefore type I fractures include a wide range of both small and large posterolateral fragments [59]. J Orthop Trauma 32(Suppl 1):S1S170. A common spot for avulsion fractures is at the lateral malleolus or outside ankle bone. The use of a posteromedial approach for type II fractures have resulted in good Olerud and Molander ankle score (OMAS)[64]. Percutaneous skeletal fixation. https://doi.org/10.1053/j.jfas.2017.05.028, Wang X, Zhang C, Yin JW, Wang C, Huang JZ, Ma X, Wang CW, Wang X (2017) Treatment of medial malleolus or pure deltoid ligament injury in patients with supination-external rotation Type IV ankle 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. 2% (44/2332) 5. Summarizing all of the previously described points, we believe that, to date, no classification is able to adequately describe the complexity of the PMF. J Foot Ankle Surg 54(4):55964. Non-surgical and surgical options exist to treat medial malleolus fractures, but the choice often comes down to the extent of the fracture. a Haraguchi type I b Haraguchi type II c Haraguchi type III. Am J Transl Res 13(6):64786487, PubMed We were not able to find an image of such a type 5 fracture: neither in the original article nor in our own fracture-database. The other two are the lateral and the posterior malleolus. It looks like nothing was found at this location. J Bone Joint Surg Am 90:18621868, Article A final update of the search was conducted 12th of May 2022 using the same search string. 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. https://doi.org/10.1016/j.injury.2020.02.109, Tucek M, Rammelt S, Kostlivy K, Bartonicek J (2021) CT controlled results of direct reduction and fixation of posterior malleolus in ankle fractures. brazilian top team schedule; rod carew urban dictionary; elite tourist characteristics; best cosmetic teeth covers; white tree frog enclosure; testosterone cypionate 200mg/ml for sale; lighthouse sketch simple. Victorian Institute of Sport Tendon Study Group. J Foot Ankle Res 8:45. https://doi.org/10.1186/s13047-015-0098-1, Article 1 [33]. https://doi.org/10.3390/diagnostics10100812, He JQ, Ma XL, Xin JY, Cao HB, Li N, Sun ZH, Wang GX, Fu X, Zhao B, Hu FK (2020) Pathoanatomy and injury mechanism of typical maisonneuve fracture. Google Scholar, Yde J (1980) The Lauge Hansen classification of malleolar fractures. Of 114 (follow-up rate, 80%) patients who were followed up for a median period of 24 months, recurrent sprain occurred in 41 (36%) patients. However, there is still no clear definition and the understanding of it varies [75, 81, 94, 95]. One modification of Mason type 2B fracture was found. 185 0 obj <> endobj Detailed information about patient demographics is demonstrated in Table 2. It also includes a treatment algorithm. 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. B) The oblique view shows opening of the lateral distal physis. 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. Foot Ankle Int 38(11):12291235. Only one studied inter- and intraobserver reliability, measuring a substantial Kappa of 0.64 and 0.63 respectively [13]. J Orthop Trauma 33(12):e452e458. The most effective methods for assessing tibiotalar instability include stress and weight-bearing radiographs. 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. 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. PubMed 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. Part A assesses study size, average follow-up time, percentage of patients with follow-up, number of interventions, study type, diagnostic certainty, description of surgical method, and postoperative rehabilitation. 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 190 0 obj <>stream Therefore, the aims of this systematic review were first, to determine how many studies use a classification of the PMF; second, to identify and to describe which classifications of PMF exist; third to examine which classification system does have the most reliable (inter- and intra- observer) scores; and fourth, to evaluate the predictive value of the classifications in terms of postoperative outcomes. Many classifications describing posterior malleolar fractures (PMF) exist. https://doi.org/10.1097/00005131-199408000-00009, Buchler L, Tannast M, Bonel HM, Weber M (2009) Reliability of radiologic assessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures. Open Access funding enabled and organized by Projekt DEAL. Foot Ankle Surg 26(2):138145. Ununited osteochondral fractures of the distal fibula. All Rights Reserved. Springer Science & Business Media, Berlin, Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium-2018. A type 3 fracture is characterized by a coronal fracture line that involves the entire posterior plafond due to an axial loading of a plantarflexed talus (Fig. ]88?N-=pC[QuW/!l|SxI qcpn _n 2@ m?y:#7|M^S1.&TT]2Lgm6_+_;_v{zW UB1-)D!Tc`U= CyUs@ovtq~!#'7^k&w[TSO)T_HUE] T8}T=F \Uy8=m8[ #t Int Orthop 36(9):192936. 