Journal of Musculoskeletal Trauma

Comparison of the Size of the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures Measured Using Lateral Plain Radiography and Three-Dimensional Computed Tomography: Gun-Woo Lee, Dong-Min Jung, Woo Kyoung Kwak, Keun-Bae Lee; J Korean Fract Soc 2022;35(3):91-96. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.91

Abstract PDF: 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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Assessment of Noncontiguous Posterior Malleolar Fractures in Distal One-Third Tibia Shaft Fractures with Proximal Fibula Fractures: Dae-Geun Kim, Byung Hoon Kwack; J Korean Fract Soc 2022;35(3):103-108. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.103

Abstract PDF: Purpose
Posterior malleolar fractures after intramedullary nail surgery rarely occur in distal tibia shaft fractures. The importance of preoperative ankle evaluation in preventing these fractures is also common knowledge. There are no studies in the literature on posterior malleolar fractures in distal onethird tibia shaft fractures except for distal metaphyseal tibia fractures to the best of our knowledge. The purpose of this study was to evaluate the incidence and radiological features of posterior malleolar fractures in distal one-third tibia shaft fractures with proximal fibula fractures.
Materials and Methods
Thirty-one patients diagnosed with distal one-third tibia shaft fractures with proximal fibula fractures from January 2016 to May 2021 were retrospectively reviewed. With the aid of plain radiographs and computed tomography (CT) scans, the fracture patterns of the tibia and fibula were classified according to the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification, and posterior malleolar fractures were identified. The fracture pattern was classified according to the Haraguchi classification, and the angle between the bimalleolar axis and the posterior malleolar fracture line was measured when there was a posterior malleolar fracture.
Results
Out of the 31 distal one-third tibia shaft fractures with proximal fibula fractures, 16 cases (51.6%) had noncontiguous posterior malleolar fractures that were confirmed on a CT scan, while 3 cases (18.8%) were visible on initial plain radiographs. There was no statistically significant variation seen in the presence of a posterior malleolar fracture in the tibia (p=0.15) and fibula (p=0.87) fractures. According to the Haraguchi classification, there were 15 posterolateral-oblique fractures (Type I) and 1 medial-extension fracture (Type II), and the mean angle was 24.5°.
Conclusion
Noncontiguous posterior malleolar fractures occurred in approximately half of the distal one-third tibia shaft fractures with proximal fibula fractures, and a CT scan was considered necessary to diagnose posterior malleolar fractures before surgery

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Posterior Anti-Glide Plating for Supination External Rotation Type Lateral Malleolar Fractures: Clinical Comparison of Locking versus Non-Locking One-Third Semi-Tubular Plate Fixation: Jun Young Lee, Yong Jin Cho, Dong Hyuk Cha, Hyun Bai Choi, Jung Ho Lee; J Korean Fract Soc 2022;35(2):57-62. Published online April 30, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.2.57

Abstract PDF: Purpose
The purpose of this study was to evaluate and compare the clinical and radiological outcomes between locking plates and non-locking plates using posterior anti-glide plating for supination external rotation type lateral malleolar fractures.
Materials and Methods
A total of 50 patients who underwent internal fixation of posterior anti-glide plating due to lateral malleolar fractures, classified as supination-external rotation (SER) as per the Lauge-Hansen classification system, at our hospital from January 2017 to November 2018 were retro-spectively evaluated. Patients were divided into two groups: 1/3 semi-tubular locking plate (24 patients) and 1/3 semi-tubular non-locking plate (26 patients). A radiographic assessment was performed after surgery to evaluate the time of bone union. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score was measured after the surgery to evaluate the clinical outcomes.
Results
The two groups showed similar distributions in sex, age, height, body mass index, fracture pattern, and mean follow-up period. Complete bone union was obtained in all cases and the mean bone union time was 13.00±3.38 weeks in Group 1 and 12.92±3.26 weeks in Group 2 (p=0.87). The mean AOFAS score at 24 weeks was 95.66±2.86 in Group 1 and 95.84±2.79 in Group 2 (p=0.82). The mean AOFAS score at 48 weeks was 97.25±3.54 in Group 1 and 96.57±3.07 in Group 2 (p=0.47). Two cases of complications were observed in the non-locking plate group.
Conclusion
For the treatment of Lauge-Hansen SER type lateral malleolar fracture, internal fixation us-ing locking 1/3 semi-tubular plate and non-locking 1/3 semi-tubular plate are both favorable fixation methods.

