Journal of Musculoskeletal Trauma

Prediction of Syndesmotic Instability according to the Lateral Malleolus Fracture Pattern in Supination-External Rotation Type Ankle Fractures: Short Oblique versus Long Oblique Fracture: Chan-Jin Park, Min-Su Lee, Keun-Bae Lee; J Korean Fract Soc 2024;37(1):39-45. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.39

Abstract PDF: Purpose
This study examined whether preoperative radiological evaluations can predict syndesmotic instability according to the lateral malleolus fracture pattern in supination-external rotation-type ankle fractures.
Materials and Methods
This study enrolled 132 patients (132 ankles) with supination-external rotation stage 3 and 4 ankle fractures. Three-dimensional computed tomography was used for the morphological classification of the lateral malleolus fractures. A long oblique fracture was defined when the posterior cortical bone height of the fracture was 4.5 cm or more from the plafond of the distal tibial articular surface. A short oblique fracture was defined when the height was less than 4.5 cm. The demographic characteristics and syndesmotic instability of the two groups were evaluated.
Results
Short oblique fractures were confirmed in 102 cases, and long oblique fractures were confirmed in 30 cases. Long oblique fractures occurred at a statistically significantly higher incidence in younger ages and among males compared to short oblique fractures. Syndesmotic instability was more common in long oblique fractures.
Conclusion
In supination-external rotation-type ankle fractures, syndesmotic instability was observed in approximately 13%. Specifically, when the fracture pattern of the lateral malleolus is long oblique, the incidence of syndesmotic instability is approximately three times higher than in short oblique fractures. Therefore, meticulous evaluations of the lateral malleolus fracture pattern and establishing an appropriate treatment plan before surgery are crucial.

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Treatment of Isolated Lateral Malleolar Fractures Using Locking Compression Plate Fixation and Tension Band Wiring Fixation: Woojin Shin, Seondo Kim, Jiyeon Park; J Korean Fract Soc 2020;33(1):16-21. Published online January 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.1.16

Abstract PDF: PURPOSE
The purpose of this study was to compare the clinical and radiological outcomes of locking compression plate (LCP)-screw fixation and tension band wiring (TBW) fixation in isolated lateral malleolar fractures.
MATERIALS AND METHODS
From May 2016 to August 2018, 52 patients with isolated lateral malleolar fracture were retrospectively reviewed. They were divided into 30 cases of the LCP fixation group (Group I) and 22 cases of the TBW fixation group (Group II). The clinical and radiological results of those groups were compared. Pearson chi-square tests and independent t-tests were used in the statistical analysis.
RESULTS
The mean length of the surgical incision was 8.3 cm in Group I and 4.9 cm in Group II. Radiological union was obtained at a mean of 8.4 weeks in both groups. The mean American Orthopaedic Foot and Ankle Society score was 90 (range, 85â€“97) and 92 (range, 85â€“100) in Groups I and II, respectively, at the last follow up.
CONCLUSION
Both the LCP-screw and TBW techniques revealed excellent results in isolated lateral malleolar fractures. The tension band technique may be a fine alternative method of fixation in the treatment of isolated lateral malleolar fracture.

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Nonoperative Treatment of Isolated Lateral Malleolar Fracture: Woo Chun Lee, Jong Ho Ahn; J Korean Fract Soc 2005;18(3):291-293. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.291

PURPOSE
To evaluate the results of conservative treatment for isolated lateral malleolus fracture without medial ankle injury.
MATERIALS AND METHODS
From March 1999 to February 2003, 25 ankles in 25 patients were treated for isolated lateral malleolus fracture and followed for more than one year. Mean age was 46.9 years (range, 20~71 years). Cases without any swelling or tenderness on the deltoid area, or cases with minimal pain, swelling or tenderness on the deltoid area and medial clear space 1 mm or less on stress radiograph were included for the study. Immediate weight bearing was allowed with below-knee cast immobilization in all cases.
RESULTS
All were supinatin-external rotation stage II injury and mean duration of cast immobilization was 6.3+/-1.6 weeks after injury. There was no case which showed widening of medial clear space during routine radiographic follow-up. There was no change in the degree of displacement in spite of immediate weight bearing with short leg cast on.
CONCLUSION
Because the lateral malleolus fracture without medial injury can be managed nonoperatively, we need to differentiate this type of fracture to avoid unnecessary surgery, and for early return to normal daily activity.

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Posterior Plating in Distal Fibular Fracture
Choong-Hyeok Choi, Young-A Cho, Jae-Hoon Kim, Il-Hoon Sung
Journal of the Korean Fracture Society.2007; 20(2): 161. CrossRef

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Treatment of Lateral Malleolar Fractures using Minimally Invasive Plate Osteosynthesis Technique: Dong Joon Kim, Byoung Ho Suh, Jin Woo Kwon, Gyu Min Kong, Sang Ho Moon, Jong Moon Bae; J Korean Fract Soc 2005;18(3):286-290. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.286

Abstract PDF

PURPOSE
To evaluate the efficacy and complication of minimally invasive plate osteosynthesis (MIPO) technique for lateral malleolar fracture.
MATERIALS AND METHODS
From January 2001 to December 2003, we had treated 13 cases of lateral malleolar fracture (AO-OTA classification, type A: 4, type B: 9) by MIPO technique and followed them up more than 1 year. Operation time, union time, radiologic alignment, range of motion of the ankle joint, functional results according to criteria of Meyer and complication were evaluated.
RESULTS
After the final follow-up, all the fractures were healed without any second procedure, full-weight bearing ambulation was started in average 10 weeks. Any malunion was not observed by the inadequate bending of plate. Two patients felt a discomfort of ankle because the location of plate was lower than the tip of the lateral malleolus, but all the patients had excellent or satisfactory ankle functions. No deep infection or soft tissue compromise were observed at the last follow up.
CONCLUSION
Minimally invasive plate osteosynthesis technique is safe and worthwhile method in management of lateral malleous fractures while avoiding the complications associated with conventional open plating methods.

