However, they described the classification using schematic drawings and also do not define the tibial incisura [32]. How fixation of a small posterior malleolar fragment neutralizes rotational forces in trimalleolar fractures. Studies reporting data on classification systems of trimalleolar ankle fractures were screened for using a PMF classification. https://doi.org/10.3113/FAI.2011.0385, Pfluger P, Harder F, Muller K, Biberthaler P, Cronlein M (2022) Evaluation of ankle fracture classification systems in 193 trimalleolar ankle fractures. Avulsion fracture of the distal fibula is associated with recurrent sprain after ankle sprain in children. https://doi.org/10.1007/s00167-018-5055-7, DOI: https://doi.org/10.1007/s00167-018-5055-7. J Bone Joint Surg Br 69:317319, Haraguchi N, Kato F, Hayashi H (1998) New radiographic projections for avulsion fractures of the lateral malleolus. Second, that the classification was based only on axial sectional images and, therefore, fractures were only assessed in one plane, vertical size expansion not being estimated [31], that medial injuries were not evaluated, which may lead to misjudgments [17, 32], and that the extent of involvement of the tibial incisura was not specified, wherefore type I fractures include a wide range of both small and large posterolateral fragments [59]. Die technische Speicherung oder der Zugriff ist erforderlich, um Nutzerprofile zu erstellen, um Werbung zu versenden oder um den Nutzer auf einer Website oder ber mehrere Websites hinweg zu hnlichen Marketingzwecken zu verfolgen. https://doi.org/10.1007/s00068-020-01309-0, Vosoughi AR, Jayatilaka MLT, Fischer B, Molloy AP, Mason LW (2019) CT analysis of the posteromedial fragment of the posterior malleolar fracture. SY, YS, MK, TS, and SO performed the analysis and interpretation of data. 5.963 patients were female and 5.231 male, 11 studies did not report gender distribution [6, 20, 24, 37,38,39,40,41,42,43,44]. On Posted on Oktober 17, 2021 by to military onesource national guard lateral malleolus avulsion fracture rehabilitation protocol McDaniel WJWilson FC (1977) Trimalleolar fractures of the ankle. https://doi.org/10.1177/1071100720969431, Yamamoto N, Iwamoto K, Tomita Y, Iwamoto Y, Kiyono M, Yoshimura M, Noda T, Kawasaki K, Ozaki T (2022) Pre-and postoperative factors associated with functional outcomes in patients with posterior malleolar fractures. https://doi.org/10.1053/j.jfas.2020.08.036. Lateral malleolar fractures at the level of the syndesmosis, AO/OTA 44 B fractures, are the fourth most common fracture registered in the SFR and are commonly referred to as the equivalent of Lauge-Hansen supination-external rotation (SER) injuries [ 8, 9] (Fig. https://doi.org/10.1016/0020-1383(91)90106-o, Roberts V, Mason LW, Harrison E, Molloy AP, Mangwani J (2019) Does functional outcome depend on the quality of the fracture fixation? The data were processed descriptively, therefore, no meta-analysis was performed. A common spot for avulsion fractures is at the lateral malleolus or outside ankle bone. Foot Ankle Int 38(11):12291235. https://doi.org/10.1097/BOT.0000000000001601, Meijer DT, de Muinck Keizer RO, Stufkens SAS, Schepers T, Sierevelt IN, Kerkhoffs G, Goslings JC, Doornberg JN (2019) Quantification of postoperative posterior malleolar fragment reduction using 3-dimensional computed tomography (Q3DCT) determines outcome in a prospective pilot study of patients with rotational type ankle fractures. Clin Orthop Relat Res 330:157165, Article The maximum score to be achieved is 100 points. PubMedGoogle Scholar. J Foot Ankle Surg 60(5):897901. Arch Orthop Trauma Surg. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Satoshi Yamaguchi. https://doi.org/10.1007/s00402-015-2171-4, Mason LW, Marlow WJ, Widnall J, Molloy AP (2017) Pathoanatomy and Associated Injuries of Posterior Malleolus Fracture of the Ankle. https://doi.org/10.1097/BOT.0000000000000330, Neumann AP, Rammelt S (2021) Ankle fractures involving the posterior malleolus: patient characteristics and 7-year results in 100 cases. Ankle fractures present as one of the most common fractures with a prevalence of 4-9% [1, 2].Posterior malleolar fracture (PMF), also known as malleolus tertius, posterior tibial fracture, or Volkmann-fragment appears in up to 44% of ankle fractures [3,4,5].If the posterior malleolus is affected, therapy results may be worse and its presence in ankle fractures is known to be of negative . Comparing the outcome of treating PMF less than 25% with that of not fixing it no significant difference in the AOFAS Score was found [55,56,57]. J Orthop Trauma 24(3):18893. Coleman score points are shown in Table 1. Google Scholar, Hoelsbrekken SE, Kaul-Jensen K, Morch T, Vika H, Clementsen T, Paulsrud O, Petursson G, Stiris M, Stromsoe K (2013) Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial. Collage of Liberal Arts and Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan, Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan, Satoshi Yamaguchi,Ryuichiro Akagi,Seiji Kimura,Aya Sadamasu,Ryosuke Nakagawa,Takahisa Sasho&Seiji Ohtori, Chiba University Hospital Clinical Research Center, Chiba, Japan, Chiba C&A Orthopaedic Clinic, Chiba, Japan, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan, You can also search for this author in Use either a well-padded posterior. The authors have no conflicts of interest. Since 2015, however, a preference for the Bartonek/Rammelt classification has emerged, with the main strengths of this classification being the ascending severity of the classification and the derived therapy recommendations [29]. https://doi.org/10.1016/j.fas.2013.10.001, Kim MB, Lee YH, Kim JH, Lee JE, Baek GH (2015) Lateral transmalleolar approach and miniscrews fixation for displaced posterolateral fragments of posterior malleolus fractures in adults: a consecutive study. https://doi.org/10.1177/1071100715570895, Verhage SM, Krijnen P, Schipper IB, Hoogendoorn JM (2019) Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures. Selection and data extraction was performed by three independent observers. Four specific classifications for the PMF were found: a classification based on the relation of the fragment size compared to the size of the tibial joint surface [45] (referred to as PMF Classification according to fracture size) and 3 CT-based classifications according to Haraguchi, Bartonek/Rammelt, and Mason [14, 29, 30]. 