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Treatment of Ankle Fracture and Dislocation: Chan Kang; J Korean Fract Soc 2022;35(1):38-49. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.38

Abstract PDF: Ankle fractures are the most common type of foot and ankle fracture injury. Several types of fractures occur in the ankle structures (medial malleolus, lateral malleolus, posterior malleolus, and Chaput’s tubercle) with various mechanisms and extent of fracture force. Moreover, fractures can be accompanied by other injuries, such as distal tibiofibular syndesmotic injury, medial deltoid ligament rupture, and lateral ligament complex rupture. Ankle dislocation can be accompanied when an injury is caused by a greater fracture force. Non-surgical treatments or combined surgeries may be performed depending on the mechanism and fracture type. Generally, a stable fracture maintaining anatomical reduction is treated conservatively, but surgical treatment is performed when this is not the case. Furthermore, surgeries for stable fractures can be offered when the patients demand early weight bearing due to their occupation, age, and performance state. Restoring the ankle mortise in its anatomical shape before the injury and starting early rehabilitation for functional recovery simultaneously until a union is achieved is important. Traumatic arthritis can occur if the treatment focuses only on fractures and neglects ligament injuries, such as distal tibiofibular syndesmotic injury and medial deltoid ligament rupture. Shortening, angular deformation, and rotational deformation of the fibular promote the progression of traumatic ankle arthritis in the long term, which may further cause chronic ankle pain. An overlooked displaced posterior malleolus fracture also causes traumatic arthritis through anteroposterior instability of the ankle joint.

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Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results: Gwang Chul Lee, Jun Young Lee, Sang Ho Ha, Jae Won You, Sang Hong Lee, Hong Moon Sohn, Ki Young Nam, Kwang Hyo Seo; J Korean Fract Soc 2011;24(4):328-334. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.328

Abstract PDF

PURPOSE
To analyze the long term follow up results of treatment with posterolateral approach and to investigate its usefulness in the patients of trimalleolar fracture with posterior fragment which is above 25% of articular involvement.
MATERIALS AND METHODS
There were 34 cases of trimalleolar fracture in our hospital from May 2004 to April 2008. We investigated 20 patients who underwent operation with the posterolateral approach and over-2 years follow up cases. The mean follow up period was 34 (24~58) months. Preoperative posterior malleolar fragment involved above 25% of articular surface in all cases and displaced more than 2 mm in 11 cases. We analyzed the radiologic type of posterior malleolar fragments and evaluated the function and pain through AOFAS score and complications.
RESULTS
All cases showed primary union at mean 13.1 weeks. The complications are that partial ankylosis result of soft tissue contracture is seen in 2 cases (10%) and post-traumatic arthritis is seen in 1 cases (5%) and 17 cases (85%) of all patients are showed excellent AOFAS score.
CONCLUSION
The posterolateral approach is a valuable method because that it enables us to easily reduction and internal fixation of the posterior malleolus and lateral malleolus at one time and the results are satisfied for a long time follow up.

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Outcomes of Immediate Operative Treatment of Ankle Trimalleolar Open Fractures
Jun-Young Lee, Yong-Jin Cho, Sin-Wook Kang, Yung-Min Cho, Hyun-Bai Choi
Journal of Korean Foot and Ankle Society.2020; 24(1): 25. CrossRef

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Treatment of the Posterior Malleolar Fracture Using Posterior Approach: Hyun Wook Chung, Dong Hwan Kim, Si Hoon Yoo, Jin Soo Suh; J Korean Fract Soc 2010;23(1):50-56. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.50

Abstract PDF

PURPOSE
For fixation of the large posterior malleolar fracture fragment, indirect anterior fixation with cannulated screw has been widely used, but the anatomical reduction is not always obtained. The purpose of this article is to evaluate the clinical result of posterior malleolar fractures treated with anatomical reduction and internal fixation using posterior approach.
MATERIALS AND METHODS
We have analyzed the 15 patients with posterior malleolar fractures, treated with posterior approach from August 2005 to August 2008. The mean follow up period was 17.6 months, We have reviewed the perioperative joint integrity, method of operation, postoperative care, bony union and complication. A clinical outcome was evaluated by AOFAS (American orthopedic foot and ankle society) scaling system and Olerud & Molander scoring system.
RESULTS
Among 15 cases, posterolateral approach and posteromedial approach were chosen in 9 cases and 6 cases respectively. The radiologic unions were achieved at 12.4 (12~18) weeks. Mean AOFAS score was 90.3 (72~98), and Olerud & Molander score was "excellent" in 5 cases, "good" in 7 cases, "fair" in 1 case and "poor" in 2 cases. Postoperative complications in 2 cases revealed a posttraumatic arthritis and a scar band contracture respectively.
CONCLUSION
In posterior malleolar fracture of ankle joint, the integrity of joint has closely affected clinical outcomes. We suggest that a posterior approach for posterior malleolar fracture with especially incarcerated fragments and comminuted fractures, can be a useful method for anatomical reduction and stable fixation, and satisfactory clinical results.

