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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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

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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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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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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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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