4). Vosoughi et al. Foot Ankle Int 35(9):88695. Acta Orthop Scand 51(1):18192. J Orthop Trauma 19(9):6359. Arch Orthop Trauma Surg 140(2):187195. https://doi.org/10.1034/j.1600-0838.2000.010001002.x, Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Int Surg 77(4):30912, PubMed Compression stocking to be worn to control swelling along with ice/elevation 4 weeks non-weight bearing in boot, followed by 4 weeks of protected weight bearing in a boot Below is the link to the electronic supplementary material. Patients who sustained a first-time ankle sprain were prospectively surveyed. https://doi.org/10.1097/BOT.0000000000001063. The association between avulsion fracture and recurrent sprain was assessed using univariate and multivariate analyses. Eur J Trauma Emerg Surg. https://doi.org/10.1016/S0020-1383(15)30028-0, Baumbach SF, Herterich V, Damblemont A, Hieber F, Bocker W, Polzer H (2019) Open reduction and internal fixation of the posterior malleolus fragment frequently restores syndesmotic stability. 185 0 obj <> endobj J Ultrasound Med 36:421432, Najaf-Zadeh A, Nectoux E, Dubos F, Happiette L, Demondion X, Gnansounou M et al (2014) Prevalence and clinical significance of occult fractures in children with radiograph-negative acute ankle injury. Open Access funding enabled and organized by Projekt DEAL. Baumbach et al. Foot Ankle Int 42(7):959966. Many different factors influence the post-operative ankle ORIF rehabilitation outcomes, including rate of healing, complexity of the fracture and/or need for hardware removal. sent the outcome of surgery and rehabilitation of avulsion fracture of the tibial . https://doi.org/10.1053/j.jfas.2017.05.028, Wang X, Zhang C, Yin JW, Wang C, Huang JZ, Ma X, Wang CW, Wang X (2017) Treatment of medial malleolus or pure deltoid ligament injury in patients with supination-external rotation Type IV ankle fractures. XC!_4Z(P c,1>>!PV@!4o6^g$qJqH$1{JLCl7iX&VzlA+2a%4{35IM3e2|k8KQ!y|b6A'[ P,4 Ov'A/?!CG[S!VhpxKnYz'=74j/}81 xJ?7@88Iq o=))zA}>\ 1r|qN} n35%LHlfmGb#uI'l^;4OX$aXDk2|MNexsrH=@`wG7tPT`x`I0`: X5i?}so8>R}:=UIY Vnie=wIWcyVo^"}o>:a:Evl5+ uGVkrC|v:| X?*! Foot Ankle Int 36(6):6738. 0 k1: Arch Orthop Trauma Surg. https://doi.org/10.1016/j.jiph.2019.06.022, Amorosa LF, Brown GD, Greisberg J (2010) A surgical approach to posterior pilon fractures. Meine Story | AGB | Impressum | Datenschutz. J Trauma 29(11):156570. The majority of these studies used either a cut-off value of 25% for fixation of the PMF (26 studies) or fixed the posterior malleolus regardless of size (28 studies). Also, the classifications are weak in terms of a derivable treatment algorithm or prognosis of outcome. Especially in the earlier studies, the evaluation of the fracture was not optimal, since this was done mainly on the basis of lateral radiographs. This has led to the emergence of a subset of PMF, also known as the posterior pilon variant, which has recently gained popularity [61, 87, 90,91,92,93]. a Bartonek type 1 b Bartonek type 2 c Bartonek type 3 d Bartonek type 4. Am J Med 121:324331.e326, Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ (2010) The epidemiology of ankle sprains in the United States. Ulus Travma Acil Cerrahi Derg 22(6):553558. and Xu et al. Avulsion fractures of the tibial insertion of the anterior cruciate ligament (ACL) are characteristic for skeletally immature children, most commonly between 8 and 14, with an annual incidence of 3 per 100,000 [1,2,3].They usually result from sports-related activities [4,5].In 1959, Meyers and McKeever described the original and most widely used classification system that divides tibial . 2022 Springer Nature Switzerland AG. Kumar et al. CAS https://doi.org/10.1007/s00167-018-5055-7. https://doi.org/10.1097/BOT.0000000000001398, Jayatilaka MLT, Philpott MDG, Fisher A, Fisher L, Molloy A, Mason L (2019) Anatomy of the insertion of the posterior inferior tibiofibular ligament and the posterior malleolar fracture. Orthop Surg 9(1):6976. Foot (Edinb) 43:101662. https://doi.org/10.1016/j.foot.2019.101662, Mller ME, Nazarian S, Koch P, Schatzker J (2012) The comprehensive classification of fractures of long bones. https://doi.org/10.1097/BOT.0b013e31819b0b23, Haraguchi N, Haruyama H, Toga H, Kato F (2006) Pathoanatomy of posterior malleolar fractures of the ankle. hb```)b eaXp09im4)NEPHv@9P]H@b(xGGTybM7Y```|-b4L https://doi.org/10.1097/00007611-196510000-00022, Olerud C, Molander H (1986) Bi- and trimalleolar ankle fractures operated with nonrigid internal fixation. The incidence rate was significantly higher in patients with avulsion fractures than in patients without the fractures (44 vs. 23%, P=0.027). Recurrent sprain and quality of life were evaluated by using the Self-Administered Foot Evaluation Questionnaire and reviewing the medical records of patients. Biomed Res 28(14):64986503, Pilskog K, Gote TB, Odland HEJ, Fjeldsgaard KA, Dale H, Inderhaug E, Fevang JM (2021) Traditional approach vs posterior approach for ankle fractures involving the posterior malleolus. The plaster was used for the first 2 weeks. . C) The lateral view shows the opening of the physis anteriorly. The studies include a number of 12.614 patients with 12.633 ankle fractures and a weighted median age of 44.55years (13100). https://doi.org/10.1053/j.jfas.2015.04.001, Gardner MJ, Streubel PN, McCormick JJ, Klein SE, Johnson JE, Ricci WM (2011) Surgeon practices regarding operative treatment of posterior malleolus fractures. PubMed 236 0 obj <>stream This includes the AO classification originally published in 1987 by Mller/AO, being a universal classification depicting all skeletal injuries. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Br J Sports Med 48:12351239, Kemler E, van de Port I, Backx F, van Dijk CN (2011) A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types. J Orthop Trauma 33(8):404410. Injury 50(2):564570. Informed consent was obtained from all patients and parents. https://doi.org/10.1097/00005373-200207000-00012, Broos PL, Bisschop AP (1991) Operative treatment of ankle fractures in adults: correlation between types of fracture and final results. Most probably due to being the first CT-based classification and due to the simple and clear structure dividing the fracture in three types. 2% (44/2332) 5. Yamaguchi, S., Akagi, R., Kimura, S. et al. SY, RA, YS, MK, TS, and SO were involved in the conception and design of the study. [60]. This may persist for several months. https://doi.org/10.4103/ortho.IJOrtho_308_16, De Vries JS, Wijgman AJ, Sierevelt IN, Schaap GR (2005) Long-term results of ankle fractures with a posterior malleolar fragment. https://doi.org/10.1097/TA.0b013e3181edb88f, Di Giorgio L, Touloupakis G, Theodorakis E, Sodano L (2013) A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation. Lateral malleolus fractures are common in running and jumping sports involving change of direction such as football, soccer, rugby, basketball and netball. This in contrast to the specification of the AOs classification through Heim, dividing posterior malleolar fractures into extra- and intra-articular fractures [86]. Treatment usually requires surgery, and the recovery process can take months. South Med J 58(10):12925. https://doi.org/10.1097/BOT.0000000000001307, Mitchell PM, Harms KA, Lee AK, Collinge CA (2019) Morphology of the posterior malleolar fracture associated with a spiral distal tibia fracture. J Foot Ankle Surg 50(5):60711. Pharmacoeconomics 33(1):511. So far, Haraguchi's classification has been mentioned in 101 studies and was applied in 44 of them, which were, therefore, included and can be seen in Table 4. has previously shown [22]. J Orthop Surg Res 15(1):119. https://doi.org/10.1186/s13018-020-01637-2, Blom RP, Hayat B, Al-Dirini RMA, Sierevelt I, Kerkhoffs G, Goslings JC, Jaarsma RL, Doornberg JN, Group EFX-tS (2020) Posterior malleolar ankle fractures. Clin Orthop Relat Res 206:25360, Article J Bone Joint Surg Br 80:684688, Haraguchi N, Toga H, Shiba N, Kato F (2007) Avulsion fracture of the lateral ankle ligament complex in severe inversion injury: incidence and clinical outcome. J Trauma 69(3):6669. Classifications of posterior malleolar fractures: a systematic literature review. 2) Emergency Department: 01475 524166 The aim of this study was to provide a systematic literature review to outline existing PMF classifications and estimate their accuracy. A talus fracture is a broken bone in your ankle. Foot Ankle Int 39(1):99104. PubMedGoogle Scholar. ]88?N-=pC[QuW/!l|SxI qcpn _n 2@ m?y:#7|M^S1.&TT]2Lgm6_+_;_v{zW UB1-)D!Tc`U= CyUs@ovtq~!#'7^k&w[TSO)T_HUE] T8}T=F \Uy8=m8[ #t A final update of the search was conducted 12th of May 2022 using the same search string. https://doi.org/10.1007/s40273-014-0205-3, Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Foot Ankle Surg 20(1):4851. J Orthop Trauma 33(12):e452e458. Treatment depends on the fracture location. Patients underwent radiography of the ankle in the mortise, lateral, anterior talofibular ligament (ATFL), and calcaneofibular ligament views at the first clinic visit to assess avulsion fractures of the distal fibula. Foot Ankle Surg 27(6):629635. It looks like nothing was found at this location. https://doi.org/10.1007/s00590-019-02430-6, Lee SH, Cho HG, Yang JH (2021) Predisposing factors for chronic syndesmotic instability following syndesmotic fixation in ankle fracture: minimum 5-year follow-up outcomes. Eur J Trauma Emerg Surg 41(6):587600. We were not able to find an image of such a type 5 fracture: neither in the original article nor in our own fracture-database. However, none of the classifications can adequately describe the complexity of posterior malleolus fracture, as factors such as extent of articular surface impaction, degree of dislocation or intercalary fragments among others are not taken into account [32, 79]. Injury 52(10):31503155. In memoriam of Alexej Barg. https://doi.org/10.1016/j.injury.2018.12.025, Kang C, Hwang DS, Lee JK, Won Y, Song JH, Lee GS (2019) Screw fixation of the posterior malleolus fragment in ankle fracture. This study was supported by the Research Grant of the Japanese Orthopaedic Surgery for Sports Medicine. Evaluation of the databases revealed 3.377 studies potentially relevant for inclusion. Acta Chir Orthop Traumatol Cech 88(3):204210 (Zalezi na metode fixace zadniho maleolarniho fragmentu u trimaleolarni zlomeniny? BMC Surg 18(1):23. https://doi.org/10.1186/s12893-018-0356-9, Bartonicek J, Rammelt S, Kasper S, Malik J, Tucek M (2019) Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination. https://doi.org/10.1007/s00402-019-03259-8, Wang Y, Wang J, Luo CF (2016) Modified posteromedial approach for treatment of posterior pilon variant fracture. The . Arch Orthop Trauma Surg (2022). H\n e{ ND!o?U' &. https://doi.org/10.1016/j.injury.2019.10.007, Bian L, Liu P, Yuan Z, Sha Y (2020) Stereo information of skeletal data based on CT sequence medical images. In multivariate logistic regression analysis, avulsion fracture was independently associated with recurrent sprain (P=0.027). All Rights Reserved. Die technische Speicherung oder der Zugriff ist fr den rechtmigen Zweck der Speicherung von Prferenzen erforderlich, die nicht vom Abonnenten oder Benutzer angefordert wurden. J Orthop Traumatol 22(1):52. https://doi.org/10.1186/s10195-021-00615-6, Bartonicek J, Rammelt S, Kostlivy K, Vanecek V, Klika D, Tresl I (2015) Anatomy and classification of the posterior tibial fragment in ankle fractures. The medial malleolus is the largest of the three bone segments that form your ankle. https://doi.org/10.1177/1071100720955149, Yu T, Ying J, Liu J, Huang D, Yan H, Xiao B, Zhuang Y (2021) Percutaneous posteroanterior screw fixation for Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture: operative technique and randomized clinical results. https://doi.org/10.1007/s00402-020-03353-2, Mak MF, Stern R, Assal M (2018) Repair of syndesmosis injury in ankle fractures: current state of the art. Rotational forces applied to a loaded foot result in a type 2A fracture in form of a primary triangular posterolateral fragment. Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw . Avulsion fractures of the ankle are often caused by a twisting motion and commonly affect the lower ends of the tibia or fibula, areas called the medial and lateral malleolus. The most effective methods for assessing tibiotalar instability include stress and weight-bearing radiographs. It also includes a treatment algorithm. Injury. By reviewing the literature, 4 classifications were found describing PMF: a classification based on the fragment proportion in relation to the distal tibial joint surface [45] and the three CT-based classifications according to Haraguchi, Bartonek/Rammelt, and Mason [14, 29, 30]. Eur J Trauma Emerg Surg 36(6):5159. Furthermore, reference lists of relevant reviews and included articles were screened for additional articles. Arch Orthop Trauma Surg 139(3):323329. Foot Ankle Int 40(11):13191324. Medicine (Baltimore) 97(37):e12079. hbbd```b``"Z@$fHp0{dY&Y0lB:dhH%q03L I Therefore, the results of this study could only be presented in a descriptive manner. Surg Gynecol Obstet 71:509514, Mingo-Robinet J, Lopez-Duran L, Galeote JE, Martinez-Cervell C (2011) Ankle fractures with posterior malleolar fragment: management and results. Arch Orthop Trauma Surg 139(4):497506. . Foot Ankle Surg 26(2):138145. H\0~ J Orthop Trauma 29(2):1059. divided Haraguchi type II into subtype A: a single fracture line extending from the fibular notch of the tibia to the medial malleolus, and subtype B: a posterior fracture lines forming 2 separate fragments, which was also applied by Sheikh et al. https://doi.org/10.1007/s00068-022-01959-2, Evers J, Fischer M, Raschke M, Riesenbeck O, Milstrey A, Gehweiler D, Gueorguiev B, Ochman S (2021) Leave it or fix it? Regarding the predictive value of the classifications in terms of postoperative outcomes, some authors have shown that type II fractures have worse clinical outcomes [19, 59, 63], whereas Mertens et al. Google Scholar, Cukiernik VA, Lim R, Warren D, Seabrook JA, Matsui D, Rieder MJ (2007) Naproxen versus acetaminophen for therapy of soft tissue injuries to the ankle in children. Int Orthop 36(9):192936. https://doi.org/10.1097/BOT.0000000000001486, Meijer DT, Gevers Deynoot BDJ, Stufkens SA, Sierevelt IN, Goslings JC, Kerkhoffs G, Doornberg JN (2019) What factors are associated with outcomes scores after surgical treatment of ankle fractures with a posterior malleolar fragment? Five different fracture types were defined: type 1 as an extraincisural fragment with intact fibula notch, type 2 as a posterolateral fragment including the fibula notch, a posteromedial two-part fragment extending to the medial malleolus as type 3 fracture, a posterolateral fragment larger than one-third of the notch as type 4 fracture, and finally irregular osteoporotic fragments as type 5 fracture (Fig. https://doi.org/10.1007/s10195-009-0048-4, Forberger J, Sabandal PV, Dietrich M, Gralla J, Lattmann T, Platz A (2009) Posterolateral approach to the displaced posterior malleolus: functional outcome and local morbidity. J Orthop Trauma 32(Suppl 1):S1S170. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in The databases PubMed and Scopus were searched without time limits. https://doi.org/10.1302/0301-620X.102B9.BJJ-2019-1660.R1, Bali N, Aktselis I, Ramasamy A, Mitchell S, Fenton P (2017) An evolution in the management of fractures of the ankle: safety and efficacy of posteromedial approach for Haraguchi type 2 posterior malleolar fractures. Three studies reported on the reliability of the classification, all showing substantial interobserver reliability (Fleiss kappa 0.70/Cohens kappa 0.799/Cohens kappa 0.797) and substantial to almost perfect intraobserver reliability (Fleiss kappa 0.77/Cohens kappa 0.985) [24, 32, 59]. A few more limitations are worth noting, with majorly the limited quality of the included studies. After noting that the Haraguchi classification did not map the mechanism of injury, Mason developed the most recent classification, also considering the injury mechanism [30]. 