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Single lateral approach for open reduction and internal fixation of posterior malleolar fragment in Weber B rotational ankle fracture
Jaehyung Lee, Hwan Ryu, Jae Yong Park
Medicine.2023; 102(3): e32725. CrossRef
Posterior Malleolus Fractures in Trimalleolar Ankle Fractures: Malleolus versus Transyndesmal Fixation
Bilgehan Tosun, Ozgur Selek, Umit Gok, Halil Ceylan
Indian Journal of Orthopaedics.2018; 52(3): 309. CrossRef
Single Oblique Posterolateral Approach for Open Reduction and Internal Fixation of Posterior Malleolar Fractures With an Associated Lateral Malleolar Fracture
Jun Young Choi, Ji Hoon Kim, Hyeong Tak Ko, Jin Soo Suh
The Journal of Foot and Ankle Surgery.2015; 54(4): 559. CrossRef

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Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle: Jae Sung Lee, Soo Yong Kang, Han Jun Lee, Young Bong Ko; J Korean Fract Soc 2009;22(2):98-103. Published online April 30, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.2.98

Abstract PDF

PURPOSE
The purpose of this study was to classify posterior malleolar fractures according to the position of fragments and to analyze radiologic features of each type.
MATERIALS AND METHODS
We analyzed forty-six patients of ankle fractures involving a posterior malleolus who were treated between January 2004 and December 2007. The posterior malleolar fractures were categorized into three types (posterolateral, posteromedial, shell) based on the major fracture line. In each type, we analyzed amount of displacement, involvement of articular surface, existence of subluxation and osteochondral impacted fragments.
RESULTS
The forty-six patients were categorized into three types: Posterolateral (PL) type (33 cases, 72%), Posteromedial (PM) type (8 cases, 17%), shell type (5 cases, 11%). Of the 8 cases with PM type, 7 cases showed displacement more than Grade II, 4 cases showed subluxation of ankle joint, and 3 cases showed osteochondral impacted fragment. Average involvement of articular surface of PM type is 35% (15~65%).
CONCLUSION
Posterior malleolar fractures with medial extension tended to have adverse effect on ankle stability and Preoperative CT scan is essential for evaluation of fracture type and determination of appropriate surgical approach.

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Treatment of Isolated Posterior Malleolus Fracture in the Ankle
Ji Hoon Kim, Seong Mu Cha, Dae Yeon Jo, Jin Soo Suh
Journal of the Korean Orthopaedic Association.2014; 49(1): 29. CrossRef

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The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique: Jae Sung Lee, Han Jun Lee, Jae Hyun Yoo, Hee Chun Kim; J Korean Fract Soc 2009;22(1):19-23. Published online January 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.1.19

Abstract PDF: PURPOSE
To evaluate the usefullness of the percutaneous reduction technique with K-wire that could reduce the displaced posterolateral fracture fragment which persisted even after an anatomical reduction of the lateral malleolar fracture.
MATERIALS AND METHODS
From January 2004 to December 2006, we reviewed 72 patients who underwent surgical treatment for their trimalleolar fractures. We estimated the clinical and radiological results of 5 cases treated by percutaneous reduction technique with K-wire when more than the distal tibial articular step-off was left after reduction of the lateral malleolar fracture. The method of reduction starts with temporary fixation of lateral malleolar fracture followed by checking ankle radiographic image to confirm the accuracy of reduction. In case of incomplete reduction of the posterior fragment, a K-wire is inserted into the posterior fragment and pushed downward to the ankle joint level, and then lag screws were inserted.
RESULTS
The average articular involvement by the posterolateral fracture fragment was 30.2%. The average step-off after reduction of the lateral malleolar fracture was 3.7 mm. At the final follow up, step-off was less than 2 mm in all cases. In clinical results by Baird and Jackson score, 3 out of 5 cases were excellent, other 2 were good.
CONCLUSION
Percutaneous reduction technique for posterolateral fragment using the K-wire is relatively easy. This technique may be useful when the posterolateral fragment is large (more the 25% of articular surface) and not severely comminuted.

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Surgical Fixation with Biodegradable Plate for the Treatment of Ankle Fractures: Jae Young Cho, Jin Whan Kim, Sang Eun Kim, Kyung Chil Jung, Seung Hyun Choi; J Korean Fract Soc 2008;21(1):31-36. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.31

Abstract PDF

PURPOSE
The purpose of this article is to show the efficacy of a biodegradable plate for treating lateral malleolar fractures in the ankle joint.
MATERIALS AND METHODS
The 20 patients who underwent an open reduction and internal fixation for lateral malleolar fractures in the ankle joint from February, 2006 to February, 2007 in our hospital were enrolled into the study. The average age of the patients was 49.7 years and the average follow-up period was 5.6 months. The cases were analyzed by radiological bone union time and clinical results according to the criteria of Meyer et al.
RESULTS
Average radiological bone union time was 10.5 weeks. The clinical result was excellent in 19 cases (95%), good in 1 case (5%). There was one case of minimal displacement less than 1 mm, associated with anterior distal tibio-fibular ligament avulsion fracture.
CONCLUSION
For proper patients, a biodegradable plate is an effecttive alternative implant for stabilizing lateral malleolar fractures in the ankle joint, because there is no requirement for subsequent removal and slow resorption in vivo.

