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Comparison of the Size of the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures Measured Using Lateral Plain Radiography and Three-Dimensional Computed Tomography
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Gun-Woo Lee, Dong-Min Jung, Woo Kyoung Kwak, Keun-Bae Lee
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J Korean Fract Soc 2022;35(3):91-96. Published online July 31, 2022
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DOI: https://doi.org/10.12671/jkfs.2022.35.3.91
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 Abstract
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- Purpose
This study aimed to evaluate and compare the accuracy of the size of the posterior malleolar fragment measured using lateral plain radiography and three-dimensional computed tomography (3DCT) in patients with ankle trimalleolar fractures.
Materials and Methods
This study enrolled 80 patients (80 ankles) with ankle trimalleolar fractures and analyzed the size of the posterior malleolar fragments using plain radiography and 3D-CT. The articular involvement of the posterior malleolar fragments was measured as a percentage of the articular surface in the sagittal length of the tibial plafond using lateral plain radiography, and the articular surface area was directly measured using 3D-CT. In addition, we classified the patients into three groups based on the morphology of the posterior malleolar fracture, according to the Haraguchi classification method, and evaluated and compared the accuracy of the size of the posterior malleolar fragments.
Results
The mean articular involvement of the posterior malleolar fragments on plain radiography was 27.6% (range, 6.0%-53.1%), which was significantly higher than the mean of 21.9% (range, 4.7%-47.1%) measured using 3D-CT (p=0.004). In the analysis, according to the fracture morphology, the mean difference between the two methods was the largest for type I fractures at 9.1% (range, 1.8%-19.5%) and the smallest for type II fractures at 1.1% (range, –7.7% to 8.8%).
Conclusion
The articular involvement of posterior malleolar fragments measured using plain radiography showed low accuracy and significantly higher values than the actual articular involvement. Therefore, careful evaluation using 3D-CT is crucial for accurate analysis and optimal treatment in patients with ankle trimalleolar fractures.
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Current Management of Talar Fractures
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Gun-Woo Lee, Keun-Bae Lee
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J Korean Fract Soc 2022;35(1):31-37. Published online January 31, 2022
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DOI: https://doi.org/10.12671/jkfs.2022.35.1.31
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Abstract
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- Talar fracture management is one of the most challenging tasks for orthopedic surgeons. High complication rates and functional impairments after talar fractures have been well documented, and thus, surgical strategies capable of perfect anatomic reduction and stable fixation are important. The current review was undertaken to provide recommendations regarding updated surgical strategies that include surgical timing, approach, fixation methods, and the prevention and treatment of possible complications.
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Comparing Outcomes of Screw Fixation and Non-Fixation for Small-Sized Posterior Malleolar Fragment in Ankle Trimalleolar Fractures
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Jee-Wook Ko, Gun-Woo Lee, Keun-Bae Lee
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J Korean Fract Soc 2021;34(1):8-15. Published online January 31, 2021
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DOI: https://doi.org/10.12671/jkfs.2021.34.1.8
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Abstract
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- Purpose
This study was undertaken to compare outcomes of screw fixation and non-fixation of a small-sized posterior malleolar fragment involving less than 25% articular surface in ankle trimalleolar fractures.
Materials and Methods: A total of 32 consecutive ankles (32 patients), with posterior malleolar fragment involving 15%-25% of the joint surface, were enrolled in the study. Patients were divided into 2 groups according to whether the fragment was fixed or not (fixed: 20 ankles, non-fixed: 12 ankles).
The minimum follow-up period was 12 months. Median size of the posterior malleolar fragment in the fixed and non-fixed groups were 24.6% (range, 22.3%-25.0%) and 22.1% (range, 17.4%-24.3%), respectively. Complications as well as clinical and radiographic outcomes were compared and analyzed between the two groups.
Results: Clinical outcomes, including American Orthopaedic Foot & Ankle Society (p=0.501), visual analogue scale (p=0.578), and ankle range of motion (p=0.552), showed no difference between groups at the final follow-up. No differences were obtained in the radiographic outcomes, including joint stepoff (p=0.289) and fragment gap (p=0.289). Complications, including 1 case of delayed union and 1 case of wound infection, were reported in the fixed group.
Conclusion: Clinical outcomes and radiographic outcomes of the non-fixation group were satisfactory and comparable to the fixation group. Our results indicate that anatomical reduction with small-sized posterior malleolar fragment in ankle trimalleolar fractures is sufficient for satisfactory outcomes, without the need for additional internal fixation.
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