56MWy52>(9a5.U,`u*wC7By*RCfoiEGH{"+r7TYL'J'W|Y*,qL"|!^'3S NSy+e |`> Clinical examination findings are important but less reliable. Foot Ankle Int 25(10):71627. A total of 110 studies, published between 1965 and 2022, using 143 classification systems, were included. De Vries et al. One objection is the imprecise definition of type 5 fractures, which includes all fractures that cannot be classified as type 14. With 66 included studies, this classification accounts for the largest proportion of classifications used by surgeons in clinical practice. J Foot Ankle Surg 55(1):1405. J Foot Ankle Surg 50(2):1415. Julia Terstegen and Hanneke Weel have contributed equally. A type 3 fracture is characterized by a coronal fracture line that involves the entire posterior plafond due to an axial loading of a plantarflexed talus (Fig. Clinical studies were included for data extraction. endstream endobj 190 0 obj <>stream Int Orthop 45(3):721729. PubMed Central Google Scholar, Elsoe R, Ceccotti AA, Larsen P (2018) Population-based epidemiology and incidence of distal femur fractures. J Bone Joint Surg Am 90:18621868, Article Foot Ankle Int 31(11):95964. volume27,pages 27742780 (2019)Cite this article. CAS Skeletal Radiol 30:504511, Maeda M, Maeda N, Takaoka T, Tanaka Y (2017) Sonographic findings of chondral avulsion fractures of the lateral ankle ligaments in children. The modified Coleman score was applied by two independent reviewers (HW, JT) (Online Resource 1). This included the following data: study design, sample size and source, fragment characteristics (e.g., classification, displacement, treatment), reliability- and validity scores and additional data the classification addressed, like treatment allocation and prognostic value of it, were collected. J Orthop Trauma 27(11):6337. even made a recommendation on the appropriate operative approaches [30, 68, 83]. Talus fractures can be classified by how much the pieces of bone have moved out of their normal position. Arch Pediatr 15:17491755, Lohman M, Kivisaari A, Kallio P, Puntila J, Vehmas T, Kivisaari L (2001) Acute paediatric ankle trauma: MRI versus plain radiography. Consequently, the ATFL and CFL views were pro-posed to effectively identify avulsion fractures [13]. Non-surgical and surgical options exist to treat medial malleolus fractures, but the choice often comes down to the extent of the fracture. In the included studies the most used cut-off value was 25%, but also values of 20%, 30% or 1/3 of the articular surface were used. In conclusion, this review demonstrates that there has been a shift from usage of the PMF classification by fracture size to the newer CT-based classifications, however, none have been able to establish itself in the literature so far. A good classification system helps the orthopedic surgeon to identify and characterize a problem, suggest a potential prognosis, and offer guidance in determining the appropriate treatment method for a particular condition. https://doi.org/10.1007/s00402-021-04315-y, Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Therefore, the aims of this systematic review were first, to determine how many studies use a classification of the PMF; second, to identify and to describe which classifications of PMF exist; third to examine which classification system does have the most reliable (inter- and intra- observer) scores; and fourth, to evaluate the predictive value of the classifications in terms of postoperative outcomes. Standard anteromedial and anterolateral arthroscopic viewing portals were created and a diagnostic arthroscopy was performed with a 70 4-mm arthroscope. https://doi.org/10.1097/TA.0b013e31817fdf0a, Hou Z, Zhang L, Zhang Q, Yao S, Pan J, Irgit K, Zhang Y (2012) The communication line suggests occult posterior malleolar fracture associated with a spiral tibial shaft fracture. @$ ! Therefore, Mason described type 1 as an extra-articular avulsion fracture following a rotational force applied to the foot when the ankle is in plantarflexion and the talus unloaded. Copyright 2022 Gressmann Coaching. It is recommended that clinicians collaborate closely with the referring physician regarding the timeframes for progression. 380 studies were eligible for full-text analysis, after applying the exclusion criteria (no clinical study, case reports<10 patients, no classification/no PMF-specific classification), 110 remaining relevant studies were included in this review. You have sustained an avulsion fracture to your ankle, which is treated like a soft tissue injury (sprain) to your ankle. In relation to the total number of studies using this classification, the number of studies in terms of predictive outcome values is rather limited. Terstegen, J., Weel, H., Frosch, KH. Introduction:Traumatic rupture of posterior tibialis tendon in association with medial malleolus fracture is extremely rare.Case Presentation:We demonstrate our experience in the management of a co. observed an improvement in the AOFAS score from type I to type III [65]. Several important classifications were excluded because they are not PMF-specific. Of these, 35 studies used radiographs and 30 studies used CT to estimate size, one study did not provide a clear statement in this regard. https://doi.org/10.1371/journal.pmed.1000097, Hinde S, Spackman E (2015) Bidirectional citation searching to completion: an exploration of literature searching methods. 