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Delayed Foreign-body Reaction of Ankle Fracture Treated with a Biodegradable Plate and Screws - A Case Report -
Chul-Hyun Park, Dae-Hyun Song, Jae Ho Cho
Journal of the Korean Fracture Society.2012; 25(2): 142. CrossRef

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The Necessity of Deltoid Ligament Repair in Lateral Malleolar Fracture Combined with Medial Clear Space Widening: Bo Kyu Yang, Sung Ho Hahn, Seung Rim Yi, Young Joon Ahn, Jae Ho Yoo, Min Seok Kim, Byung June Chung; J Korean Fract Soc 2005;18(3):281-285. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.281

Abstract PDF: PURPOSE
To evaluate the necessity of deltoid ligament repair in lateral malleolar fracture associated with medial clear space widening.
MATERIALS AND METHODS
The 82 cases of 82 patients received surgical treatment for lateral malleolar fracture with medial clear space widening in our hospital from Jan. 1996 to Feb. 2002. 73 male and 9 female patients were included respectively. Average follow-up period was 13.2 month (12~50). The methods of internal fixation of lateral malleolar fracture were 66 cases by cortical screw, 16 by plate and screws, and 9 by transfixing screw.
RESULTS
Satisfactory reduction was obtained in 65 of 73 cases by only internal fixation of lateral malleolar fracture. Transfixing screw was needed in 8 cases. There was no need for repair of deltoid ligament. In clinical evaluation, no cases of limitation of movement in ankle was seen at final follow-up time. In radiologic evaluation, average medial clear space widening before operation was 5.89 mm (4.5~13 mm) and that of last follow-up time was 2.54 mm (1.5~3.5 mm). 95.2% was above good result.
CONCLUSION
In treatment of unstable lateral malleolar fracture associated with medial clear space widening due to rupture of deltoid ligament, we obtained satisfactory result by accurate anatomical reduction or internal fixation. In these cases, there were no need for repair of deltoid ligament.

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Comparison between X-ray and Three Dimensional Computed Tomography in Trimalleolar Ankle Fractures: Sang Jun Song, Hyung Ku Yoon, Dong Eun Shin, Soo Hong Han, Jae Hwa Kim, Hyung Kun Park, Yong Sub Han; J Korean Fract Soc 2005;18(2):160-164. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.160

Abstract PDF

PURPOSE
To evaluate the accuracy of X-ray evaluation in classification, displacement and size of posterior malleolar fragment, comparing with three dimensional computed tomography (3D CT) in trimallelar ankle fractures.
MATERIALS AND METHODS
20 cases of trimalleolar ankle fractures evaluated with preoperative 3D CT, and followed up periods were at least 2 years. All cases were classified according to the Danis-Weber and Lauge-Hansen classification. Displacement and size of posterior malleolar fragment were measured using PACS. The reliability between simple X-ray and 3D CT was evaluated in the Danis-Weber and Lauge-Hansen classification (kappa analysis). The correlation between simple X-ray and 3D CT was evaluated in displacement and size of posterior malleolar fragment (correlation analysis).
RESULTS
Degree of agreement of Danis-Weber classification in simple X-ray and 3D CT was 0.700 kappa value, and that of Lauge-Hansen was 0.605 kappa value. Measurement of simple X-ray and 3D CT about displaced status of posterior malleolar fragment showed statistically significant positive linear correlation (p= 0.000), but correlation of measurement of size in simple X-ray and CT was not statistically significant (p=0.102).
CONCLUSION
CT or operative field will be more accurate than simple X-ray to select the method of treatment and operation, especially when the displacement and size of posterior malleolar fragment are important to decide.

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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
Gun-Woo Lee, Dong-Min Jung, Woo Kyoung Kwak, Keun-Bae Lee
Journal of the Korean Fracture Society.2022; 35(3): 91. CrossRef

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Modified Tension Band Wiring using Cortical Screw for Medial Malleolar Fractures: Ho Rim Choi, Hyun Woo Doh, Byoung Heum Kim, Kyou Hyeun Kim, Jong Seok Park, Joon Min Song; J Korean Fract Soc 2004;17(4):319-322. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.319

Abstract PDF: PURPOSE
To evaluate the clinical results of modified tension band wire technique using cortical screw for treatment of displaced medial malleolar fractures of the ankle.
MATERIALS AND METHODS
From January 2001 to January 2003, 24 patients were treated by modified tension band wiring using cortical screw for medial malleolar fracture. The follow-up period was 12~35 months (average 18 months). There were 13 males and 11 females, and the mean age was 46 years. Fractures were classified by Lauge-Hansen's classification. The results were analyzed by Meyer and Kumler's criteria.
RESULTS
There were 13 cases (54%) of excellent, 9 cases (38%) of good, and one case of fair because of limitation of motion of the ankle joint and one case of poor which showed post-traumatic arthritis of the ankle.
CONCLUSION
Modified tension band wire technique using cortical screw can be an effective operative method for the treatment of displaced medial malleolar fractures of the ankle.