2) Emergency Department: 01475 524166 Foot Ankle Int 30(5):41926. Orthop Surg 9(1):6976. Pediatrics 119:e1256e1263, Busconi BD, Pappas AM (1996) Chronic, painful ankle instability in skeletally immature athletes. Modifications of the Haraguchi classification were found three times. J Orthop Trauma 32(11):543547. A meta-analysis. avulsion tip fractures of medial or lateral malleolus . 2). Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in Four specific classifications for the PMF were found: a classification based on the relation of the fragment size compared to the size of the tibial joint surface [45] (referred to as PMF Classification according to fracture size) and 3 CT-based classifications according to Haraguchi, Bartonek/Rammelt, and Mason [14, 29, 30]. The review was performed and reported according to the PRISMA 2020 checklist [33]. PubMed Central Eur J Trauma Emerg Surg 41(6):587600. Indian J Orthop 52(3):309314. One objection is the imprecise definition of type 5 fractures, which includes all fractures that cannot be classified as type 14. 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 few studies using these radiographic projections have reported a high incidence of avulsion fractures in children [1418, ]. 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? CAS observed an improving AOFAS score from type I to type III [65], Xie et al. However, as the Bartonek/Rammelt classification has the greatest potential due to its treatment algorithm, its reliability in combination with consistent predictive values, its usage in clinical practice and research appears advisable. Foot Ankle Int 30(4):30914. Foot Ankle Int 25(10):71627. Int Orthop 41(9):19351943. Subsequently, the conviction increases that not the size, but the fracture morphology is crucial for the improvement of outcome [19]. In the matter of inter- and intraobserver reliability, the available evidence is also meager, Bchler et al. Most probably due to being the first CT-based classification and due to the simple and clear structure dividing the fracture in three types. 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. 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]. A few more limitations are worth noting, with majorly the limited quality of the included studies. This occurs as tendons can bear more load than the bone. https://doi.org/10.12669/pjms.36.3.1671, Martin KD, Tripp CT, Huh J (2021) Outcomes of posterior arthroscopic reduction and internal fixation (PARIF) for the posterior malleolar fragment in trimalleolar ankle fractures. Clin Orthop Relat Res 468(4):112935. Patients who sustained a first-time ankle sprain were prospectively surveyed. lateral malleolus avulsion fracture rehabilitation protocol Avez-vou des questions ? Injury 33(8):72934. The first CT-based classification found, was developed 2006 by Haraguchi et al. Usually, you will need to stay off the ankle for several weeks after surgery. By reviewing the literature, 4 classifications were found describing PMF: a classification based on the fragment proportion in relation to the distal tibial joint surface [45] and the three CT-based classifications according to Haraguchi, Bartonek/Rammelt, and Mason [14, 29, 30]. trevor lawrence passing yards . Comparing the outcome of treating PMF less than 25% with that of not fixing it no significant difference in the AOFAS Score was found [55,56,57]. Selection and data extraction was performed by three independent observers. https://doi.org/10.1007/s11999-009-1111-4, Sultan F, Zheng X, Pan Z, Zheng Q, Li H, Wang J (2020) Characteristics of intercalary fragment in posterior malleolus fractures. https://doi.org/10.1007/s00167-018-5055-7, DOI: https://doi.org/10.1007/s00167-018-5055-7. %%EOF 0 Arch Orthop Trauma Surg. In addition, half of all studies using Masons classification were conducted by the author's own research group, and it was Mason himself who found the highest interobserver reliability in his study (kappa 0.919) whereas other authors found considerable lower reliability scores (Fleiss kappa 0.61 / Cohens kappa 0.717) [24, 30, 32, 43, 44, 67, 68, 83]. Google Scholar, Elsoe R, Ceccotti AA, Larsen P (2018) Population-based epidemiology and incidence of distal femur fractures. 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. No funding was received for conducting this study. The study protocol was registered in the PROSPERO database (CRD42021264268). Injury 51(4):11181124. reported a better outcome with surgical treatment of type I fractures smaller than 25% [49]. https://doi.org/10.1097/TA.0b013e3181e4f81e, Langenhuijsen JF, Heetveld MJ, Ultee JM, Steller EP, Butzelaar RM (2002) Results of ankle fractures with involvement of the posterior tibial margin. If the posterior malleolus is affected, therapy results may be worse and its presence in ankle fractures is known to be of negative prognostic value [1, 4, 6,7,8,9,10]. Injury 52(10):31503155. hbbd```b``"Z@$fHp0{dY&Y0lB:dhH%q03L I J Trauma 53(1):5560. Knee Surgery, Sports Traumatology, Arthroscopy XC!