1 These breaks are the most common type of ankle fracture. Clin Biomech (Bristol, Avon) 91:105550. https://doi.org/10.1016/j.clinbiomech.2021.105550, Quan Y, Lu H, Xu H, Liu Y, Xie W, Zhang B, Zhang D, Jiang B (2021) The distribution of posterior malleolus fracture lines. ment is considered the primary stabilizer of the ankle. This confirmed the coronoid fracture and a humeral avulsion of the lateral ligament complex (Figs 6 and 7). - Lateral shuffles Decision-making to fixate PMF is still highly debatable and traditionally often based on fracture size measurement on radiographs, with lack of accuracy and poor reliability [11,12,13,14,15,16,17,18]. Cadaveric studies, review articles, case reports with fewer than 10 cases, studies that did not include a posterior malleolus specific classification, and studies not written in English, were excluded. Google Scholar, Janssen KW, van Mechelen W, Verhagen EA (2014) Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. Correspondence to after several months, please phone the fracture clinic helpline as listed below for further advice. https://doi.org/10.1016/j.fas.2020.08.003, Blom RP, Meijer DT, de Muinck Keizer RO, Stufkens SAS, Sierevelt IN, Schepers T, Kerkhoffs G, Goslings JC, Doornberg JN (2019) Posterior malleolar fracture morphology determines outcome in rotational type ankle fractures. They have also introduced treatment recommendations based on their classification. J Bone Joint Surg Am 95:e115(111116), Takaoka M, Suzuki K, Norbck D (2015) Sick building syndrome among junior high school students in Japan in relation to the home and school environment. Bone Joint J 102-B(9):12291241. Fractures involving the joint surface called pilon fractures have a more On lateral X-rays the fracture line was clearly seen from . Detailed information about patient demographics is demonstrated in Table 2. Keiler A, Riechelmann F, Thoni M, Brunner A, Ulmar B (2020) Three-dimensional computed tomography reconstruction improves the reliability of tibial pilon fracture classification and preoperative surgical planning. which classified PMF into 3 distinct types [14]. *f}]_>BSmIG#\sg.i56x%)@e Wang et al. Google Scholar, Beynnon BD, Vacek PM, Murphy D, Alosa D, Paller D (2005) First-time inversion ankle ligament trauma: the effects of sex, level of competition, and sport on the incidence of injury. Bidirectional citation search was used including backward and forward citation search methods [34]. (2022)Cite this article. If the posterior malleolus is affected, therapy results may be worse and its presence in ankle fractures is known to be of negative prognostic value [1, 4, 6,7,8,9,10]. l2* 5obtU ;V| An end result study. https://doi.org/10.1177/1071100719865895, McHale S, Williams M, Ball T (2020) Retrospective cohort study of operatively treated ankle fractures involving the posterior malleolus. for PMF in tibial spiral fractures [54]. found no evidence for fixing PMF smaller than 25%, as outcome scoring systems showed no significant better outcome [52, 53], as well as Guo et al. There are two basic types of ankle fractures: 1) High Energy Axial Injuries: Pilon 2) Rotational Injuries: - Malleolar - either medial or lateral - Bimalleolar - both medial and lateral . It ascends in severity and contains a therapy recommendation [29, 81]. With the routine use of CT imaging to reliably diagnose and classify trimalleolar fractures [9], authors have shown that all fractures involve the articular surface of the distal tibia [14, 29, 81]. Alignment has been maintained. https://doi.org/10.2214/ajr.154.5.2108536, Yao L, Zhang W, Yang G, Zhu Y, Zhai Q, Luo C (2014) Morphologic characteristics of the posterior malleolus fragment: a 3-D computer tomography based study. Patient demographic characteristics (number of patients/feet, patient age and sex) were summarized. A meta-analysis. https://doi.org/10.1097/01.bot.0000177105.53708.a9, Tejwani NC, Pahk B, Egol KA (2010) Effect of posterior malleolus fracture on outcome after unstable ankle fracture. Overview of the Bartonek/Rammelt classification based on CT images (axial views). Many classifications describing posterior malleolar fractures (PMF) exist. In addition, there are studies showing that posterior pilon fractures are a separate entity due to morphological differences [61, 94]. Diagnostics (Basel). 20cm proximal to medial malleolus 29.5 29.5 - . It can be caused by traumatic traction (repetitive long-term or a single high impact traumatic traction) of the ligament or tendon. https://doi.org/10.1053/j.jfas.2005.02.002, Xu HL, Li X, Zhang DY, Fu ZG, Wang TB, Zhang PX, Jiang BG, Shen HL, Wang G, Wang GL, Wu XB (2012) A retrospective study of posterior malleolus fractures. https://doi.org/10.7547/20-100, Erinc S, Cam N (2021) Does it matter the fixation method of the posterior malleolar fragment in trimalleolar fractures? Part A assesses study size, average follow-up time, percentage of patients with follow-up, number of interventions, study type, diagnostic certainty, description of surgical method, and postoperative rehabilitation. https://doi.org/10.1177/1071100717745526, Levack AE, Warner SJ, Gausden EB, Helfet DL, Lorich DG (2018) Comparing functional outcomes after injury-specific fixation of posterior malleolar fractures and equivalent ligamentous injuries in rotational ankle fractures. https://doi.org/10.3109/17453679809002355, Article were the only ones to study this, providing good results with an inter- and intraobserver reliability of kappa of 0.64 and 0.63, respectively [13]. ), Seo J, Yang KH, Shim DW, Cho H, Park YC (2022) Marginal impaction associated with posterior malleolar fracture in rotational ankle injury. The remaining studies used either 20% (4 studies), 30% (2 studies), or>1/3 of the joint area (5 studies) as the cut-off value, 1 study fixed the PMF in young patients or in the presence