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Surgical Treatment of Internal Malleolar Fracture of the Ankle: Rush Rod Versus Plate Osteosynthesis: Hak Jun Kim, Kwon Ick Ha, Jae Ik Shim, Taik Seon Kim, Jeong Ro Yoon, Young Bae Kim, Woo Seung Lee, Jae Young Chang; J Korean Soc Fract 2003;16(4):519-525. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.519

Abstract PDF: PURPOSE
We evaluated the results between the methods of open reduction and internal fixation using plate and screws and the methods of closed reduction and fixation with rush pin in lateral malleolar fractures.
MATERIALS AND METHODS
We analysed the 33 fractures of lateral malleolus which had been treated by open reduction and internal fixation using plate and screws or closed reduction and fixation with rush pin from January 1995 to January 2002 and had been observed over 1 year. The 33 patients were observed for the comparison of radiologic and clinical results in according to the measure of McLennan and Ungersma.
RESULTS
Among the 33 cases, 15 cases were treated by open reduction and internal fixation with plate, and 18 cases were treated by closed reduction and Rush rods fixation. In according to the measure of McLennan and Ungersma, good radiologic result was 60% (9 cases) and excellent clinical result was 27% (4 cases) in plate fixation, and good radiologic result was 61% (11 in 18 cases) and excellent clinical result was 39% (7 in 18 cases) in Rush rods fixation.
CONCLUSION
In ankle fractures of elderly patients who have soft tissue problems and osteoporotic bony quality, radiologic and clinical results of internal fixation of distal fibula were relatively same between fixation with plate and screws and Rush rods. Therefore, closed reduction and internal fixation with Rush rods is one of the good treatment modalities of distal fibular fracture.

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The role of posterior malleolar fragments in ankle pain after trimalleolar fractures: Su Young Bae, Dong Hoon Sihn; J Korean Soc Fract 2003;16(1):59-66. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.59

Abstract PDF

PURPOSE
There are some criticisms of indication for internal fixation of the posterior malleolar fragments in trimalleolar fractures. We tried to find out clinical and radiologic factors which affect on a clinical outcome of trimalleolar fractures.
MATERIALS AND METHODS
Thirty three patients who were treated for trimalleolar fractures and given anatomical reduction of lateral and medial malleolus were included. We divided patients into two groups, a group without the pain and the other group with the pain. Preoperative and postoperative lateral plain radiographic films were used to estimate fragment size, post-reduction gap and step off. By reviewing the medical records, other factors such as the time of ankle motion, weight loading and whether posterior malleolus was fixed. or not were stucdied. A clinical outcome was evaluated by AOFAS(American Orthopaedic Foot and Ankle Society) scaling system. We performed statistical analysis using Logistic regression analysis and Chi-square test on each factors.
RESULTS
There was no definite difference between two groups on the functional outcome. There was one case showing limited ankle motion. Seven patients were involved in the group with the pain and 23 in the group without the pain. The remnant fracture gap and step off of joint surface statistically showed the meaningful corellation with the pain but a fragment size and a surgical fixation, time of motion and weight loading did not show any significances.
CONCLUSION
We doubt the significance of the size of posterior malleolar fragment. We concluded that anatomical reduction of posterior malleolus is the most significant factor of a clinical outcome regardless of the size or internal fixation, especially the pain after trimalleolar injuries.

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Treatment of Isolated Posterior Malleolus Fracture in the Ankle
Ji Hoon Kim, Seong Mu Cha, Dae Yeon Jo, Jin Soo Suh
Journal of the Korean Orthopaedic Association.2014; 49(1): 29. CrossRef
Treatment of the Posterior Malleolar Fracture Using Posterior Approach
Hyun Wook Chung, Dong Hwan Kim, Si Hoon Yoo, Jin Soo Suh
Journal of the Korean Fracture Society.2010; 23(1): 50. CrossRef
Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle
Jae Sung Lee, Soo Yong Kang, Han Jun Lee, Young Bong Ko
Journal of the Korean Fracture Society.2009; 22(2): 98. CrossRef

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Modified Tension Band Wiring using Cortical Screw for Displaced Medial Malleolar Fractures: Jong Oh Kim, Sang Hun Ko; J Korean Soc Fract 2002;15(4):459-464. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.459

Abstract PDF: PURPOSE
To evaluate the clinical results of minimal incision and modified tension band wiring using 3.5mm cortical screw in the treatment of ankle fracture including displaced medial malleolar fractures MATERIALS AND METHODS: From March 1997 to May 2001, 77 patients were treated by modified tension band wiring using minimal incision about 4cm for medial malleolar fracture.
RESULTS
According to Lauge-Hansen classification, there were 47 supination-external rotation type fractures (61%), 14 supination -adduction type fractures (18.2%), 10 pronation-external rotation type(12.9%), 6 pronation-abduction type fracture(7.8%). The average time to union was 12.5weeks. In the functional outcome (according to Meyer and Kumler), 71 patients(92%) showed excellent results.
CONCLUSION
We concluded that modified tension band wiring using cortical screw proved effective fixation method in the treatment of the displaced medial malleolar fracture. The merits of this procedure are minimal incision about 4cm and preservation of blood supply on suprafracture area due to not injuried periosteum, stable fixation and early range of motion of joint, simple procedure and reduced surgical time.

