Two-staged management of ankle fracture-dislocations with a posterior fragment: computer-tomography-based classification, treatment and its outcome.
Ankle fracture
Ankle joint osteoarthritis
Computed-tomographic fracture classification
Osteosynthesis
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
07
02
2023
accepted:
11
06
2023
medline:
11
9
2023
pubmed:
19
6
2023
entrez:
19
6
2023
Statut:
ppublish
Résumé
Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value. Current computed-tomography (CT)-based fracture classifications led to an increase in fixation of the posterior malleolus. The aim of this study was to describe the functional outcome after a two-stage stabilisation with direct fixation of the posterior fragment in trimalleolar dislocation fractures. In a retrospective study, all patients presenting with a trimalleolar dislocation fracture, an available CT scan, and a two-stage operative stabilisation including the posterior malleolus by a posterior approach were included. All fractures were treated with initial external fixator and delayed definitive stabilisation including fixation of the posterior malleolus. Next to clinical and radiological follow-up, outcome measures (Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS), Activity of Daily Living (ADL), Hulsmans implant removal score) and complications were analysed. Between 2008 and 2019, of 320 trimalleolar dislocation fractures, 39 patients were included. Mean follow-up was 49 months (standard deviation (SD) 29.7, range 16-148). Mean age was 60 years (SD 15.3, 17-84) with 69% female patients. The mean FAOS was 93/100 (SD 9.7, 57-100), NRS 2 (interquartile range (IQR) 0-3) and ADL 2 (IQR 1-2). Four patients showed a postoperative infection, three re-operations had to be performed and implants were removed in 24 individuals. A two-stage procedure of trimalleolar dislocation fractures with in-direct reduction and fixation of the posterior tibial fragment through a posterior approach leads to good functional outcome scores with a low rate of complications.
Identifiants
pubmed: 37335355
doi: 10.1007/s00402-023-04949-0
pii: 10.1007/s00402-023-04949-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
6193-6200Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Odak S, Ahluwalia R, Unnikrishnan P et al (2016) Management of posterior malleolar fractures: a systematic review. J Foot Ankle Surg 55:140–145. https://doi.org/10.1053/j.jfas.2015.04.001
doi: 10.1053/j.jfas.2015.04.001
pubmed: 26100091
Rammelt S, Bartoníček J (2020) Posterior malleolar fractures: a critical analysis review. JBJS Rev 8:e19.00207. https://doi.org/10.2106/JBJS.RVW.19.00207
doi: 10.2106/JBJS.RVW.19.00207
pubmed: 32960029
Mittlmeier T, Saß M, Randow M, Wichelhaus A (2021) Fracture of the posterior malleolus: a paradigm shift. Unfallchirurg 124:181–189. https://doi.org/10.1007/s00113-021-00954-3
doi: 10.1007/s00113-021-00954-3
pubmed: 33512552
Müller M, Allgöwer M, Schneider R, Willenegger H (1991) Manual of internal fixation. Techniques recommended by the AO-ASF group, 3. Aufl. Springer, Berlin, Heidelberg
doi: 10.1007/978-3-662-02695-3
Langenhuijsen JF, Heetveld MJ, Ultee JM et al (2002) Results of ankle fractures with involvement of the posterior tibial margin. J Trauma 53:55–60. https://doi.org/10.1097/00005373-200207000-00012
doi: 10.1097/00005373-200207000-00012
pubmed: 12131390
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. Arch Orthop Trauma Surg 139:323–329. https://doi.org/10.1007/s00402-018-3056-0
doi: 10.1007/s00402-018-3056-0
pubmed: 30430238
Bartoníček J, Rammelt S, Kostlivý K et al (2015) Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg 135:505–516. https://doi.org/10.1007/s00402-015-2171-4
doi: 10.1007/s00402-015-2171-4
pubmed: 25708027
Weigelt L, Hasler J, Flury A et al (2020) Clinical and radiological mid- to long-term results after direct fixation of posterior malleolar fractures through a posterolateral approach. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03353-2
