Original articleLong-Term Results of Ankle Fractures With a Posterior Malleolar Fragment
Section snippets
Materials and Methods
A retrospective analysis was performed on all adult patients who sustained an ankle fracture with a posterior malleolar fragment and were treated in the Academic Medical Center (Amsterdam, The Netherlands) between 1975 and 1996. Exclusion criteria were open epiphysial plates, pathologic fractures, open fractures, a second ankle fracture, pilon fractures, and patients not being able to bear weight for reasons other than posttraumatic complications of the affected ankle. The patients were seen at
Results
According to the AO-classification, 34 fractures were classified as type 44B and 11 as type 44C. None of the patients was treated nonoperatively. A fracture-dislocation was seen in 20 of the 45 patients. The means of the outcome measures for the evaluated population are presented in Table 1. The mean size of the posterior malleolar fragment was 19.4% (range, 3%–49%). Thirteen of the 45 patients had posterior malleolar fragments that comprised more than 25% of the joint surface. Eleven of the 45
Discussion
The majority of our patients showed good results after a mean follow-up of 13 years, regarding both functional and osteoarthritic scores. The AFSS score used in the current study was introduced by Phillips et al for the comparison of conservative treatment and internal fixation of severe ankle fractures in a randomized controlled trial (13). According to this score, the group that underwent internal fixation showed better results. The ankle fractures in our population were considered to be of
Conclusion
Patients with posterior malleolar fractures showed good results after a mean of 13 years follow-up. Fracture-dislocation was seen more often in combination with larger fragments and resulted in worse long-term outcome than nondislocated fractures. Outcome was not affected by size or fixation of the posterior tibial fragment. This study supports that posterior malleolar fragments smaller than 25% do not require fixation.
References (31)
- et al.
Operative treatment of ankle fractures in adultscorrelation between types of fracture and final results
Injury
(1991) - et al.
Early weight bearing after posterior malleolar fracturesan experimental and prospective clinical study
J Foot Ankle Surg
(2003) - et al.
Adult ankle fracturesan increasing problem?
Acta Orthop Scand
(1990) - et al.
Epidemiology of ankle fractures in Rochester, Minnesota
Acta Orthop Scand
(1987) - et al.
Epidemiology of ankle fracturesa prospective population-based study of 212 cases in Aalborg, Denmark
Acta Orthop Scand
(1998) - et al.
Fractures of the posterior tibial margintheir role in the prognosis of malleolar fractures
J Trauma
(1989) Operative treatment of ankle fracture-dislocationsa follow-up study of 306/321 consecutive cases
Clin Orthop
(1985)(Indications and technic for the stabilization of the posterior Volkmann’s triangle in malleolar fractures
) Unfallheilkunde
(1982)(Incidence of arthrosis following osteosynthesis of Volkmann’s triangle in malleolar fractures)
Z Unfallchir Versicherungsmed Berufskr
(1986)Trimalleolar fractureslate results after fixation of the posterior fragment
Orthopedics
(1989)