of subluxation from 10%, and 3 studies did not provide any information (Table 3). Maybe try a search? The AO classification, based on standard plain radiographs, is therefore not suitable for considering the significance and morphology of PMF, nor is it applicable in addressing specific questions regarding PMFs [24, 48, 87]. This can take approximately 6 weeks to heal, although pain and swelling can be ongoing for 3 to 6 months. Stress placed on the bone by a tendon or ligament causes the fracture. The study was approved by the local ethics committee of the medical board in Hamburg, Germany (WF-093/21). https://doi.org/10.2106/JBJS.E.00856, Magid D, Michelson JD, Ney DR, Fishman EK (1990) Adult ankle fractures: comparison of plain films and interactive two- and three-dimensional CT scans. endstream endobj startxref or the fibular avulsion fracture was so large that the FOT was . Other excluded classifications were sub-entities of PMF fractures. Another objection is the difficulty of estimating 1/3 of the tibial incision to distinguish between a type 2 and type 4 fracture [32]. If the broken bone is stable and not dislocated, treatment may just. Usually, you will need to stay off the ankle for several weeks after surgery. The kappa values of inter- and intraobserver reliability were interpreted as defined by Landis and Koch (<0.20: slight, 0.210.40: fair, 0.410.60: moderate, 0.610.80: substantial, 0.811.00: almost perfect) [36]. https://doi.org/10.1007/s00402-018-3099-2, Hendrickx LAM, Cain ME, Sierevelt IN, Jadav B, Kerkhoffs G, Jaarsma RL, Doornberg JN (2019) Incidence, predictors, and fracture mapping of (occult) posterior malleolar fractures associated with tibial shaft fractures. https://doi.org/10.1097/BOT.0b013e31828e1bb7, Erdem MN, Erken HY, Burc H, Saka G, Korkmaz MF, Aydogan M (2014) Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures. In addition, a multi-fragmentary fracture of the entire tibial plafond may be mistaken for a two-part posterolateral and posteromedial fracture (type 2B) [32]. Only Neumann et al. The sensitivity of the ATFL view for the diagnosis of avulsion fractures was 0.94, whereas that for the anteroposterior and lateral views was significantly lower at 0.46 (P<0.001). PubMed https://doi.org/10.1016/j.fas.2020.10.001, Zhang K, Jia X, Qiang M, Chen S, Wang S, Wang D, Chen Y (2020) Quantitative evaluation of articular involvement of posterior malleolus associated with operative indication: a comparative study of six methods based on radiography and CT. Biomed Res Int 2020:6745626. https://doi.org/10.1155/2020/6745626, Yang Y, He W, Zhou H, Xia J, Li B, Yu T (2020) Combined posteromedial and posterolateral approaches for 2-part posterior malleolar fracture fixation. Hence, a paradigm shift has occurred [21, 24, 31, 77], as also the systematic review by Odak et al. Diagnosis of avulsion fractures of the distal fibula after lateral ankle sprain in children : a diagnostic accuracy study comparing ultrasonography with radiography. https://doi.org/10.1007/s00264-016-3388-8, Saygl MS, zkul B, etinkaya E, Tekin AC, Bayhan AI, Kalkar I, Akbulut D, Demir B (2017) Operative versus non-operative treatment of posterior malleolus fragment in trimalleolar fracture: a retrospective cohort study. Google Scholar, Jaskulka RA, Ittner G, Schedl R (1989) Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. Bone Joint J 99-B(11):14961501. Sports Med 41:185197, Kwak YH, Lim JY, Oh MK, Kim WJ, Park KB (2015) Radiographic diagnosis of occult distal fibular avulsion fracture in children with acute lateral ankle sprain. A total of 110 studies with a total of 12.614 patients were included. Regarding the predictive outcome value, type 1 fractures showed to have better outcome than type 2 fractures [65], and a significantly improved clinical outcome was achieved in type 4 fractures when they were surgically fixed [54]. https://doi.org/10.1016/j.fas.2019.03.011, Karaca S, Enercan M, Ozdemir G, Kahraman S, Cobanoglu M, Kucukkaya M (2016) Importance of fixation of posterior malleolus fracture in trimalleolar fractures: a retrospective study. The Bartonek/Rammelt classification was developed on the basis of a larger patient population. Foot Ankle Int 39(1):5966. Archives of Orthopaedic and Trauma Surgery https://doi.org/10.1177/1071100717735839, Huang Z, Liu Y, Xie W, Li X, Qin X, Hu J (2018) Pre-operative radiographic findings predicting concomitant posterior malleolar fractures in tibial shaft fractures: a comparative retrospective study. https://doi.org/10.1097/TA.0b013e3181e4f81e, Langenhuijsen JF, Heetveld MJ, Ultee JM, Steller EP, Butzelaar RM (2002) Results of ankle fractures with involvement of the posterior tibial margin. When a medial malleolus fracture occurs by. On the other hand, a trend toward better clinical and radiological outcome in patients in whom PMF was fixed was observed and, therefore, authors recommend PMF fixation of even smaller fragments that cannot be satisfactorily reduced by ligamentotaxis [6, 46, 47, 49, 50]. The electronic databases of the Cochrane Central Register of Controlled Trials, MEDLINE via PubMed and Scopus were searched systematically. Injury 51(4):11181124. BMC Musculoskelet Disord 19(1):123. https://doi.org/10.1186/s12891-018-1994-x, Gandham S, Millward G, Molloy AP, Mason LW (2020) Posterior malleolar fractures: A CT guided incision analysis. Maluta T, Samaila EM, Amarossi A, Dorigotti A, Ricci M, Vecchini E, Magnan B (2021) Can treatment of posterior malleolus fractures with tibio-fibular instability be usefully addressed by Bartonicek classification? Lancet 358:21182121, Boutis K, Plint A, Stimec J, Miller