doi: 10.1007/s00402-020-03353-2
pubmed: 31982927
Meinberg E, Agel J, Roberts C et al (2018) Fracture and dislocation classification compendium—2018. J Orthop Trauma 32:S1–S10. https://doi.org/10.1097/BOT.0000000000001063
doi: 10.1097/BOT.0000000000001063
pubmed: 29256945
Oestern H-J, Tscherne H (1984) Pathophysiology and classification of soft tissue injuries associated with fractures. Fractures with soft tissue injuries. Springer, Berlin Heidelberg, pp 1–9
Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58:453–458
doi: 10.2106/00004623-197658040-00004
pubmed: 773941
van Bergen CJA, Sierevelt IN, Hoogervorst P et al (2014) Translation and validation of the German version of the foot and ankle outcome score. Arch Orthop Trauma Surg 134:897–901. https://doi.org/10.1007/s00402-014-1994-8
doi: 10.1007/s00402-014-1994-8
pubmed: 24748232
Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS Pain), numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF). Arthritis Care Res 63:240–252. https://doi.org/10.1002/acr.20543
doi: 10.1002/acr.20543
Katz S (1963) Studies of illness in the aged. JAMA 185:914. https://doi.org/10.1001/jama.1963.03060120024016
doi: 10.1001/jama.1963.03060120024016
pubmed: 14044222
Hulsmans MHJ, van Heijl M, Houwert RM et al (2017) High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res 475:532–539. https://doi.org/10.1007/s11999-016-5113-8
doi: 10.1007/s11999-016-5113-8
pubmed: 27830484
Roos EM, Brandsson S, Karlsson J (2001) Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int 22:788–794. https://doi.org/10.1177/107110070102201004
doi: 10.1177/107110070102201004
pubmed: 11642530
Calori GM, Colombo M, Mazza EL et al (2014) Validation of the non-union scoring system in 300 long bone non-unions. Injury 45(Suppl 6):S93–S97. https://doi.org/10.1016/j.injury.2014.10.030
doi: 10.1016/j.injury.2014.10.030
pubmed: 25457326
OʼConnor TJ, Mueller B, Ly T V, et al (2015) “A to p” screw versus posterolateral plate for posterior malleolus fixation in trimalleolar ankle fractures. J Orthop Trauma 29:e151–e156. https://doi.org/10.1097/BOT.0000000000000230
doi: 10.1097/BOT.0000000000000230
pubmed: 25162973
Assal M, Dalmau-Pastor M, Ray A, Stern R (2017) How to get to the distal posterior tibial malleolus? A cadaveric anatomic study defining the access corridors through 3 different approaches. J Orthop Trauma 31:e127–e129. https://doi.org/10.1097/BOT.0000000000000774
doi: 10.1097/BOT.0000000000000774
pubmed: 28323767
Blom RP, Meijer DT, de Muinck Keizer RJO et al (2019) Posterior malleolar fracture morphology determines outcome in rotational type ankle fractures. Injury 50:1392–1397. https://doi.org/10.1016/j.injury.2019.06.003
doi: 10.1016/j.injury.2019.06.003
pubmed: 31176480
Vacas-Sánchez E, Olaya-González C, Abarquero-Diezhandino A et al (2020) How to address the posterior malleolus in ankle fractures? A decision-making model based on the computerised tomography findings. Int Orthop 44:1177–1185. https://doi.org/10.1007/s00264-020-04481-5
doi: 10.1007/s00264-020-04481-5
pubmed: 32020283
Rammelt S, Marti RK, Zwipp H (2013) Gelenkerhaltende Osteotomien fehlverheilter Sprunggelenk- und Pilonfrakturen. Unfallchirurg 116:789–796. https://doi.org/10.1007/s00113-013-2385-2
doi: 10.1007/s00113-013-2385-2
pubmed: 23975052
Yang L, Yin G, Zhu J et al (2022) Posterolateral approach for posterior malleolus fixation in ankle fractures: functional and radiological outcome based on Bartonicek classification. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-022-04620-0
doi: 10.1007/s00402-022-04620-0
pubmed: 36334141
pmcid: 10293422
Neumann AP, Rammelt S (2022) Ankle fractures involving the posterior malleolus: patient characteristics and 7-year results in 100 cases. Arch Orthop Trauma Surg 142:1823–1834. https://doi.org/10.1007/s00402-021-03875-3
doi: 10.1007/s00402-021-03875-3
pubmed: 33835195