_4Z(P c,1>>!PV@!4o6^g$qJqH$1{JLCl7iX&VzlA+2a%4{35IM3e2|k8KQ!y|b6A'[ P,4 Ov'A/?!CG[S!VhpxKnYz'=74j/}81 xJ?7@88Iq o=))zA}>\ 1r|qN} n35%LHlfmGb#uI'l^;4OX$aXDk2|MNexsrH=@`wG7tPT`x`I0`: X5i?}so8>R}:=UIY Vnie=wIWcyVo^"}o>:a:Evl5+ uGVkrC|v:| X?*! https://doi.org/10.1016/j.injury.2021.07.038, Sheikh HQ, Mills EJ, McGregor-Riley JC, Chadwick C, Davies MB (2020) The effect of computerised tomography on operative planning in posterior malleolus ankle fractures. Arch Orthop Trauma Surg. Copyright 2022 Gressmann Coaching. The Bartonek/Rammelt classification was developed on the basis of a larger patient population. Sixty-six studies that used the size of the PMF in relation to the joint surface as a classification could be included. Avulsion fractures are frequently missed on standard anteroposterior and lateral radiographs of the ankle [13, 18]. Arch Orthop Trauma Surg (2022). There were 22 prospective studies, 88 retrospective studies; 11 studies were multicenter, and 99 single center studies (Table 1). J Trauma 29(11):156570. https://doi.org/10.1016/j.fas.2021.02.009, Article 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. Classification systems of posterior pilon fractures were also considered to be non-PMF-specific. 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]. 2022 Springer Nature Switzerland AG. Satoshi Yamaguchi. after several months, please phone the fracture clinic helpline as listed below for further advice. Foot Ankle Surg 27(6):629635. 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. Complex ankle fractures frequently involve the posterior malleolus. 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. 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? Am J Med 121:324331.e326, Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ (2010) The epidemiology of ankle sprains in the United States. Advanced exercises for sports rehabilitation . Foot Ankle Int 42(7):959966. 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. The authors would like to thank Dr. Jun Endo, Dr. Yohei Yamamoto, Dr. Akira Kawashima, Dr. Satoru Nishikawa, Dr. Mitsuaki Morita, and Dr. Yuji Shinohara for patient recruitment. As for the predictive outcome value, type 3 fractures tend to show worse postoperative outcome [68]. https://doi.org/10.1034/j.1600-0838.2000.010001002.x, Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. 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. South Med J 58(10):12925. A) The AP view shows that the fracture is intra-articular. Impact on absenteeism and quality of life]. 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. Patients with less complex fractures may progress In addition, a multi-fragmentary fracture of the entire tibial plafond may be mistaken for a two-part posterolateral and posteromedial fracture (type 2B) [32]. J Bone Joint Surg Am 95:e115(111116), Takaoka M, Suzuki K, Norbck D (2015) Sick building syndrome among junior high school students in Japan in relation to the home and school environment. Decision-making to fixate PMF is still highly debatable and traditionally often based on fracture size measurement on radiographs, with lack of accuracy and poor reliability [11,12,13,14,15,16,17,18]. https://doi.org/10.1016/j.injury.2022.02.046. 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. Arthroscopy 32(11):23732380. Yamaguchi, S., Akagi, R., Kimura, S. et al. Int Surg 77(4):30912, PubMed Talus fractures usually occur due to high-impact injuries such as car accidents. Google Scholar, Jaskulka RA, Ittner G, Schedl R (1989) Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. The boot you have been given is not needed to aid fracture healing but will help with your symptoms and should be worn whenever you're walking. 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. The incidence rate was significantly higher in patients with avulsion fractures than in patients without the fractures (44 vs. 23%, P=0.027). X-ray. Injury 46(4):S109S113. and Xu et al. Treatment depends on the fracture location. J Bone Joint Surg Am 92:22792284. 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. Recovery at a glance: No casting during recovery Come out of the boot and begin to move your ankle up and down immediately after surgery so your ankle does not get stiff. Part of Springer Nature. Incidental note of os subfibulare and os trigonum. With the routine use of CT imaging to reliably diagnose and classify trimalleolar fractures [9], authors have shown that all fractures involve the articular surface of the distal tibia [14, 29, 81]. The methodological quality of the included studies was quantified using the modified Coleman score. https://doi.org/10.1177/1071100717735839, Huang Z, Liu Y, Xie W, Li X, Qin X, Hu J (2018) Pre-operative radiographic findings predicting concomitant posterior malleolar fractures in tibial shaft fractures: a comparative retrospective study. Clin Orthop Relat Res (122):3745. All authors made the final approval of the manuscript. Also, the three modifications found [61, 62, 80] may suggest that Haraguchis classification is not as advanced to represent all fracture types. Injury 47(10):23602365. Diagnostics (Basel). Foot Ankle Surg 20(1):4851. Avulsion fracture of the fibula associated with recurrent instability of the ankle. Foot Ankle Int 40(11):13191324. https://doi.org/10.1097/00007611-196510000-00022, Olerud C, Molander H (1986) Bi- and trimalleolar ankle fractures operated with nonrigid internal fixation. Part B is comprised of outcome criteria, procedure for assessing outcomes, and description of the subject selection process. 