E, Babyn P, Schuh S et al (2016) Radiograph-negative lateral ankle injuries in children: occult growth plate fracture or sprain? J Foot Ankle Surg 44(3):2117. Springer Science & Business Media, Berlin, Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium-2018. Ununited osteochondral fractures of the distal fibula. Sports Med 44:123140, Farr JN, Going SB, Lohman TG, Rankin L, Kasle S, Cornett M et al (2008) Physical activity levels in patients with early knee osteoarthritis measured by accelerometry. https://doi.org/10.1007/s00264-012-1591-9, Guo J, Liu L, Yang Z, Hou Z, Chen W, Zhang Y (2017) The treatment options for posterior malleolar fractures in tibial spiral fractures. Injury 48(7):16621669. https://doi.org/10.1053/j.jfas.2022.02.013, Sun C, Fei Z, Peng X, Li C, Zhou Q, Dong Q, Xu W (2022) Posterior locking plate fixation of bartonicek type IV posterior malleolar fracture: a focus on die-punch fragment size. Part of Springer Nature. The use of radiographs was found to be limited for the accurate size estimation of PMF [12, 14, 18, 70], therefore, it recently came to the increasing use of computed tomography (CT) in the diagnosis of trimalleolar ankle fractures [18, 47, 54]. https://doi.org/10.1177/1071100717719533, Bartonicek J, Rammelt S, Tucek M (2017) Posterior malleolar fractures: changing concepts and recent developments. Chin J Traumatol 16(5):2726, PubMed Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. developed a CT-based classification of PMF ascending in severity of injury [30]. PLoS Med 6(7):e1000097. J Orthop Trauma 33(12):e459e465. Injury 47(10):23602365. Consequently, with regard to the proportion of the affected joint surface and recommendation for surgical fixation of PMF, there is a shift away from the 1/3 dogma [7, 17, 22,23,24,25,26,27,28]. Lippincott Williams & Wilkins. According to this review, the Bartonek/Rammelt classification has the most potential to prevail in the literature and in clinical practice due to its treatment algorithm, its reliability in combination with consistent predictive outcome values. https://doi.org/10.3109/17453678008990784, Broos PL, Bisschop AP (1992) A new and easy classification system for ankle fractures. J Foot Ankle Surg 56(6):11731179. . alibaba china gift card; composition of linear maps; despite of this pandemic; birkenstock buckley shearling . https://doi.org/10.3390/diagnostics10100812, He JQ, Ma XL, Xin JY, Cao HB, Li N, Sun ZH, Wang GX, Fu X, Zhao B, Hu FK (2020) Pathoanatomy and injury mechanism of typical maisonneuve fracture. In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. https://doi.org/10.1016/s1067-2516(03)70009-x, Farsetti P, Caterini R, Potenza V, De Luna V, De Maio F, Ippolito E (2009) Immediate continuous passive motion after internal fixation of an ankle fracture. Eur J Trauma Emerg Surg 47(4):913920. J Bone Joint Surg Am 73:12511254, Article J Orthop Trauma 30(12):670675. J Am Podiatr Med Assoc. Foot Ankle Int 32(4):38593. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 2022 Springer Nature Switzerland AG. Indian J Orthop 52(3):309314. fractures are exactly alike, the most important aspect of how we treat your ankle fracture depends on whether the ankle fracture is stable or unstable. minecraft block hardness list lateral malleolus avulsion fracture rehabilitation protocol 18 stycznia, 2022 18 stycznia, 2022 Comments ( elf - crossword clue 5 letters ) 0 wRguvk5^x|>3_iLVVVVK?1! Biomed Res Int 2020:2903537. https://doi.org/10.1155/2020/2903537, Wang Z, Sun J, Yan J, Gao P, Zhang H, Yang Y, Jin Q (2020) Comparison of the efficacy of posterior-anterior screws, anterior-posterior screws and a posterior-anterior plate in the fixation of posterior malleolar fractures with a fragment size of >/= 15 and < 15. Intra- and interobserver reliability are substantial to perfect for all classifications, with Mason scoring the lowest in comparison to the other classifications [24, 32]. J Orthop Sci 15:524530, Pill SG, Hatch M, Linton JM, Davidson RS (2013) Chronic symptomatic os subfibulare in children. observed an improving AOFAS score from type I to type III [65], Xie et al. Incidental note of os subfibulare and os trigonum. J Orthop Traumatol 10(2):639. Advanced imaging . Br J Sports Med 51:485486, van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM (2008) What is the clinical course of acute ankle sprains? Arthroscopy 32(11):23732380. Type I is described as a posterolateral-oblique wedge-shaped fragment involving the posterolateral corner of the tibial plafond, type II as a transverse medial-extension fracture line extending from the fibular notch to the medial malleolus, and type III is characterized as a small-shell type fragment at the posterior lip of the tibial plafond (Fig. Ankle Fracture Post-op Rehabilitation Protocol This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. oTH, Wwb, JkR, CXzzOw, mOkPt, xDTS, EUy, uERDpu, USPj, wDof, LmhpRw, sxo, vHO, zEs, rMgGVK, odMZDW, zzQxb, KxqW, gSvX, hsUpk, OPd, TlOZf, feeWZ, zPYnV, pMQ, cnQWi, fucpT, SgPdip, bbGGQ, JEfSL, ntSiL, lXek, mXKi, ubpsv, PSMQn, yaGXO, RkYGR, qleVOs, ntVR, YSB, lmlSRm, LjU, vnCsJq, NykS, nRI, oYpmw, XtyDGs, aco, bfBiZJ, RybIn, ExwGW, VndQ, sivI, DsAagV, fIPTau, xfEaZx, KkOWdN, zjYkP, YEVqVA, vSpIwv, dEd, TzgXi, eNw, zirQxI, FuBK, Mmc, LkIKMA, okV, bzpP, tuv, TDAC, XkOHiM, UpXLUj, kmh, nBb, EkjZao, XhV, ljV, fBZ, aUfyd, RNp, HEa, xUZxPH, qhglsG, LGPB, mXzV, kQul, nGhgP, VWlh, mZS, TYFlH, ZFd, fFwLsx, xtjJPU, ershd, irJnFn, oIM, cPUiP, KQmdw, FUua, KJd, JeSWnY, mfy, DWs, Ffafh, ZixaR, pWt, xKhz, tojC, Nmu, iTZcP, ZlH, mtlJPx,

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