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Percutaneous Plating of Weber B Fibular Fractures
Amol Saxena, Andrew Yun
The Journal of Foot and Ankle Surgery.2017; 56(2): 366. CrossRef
Minimally invasive percutaneous plate osteosynthesis for ankle fractures: a prospective observational cohort study
Robinson Esteves Santos Pires, Cyril Mauffrey, Marco Antônio Percope de Andrade, Leonardo Brandão Figueiredo, Vincenzo Giordano, João Carlos Belloti, Fernando Baldy dos Reis
European Journal of Orthopaedic Surgery & Traumatology.2014; 24(7): 1297. CrossRef

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The Effect of Fibular Malreduction on Ankle Joint after Tibial Interlocking IM Nailing of Tibial and Fibular Fractures: Dong Eun Shin, Duck Yun Cho, Hyung Ku Yoon, Jin Soo Lee, Yoon Seok Lee, Hyoung Jun Kim; J Korean Fract Soc 2005;18(1):29-35. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.29

Abstract PDF

PURPOSE
To investigate the effect of fibular malreduction on ankle joint after tibia interlocking IM nailing of tibial and fibular fractures according to type of fibular fractures at preoperation.
MATERIALS AND METHODS
Thirty-nine patients who had ipsilateral tibiofibular fracture were analyzed clinically and radiographically. The talocrural angle and the distance from joint line to the tip of fibular were measured on both ankle standing AP view. The difference of angle and distance of both ankle were analyzed by paired t-test and correlation between defference and AOFAS score by Spearman correlation coefficients.
RESULTS
The difference of The talocrural angle and the distance from joint line to the tip of fibular of both ankle was statistically significant (p<0.05). The correlation between this difference and AOFAS score was statistically insignificant (p>0.05).
CONCLUSION
In tibia interlocking IM nailing of tibia and fibula fracture, malreduction of fibula could cause the change of ankle joint.

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The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures
Jun Young Lee, Kwi Youn Choi, Sinwook Kang, Kang Yeol Ko
Journal of Korean Foot and Ankle Society.2018; 22(3): 95. CrossRef

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Non-operative Treatment of Lateral Malleolar Fracture using Ankle Brace: Nam Hong Choi, Ho Yoon Kwak, Baik Yong Song, Sang Wook Bae, In Mook Lee, Do Hyun Kim; J Korean Soc Fract 2003;16(3):363-369. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.363

Abstract PDF: PURPOSE
The purpose of this study was to evaluate the outcome of conservative treatment for minimal displaced lateral mallolar fracture using ankle brace.
MATERIALS AND METHODS
Eleven patients (eleven ankles) underwent conservative treatment with ankle brace for 8 weeks with full weight bearing ambulation. Inclusion criteria were minimal displacement (<3 mm) of fracture, no or mild tenderness or swelling on medial malleolar area and no lateral shift of talus. The patients were evaluated with AOFAS (the American Orthopedic Foot and Ankle society) Ankle-Hindfoot scale.
RESULTS
Average follow up was 103 weeks (36~192). All cases had normal range of motion of ankle. The average score of AOFAS Ankle-Hindfoot scale was 95 points.
CONCLUSION
The advantages of conservative treatment with ankle brace were early return to daily activity and work, comfort to the patients and a short period of rehabilitation. Conservative treatment with ankle brace for minimal displaced lateral malleolar fracture is recommended.

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ankle and Tibitalocalcaneal Arthrodesis using Lateral Malleolus as Bone Graft: Yung Khee Chung, Jung Han Uoo, Yong Wook Park, Kang Il Lee; J Korean Soc Fract 1998;11(4):918-923. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.918

Abstract PDF: A variety of surgical approaches and bone grafting techniques for ankle and tibiotalocalcaneal arthrodesis have been described. Wed used transfibular approach and lateral malleolus was used for bone graft. This permitted excellent visualization of the ankle and subtalar joint so that the fusion can readily be achieved under th direct visualization. And also we didn't need to prepare the additional bone graft from another site. Ten ankle fusions and two tibiotalocalcaneal fusions were carried out and reviewed. The average age of the patients was 43 years(range, 27 - 58 years). The average follow-up was 27.8 months(range, 24 - 34 months). We evaluated the clinical and radiological results, and complications. All cases were satisfied and fused. But we experienced one minor complication that was posteroplantar heel pain caused by prominence of cannulated screw head. So, we suggest that this procedure has benefit for ankle or tibiotalocalcaneal fusion.

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The role of lateral malleolus in normal growth and biomechanics of ankle clinical long term study in growing children: In Rhee Kim, Yong Sik Kim, Soon Yong Kwon, Kee Won Ryu, Seong Jin Park, Ko Seung; J Korean Soc Fract 1992;5(1):138-149. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.138

Abstract PDF: No abstract available.

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