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PROPER SCREW LENGTH FOR FIXATION OF THE MEDIAL MALLEOLAR FRACTURE OF ANKLE: Dong Bae Shin, Soo Hong Han, Seung Soo Jeon; J Korean Soc Fract 2000;13(3):522-528. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.522

Abstract PDF: PURPOSE
There is rare report about screw length in ankle fracture in spite of the anatomical characteristic that distal densest area can give enough purchase of screw threads for fixation of medial malleolar fragment. Purpose of the current study is to evaluate the results of screw fixation and to estimate proper screw length in medial malleolar fracture.
MATERIALS AND METHODS
Authors retrospectively reviewed 136 cases of medial malleolar fracture which had been performed from Janurary 1985 to December 1997. The patients were divided into 3 groups according to screw length ; under 34mm screw length (9 cases), between 35mm and 45mm (76 cases), over 46mm (50 cases). Each group was evaluated bone union time, clinical outcomes and radiological results by Meyer and Kumler.
RESULTS
Good and excellent results were achieved 121 cases (89%) on clinical result and 125 cases (91.9%) on radiological result by Meyer criteria. There were no statistical differences between three group, but the 35mm-45mm screw length group showed slightly faster union tendency.
CONCLUSION
In the treatment of medial malleolar fracture, around 40mm length screw is sufficient for fixation and it doesn,t need to use the screw over 45mm length for more rigid fixation.

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Surgical Treatment of the Bimalleolar Ankle Fractures: Kyung Jin Song, Keun Ho Yang, Kyung Rae Lee, Ju Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1999;12(4):956-960. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.956

Abstract PDF

We designed this study to evaluate the functional outcome and to suggest the guidelines in the treatment of bilnalleolar ankle fractures with clinical and radiological analysis after operative treatment. We analyzed 35 patients with bimalleolar fractures among 90 ankle fractures and followed up for more than 1 year. All 36 fractures were classified according to Lauge-Hansen system and the Meyer criteria was used for the clinical and radiological assessment. Seventeen cases(47%) were supination-external rotation(47%), 9 cases(21%) were supination- adduction: 6 cases(17%) were pronation-abduction and 4 cases(11%) were pronation-external rotation type. Satisfactory results was obtained in 32 cases(89%) according to the criteria of Meyer in the viewpoint of clinical and radiological analysis. Satisfactory results could be obtained with early anatomical reduction and rigid internal fixation for the treatment of bimalleolar ankle fractures. Distal tibiofibular syndesmosis disruption could be spontaneously reduced without trans-syndesmotic screw fixation by early open reduction and rigid internal fixation for the bimalleolar ankle fractures. Early and more accurate anatomical reduction can reduce the post-traumatic arthritis in cases with moderate talar displacement and open fractures.

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MANAGEMENT OF FRACTURES AROUND ANKLE JOINT
Pagidimarri Manasa, Devarasetty Shanmukha Sreenivas, B. Someswara Reddy
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2021; : 14. CrossRef

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HERBERT SCREW FIXATION FOR NON-COMMINUTED CLOSED MEDIAL MALLEOLAR FRACTURE: Dong Man Park, Yong Jin Kim, Jea Won Chang, Jin Cheul Park; J Korean Soc Fract 1999;12(3):638-644. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.638

Abstract PDF: It is known that the Salter-Harris type I and II fractures of the distal tibial epiphysis usually Non-comminuted closed displaced medial malleolar fracture has been treated by open reduction and internal fixation. Since fracture fragment of medial malleolar is usually thiner and smaller than that of lateral malleolar, it is more difficult to fix firmly than that of lateral malleolar. In the treatment of medial malleolar fracture, although various fixation methods in the treatment of medial malleolar fracture have been reported, several complications have been reported. And then authors have been tried to find fixation methods and firm fixation material for medial malleolar fracture to minimize complications. The purpose of this paper is to compare operation time, duration of bone union, the presence of complication, and results by Meyer and Kumler criteria between Herbert and malleolar screw and to introduce percutaneous Herbert screw fixation technique. Since March 1996, forty-four patients had undergone surgical intervention for medial malleolar fractures. Twenty-three Herbert screw and twenty-one malleolar screws were used. The results were as follows; The operation time was shorter in Herbert screw fixation group. There were no complications such as pain and tenderness due to hardware protrusion and metal lossening in Herbert screw fixation group. We come to the coonclusion that the Herbert screw fixation method was a little better than the malleolar screw fixation method according to comparison by Meyer and Kumler ctireria. We concluded that Herbert screw fixation was a better method for non-comminuted closed displaced medial malleolar fracture to obtain early union and to prevent postoperative complications.

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Arthroscopic Treatment of Isolated Anterior Malleolar Fracture of the Ankle: Dong Wha Lee, Kyoo Seog Shin, Jong Soon Kim, Yong Whee Kim; J Korean Soc Fract 1999;12(2):477-480. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.477

Abstract PDF: Isolated fractures of the anterior malleolus of the ankle are uncommon. They most often result from vertical loading or from posterior displacement of the tibia on a planted foot. Fracture of the tibial plafond with a large anterior tibial(anterior malleolus) fragment may require open reduction with internal fixation. Anatomic reduction of the articular surface can be ensured by visualizing the articular surface using an arthroscope during reduction. Two cases wherein this technique has proven effective were described.