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. EFORT Open Rev 3(1):2429. Maybe try a search? Mertens et al. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. Surgical Treatment Surgical repair is necessary when a lateral malleolus fracture is displaced. https://doi.org/10.1016/j.ejrad.2011.01.039, Sun C, Peng X, Fei Z, Li C, Zhou Q, Xu W, Dong Q (2021) The CT morphological characteristics and the clinical management strategy of posterior malleolar fractures with talar subluxation. https://doi.org/10.1016/j.jiph.2019.06.022, Amorosa LF, Brown GD, Greisberg J (2010) A surgical approach to posterior pilon fractures. J Orthop Trauma 29(9):42835. Injury 53(2):756761. More than one-third of patients experienced recurrent sprain. PubMed sent the outcome of surgery and rehabilitation of avulsion fracture of the tibial . Am J Sports Med 33:14851491, Article 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. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. On lateral X-rays the fracture line was clearly seen from . 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. Archives of Orthopaedic and Trauma Surgery J Orthop Trauma 19(9):6359. 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 Stage 1: For patients who would like to develop dynamic ankle control for sports . https://doi.org/10.1097/BOT.0000000000000330, Neumann AP, Rammelt S (2021) Ankle fractures involving the posterior malleolus: patient characteristics and 7-year results in 100 cases. even made a recommendation on the appropriate operative approaches [30, 68, 83]. Foot Ankle Int 42(2):157165. observed an improvement in the AOFAS score from type I to type III [65]. Clin Orthop Relat Res 477(4):863869. https://doi.org/10.1007/s00402-018-3056-0, Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG (2009) Direct visualization for syndesmotic stabilization of ankle fractures. The authors of the Mason classification see the advantage in the ascending degree of severity of the classification considering the accident mechanism. After excluding duplicates, title and abstract of the remaining studies were assessed. CAS Foot Ankle Int 39(3):318325. The modified Coleman score was applied by two independent reviewers (HW, JT) (Online Resource 1). When is reduction (non-operative and operative) required? Foot Ankle Int 41(10):12341239. With the exception of one study describing a worse outcome in Mason type 3 fractures [68], there are no further statements on predictive values. 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. and Tosun et al. There is one modification made by Tucek et al., who divided Bartonek type 4 into three subtypes: subtype 1 as a fracture line that passes laterally past the malleolar groove, subtype 2 as a fracture line that involves the malleolar groove, and subtype 3 as an intercollicular fracture line or a line involving the posterior colliculus [66]. Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw . PubMed 1 These breaks are the most common type of ankle fracture. Also, the classifications are weak in terms of a derivable treatment algorithm or prognosis of outcome. Baumbach et al. a Bartonek type 1 b Bartonek type 2 c Bartonek type 3 d Bartonek type 4. 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. Google Scholar, Heim D, Schmidlin V, Ziviello O (2002) Do type B malleolar fractures need a positioning screw? saw an increase in the AOFAS score and no difference in the Olerud and Molander ankle score (OMAS) [21]. J Bone Joint Surg Am 73:12511254, Article 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. Physical therapy and management of symptoms. The rehabilitation program to recover from an avulsion ankle fracture usually involves three significant stages. BMC Musculoskelet Disord 17:328. https://doi.org/10.1186/s12891-016-1182-9, Chaparro F, Ahumada X, Urbina C, Lagos L, Vargas F, Pellegrini M, Barahona M, Bastias C (2019) Posterior pilon fracture: epidemiology and surgical technique. CAS Cadaveric studies, review articles, case reports with fewer than 10 cases, studies that did not include a posterior malleolus specific classification, and studies not written in English, were excluded. https://doi.org/10.1177/1071100717745526, Levack AE, Warner SJ, Gausden EB, Helfet DL, Lorich DG (2018) Comparing functional outcomes after injury-specific fixation of posterior malleolar fractures and equivalent ligamentous injuries in rotational ankle fractures. 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