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Percutaneous Fixation in Medial Malleolar Fracture: Phil Hyun Chung, Chung Soo Hwang, Suk Kang, Ki Se Nam, Ho Kyun Bae; J Korean Soc Fract 1999;12(2):314-320. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.314

Abstract PDF: Fracture of the ankle is one of the most common fractures. Usually medial malleolar fractures, when non-displaced or minimally displaced, have been treated by closed reduction and cast immobilization for long period, so stiffness and osteoporosis of ankle were frequently inevitable. We investigated the result of percutaneous pinning or screw fixation and early mobilization in the treatment of medial malleolar fracture of the ankle. With clinical and radiological data, authors analysed 17 patients(17 ankles) who were treated with closed reduction and percutaneous pinning or screw fixation between August 1991 and May 1997. and following results were obtained. One case of pin site infection was noted and no nonunion or loss of fixation was identified and average duration of bone union was 12 weeks. According to Burwell's protocol, the good result are 16 cases, the fair is 1 case and the poor result is not observed. From the viewpoint of rehabilitation, authors consider percutaneuos pinning is an excellent plan of treatment of medial malleolar fractures, when non-displaced or minimally displaced.

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Pitfalls in Treatment of Lateral Malleolar Frcture with Plate and Screws: Jong Min Sohn, Ju Hae Jahng, Nan Kyung Ha, Dae Hyun Baek, Hyoung Gwan Kim, Bong Heon Hyun; J Korean Soc Fract 1998;11(4):900-905. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.900

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The goal in treatment of ankle fracture is the restoration of normal ankle function. Although controversy still exists over the best method of treatment, recent ariticles emphasize importance of the anatomic reduction of fibula and the benefits of early mobilization when adequate fixation is accomplished. When we fix fracture of lateral alleolus with plte and screws, the distal screws should engage the medial cortex of the fibula but not protrude into the talofibular joint. Because the penetration of screws into ankle joint may be the cause of postoperative pain and opst-traumatic arthritis. This article has reviewed a series of 36 ankle fractures, treated from March 1993 to January 1997, using plate and screws. In order to analyse the influence of the penetration of screws into the ankle joint, all fractures were classified according to the penetrating length of screw from medial cortex of lateral malleolus. Thse with the end of the screw protnided more than 2mm into joint were clssified group I, those with less than 2mm groupp II, those with no engagement group III. The results obtained from this study were as follows: 1. According to clinical and radiolgraphic assessment of the results of the treatment, open reduction and internal fixation using plate and screws in treatment of lateral malleous was a satisfactory method. The excellent or good results were achieved in 28 patients among the 36 patients (77.8%). 2. Average time of bony union was not different significally among the three groups. 3. The gain of full range of motion was delayed in group I. 4. Patients of group I complained persistent pain and discomfort more frequently than the other groups. 5. In the treatment of lateral malleolar fracture, the distal screws should engage the medial cortex of fibula to gain firm fixation,but should not protrude more than 2mm into the ankle joint.

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Features of Lateral Malleolar Fractures in Elderly Patients and Clinical Outcome of Locking Compression Plate Fixation
Seok-Min Hwang, Hong-Geun Jung, Hyung-Jin Chung, Joon-Sang Eom, Dong-Oh Lee, Jung-Hyun Cho, Jong-Tae Park
Journal of the Korean Orthopaedic Association.2016; 51(1): 77. CrossRef

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Assessment of the Stability of the Isolated Lateral Malleolar Fracture: Woo Chun Lee, Hyun Soo Park, Young Kil Han, Jang Woon Rim, Jong Deuk Rha; J Korean Soc Fract 1998;11(4):873-879. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.873

Abstract PDF: Recent advances in the understnading of the biomechanics of the ankle have given rise to the clinical uncertainty about the indications for the operative treament of isolated fractures of the lateral malleolus. If deltoid ligament injury is associated, it may be unstable and operation may be indicated. This study was done to determine if we are able to assess the stability of the isolated lateral malleolus fracture based on the fracture patterns seen on radiographs and clinical findings. 37 patients with malleolar fracture of the ankle were treated at Hanil General Hospital by open reduction and internal fixation from Dec. 1996 to Jan. 1998. Lauge-Hansen classification was tried in all cases to determine if it could be applied. Stress test under anesthesia on 10 isolated lateral malleolar fracture patients with clinical findings of injury on the deltoid ligament area, whose medial clear space were normal or widened less than 2 mm on initial film. Exploration of the deltoid ligament was performed in 6 of above 10 patients There were 21 supination-external rotation type injuries, 2 supination-adduction injuries, 1 pronation-abduction injury and 13 fractures could not be clearly categorized into specific group. In 6 among 13 unclear cases, there were short oblique fracture lime indicating pronation injury, but direction of the fracture line could not be clearly determined. In 4 cases, direction of the fracture lime indicated pronation injury, but the length of the fracture line was too long. In 3 cases, both the direction and length of the fracture line was indeterminate. The stress test on 10 isolated lateral malleolar fraactures with clinical findings of deltoid injury revealed less than 2 mm widening in 7 cases, more than 2 mm widening in 3 cases. In 3 cases with less than 2 mm widening, tearing of anterior third of superficial deltoid was confirmed by exploration. In 3 cases with more than 3 mm widening, partial rupture of the deep deltoid was observed in 2 cases and anterior third of superficial deltoid was torn in 1 case. We suggest that we cannot clearly assess the stability of isolated lateral malleolar fracture either by fracture patterns or clinical findings, so stress test can be considered in determining the stability.

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Anterior Dislocation of the Ankle without Malleolar Fractures: A Case Report: Myung Ho Lee, Boo Man Kim, Kyung Joo Seo, Jae Yool Yi; J Korean Soc Fract 1996;9(3):814-817. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.814

Abstract PDF: Ankle dislocation without malleolar fracture is very rare injury Only a few cases were reported previously in the literature and there was no report in Korea. The authors report a case of neglected anterior dislocation of the ankle joint without malleolar fracture with review of the literature.

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The Inyo Nail for the Lateral Malleolus Fracture of the Ankle: Joon Young Kim, Young An Choi, Chang Goo Shim, Bo Seok Kong; J Korean Soc Fract 1990;3(2):252-258. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.252

Abstract PDF: The incidence of ankle fracture has been steadily increasing due to a number of traffic accident and was partly related to improved leisurely life style and outdoor activities. So, many methods for treatment of ankle fracture was introduced and some of them attract our attention. By accurate anatomical reduction and rigid fixation, maintenance of the stability of talus in ankle mortise is a goal of ankle fracture treatment. The Inyo nail is a new intramedullary device that was specially designed for the provention of shortening and ratational deformity which may occur in other conventional treatment method. The authors analysed 33 cases of lateral malleolus fracture treated conservatively(13 cases), operatively using Inyo nail(6 cases), other conventional fixational device(14 cases) from March 1987 to March 1989 and reports the indications and problems in operating technique using Inyo nail.

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Tension Band Wiring with Anchoring Screw in Medial Malleolar Fracture: Young Won Rho, Taik Keun Ahn, Jong Oh Kim, Taik Seon Kim, Jai Ik Shim; J Korean Soc Fract 1990;3(2):247-251. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.247

Abstract PDF: Since development of sports and leisure, ankle fracture occurs frequently. The goal of treatment of ankle fracture is anatomic restoration of ankle joint. With introduction of tension band wiring technique by A-O group, this technique was used popularly. The authors reported 15 cases of medial malleolar fracture in which patients were treated by tension band wiring with anchoring of screw instead of primary osseous tunnel, from September 1987 to August 1989. The advantage of modified tension band wiring technique is shortening of operative time and simplicity of technique.

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A Clinical Study of the Trimalleolar Fractures of the Ankle: Sung Jun Kim, Il Yong Choi, Tae Kun Ahn; J Korean Soc Fract 1989;2(2):145-154. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.145

Abstract PDF

Injuries about the ankle joint resulted in not only fractures of the bone but also ruture of the ligamentous and soft tissue structures and it is important that accurate reduction and rigid internal fixation of fracture as well as repair of ruptured ligament should be performed. The author analyzed 35 cases of the trimalleolar fractures of the ankle which were admitted and treated in Department of Orthopaedic Surgery, Hanyang University Hospital from january 1984 to December 1988. The results obtained from this study were as follows; 1. Among the 35 cases, male was 25 cases(71.4%), female was 10 cases(28.6%), and average age was 37.43 years. 2. The main cause of the fracture was 18 cases of slip down(51.43%), and other causes were traffic accident(22.86%), fall from a height(17.14%), sports injury(5.71%), and other injuries(2.86%). 3. Open fractures were 2 cases(5.7%), and closed fractures 33 cases(94.3%). 4. According to the classification of Lauge-Hansen, the pronation-external rotation type was 22 cases(62.86%), and the supination-external rotation type, 13 cases(37.14%). 5. Open reduction was performed in 25 cases(71.43%), and closed reduction 10 cases(28.57%). 6. The average period of the cast immobilization after open reduction was 10.7 weeks, and 8. Fractures with a posterior marginal fragment invoving 25 percent of more of the tibial articular surface, open reduction was recommended.

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Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results
Gwang Chul Lee, Jun-Young Lee, Sang-Ho Ha, Jae-Won You, Sang-Hong Lee, Hong-Moon Sohn, Ki-Young Nam, Kwang-Hyo Seo
Journal of the Korean Fracture Society.2011; 24(4): 328. CrossRef
Treatment of the Posterior Malleolar Fragment of Trimalleolar Fracture Using Posterolateral Approach - Preliminary Report -
Jun-Young Lee, Sang-Ho Ha, Kyung-Hwan Noh, Sang-Jun Lee
The Journal of the Korean Orthopaedic Association.2009; 44(4): 422. CrossRef
The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique
Jae-Sung Lee, Han-Jun Lee, Jae-Hyun Yoo, Hee-Chun Kim
Journal of the Korean Fracture Society.2009; 22(1): 19. CrossRef

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