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Outcomes of posterior malleolar fractures with intra-articular impacted fragment

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

An intra-articular impacted fragment (IAIF) could lead to articular incongruity and malreduction in ankle fractures with posterior malleolar fractures (PMFs). No studies have been conducted to determine whether the presence of IAIF affects the outcome of ankle fractures with PMF. The aim of our retrospective study was to evaluate the effect of IAIF on postoperative outcomes in PMF and analyze the relationship between area of IAIF and outcomes.

Materials and methods

We conducted a retrospective study of patients with a posterior malleolar fractures between June 2012 and January 2019 with a minimum follow-up of 2 years. Results of the Olerud–Molander ankle score (OMAS), EuroQol-5D (EQ-5D) index, EQ-5D visual analog scale (VAS), AOFAS (American orthopedic foot and ankle society ankle-hindfoot scale), visual analog scale (VAS) pain score and overall patient satisfaction scale were recorded. Outcomes of the PMF with IAIF group and PMF without IAIF group were compared. Sub-group analysis was given emphasis on the AIAIF > 40 mm2 group and AIAIF < 40 mm2 group in PMF with IAIF.

Results

A total of 128 patients were included in the study, consisting of 86 patients with IAIF and 42 patients without IAIF. Regarding the osteoarthritis grade (> 1,  ≤ 1), the differences werestatistically significant between the two groups (P = 0.044). The risk of articular malreduction was higher in the PMF with IAIF group than in the PMF without IAIF group (P = 0.035). Osteoarthritis grade (> 1,  ≤ 1) was closely related to articular malreduction (P < 0.001). There were 51 patients in the AIAIF > 40 mm2 group and 35 patients in the AIAIF < 40 mm2 group of 86 patients in PMF with IAIF. There were statistically significant differences in trimalleolar fracture (P = 0.004), malreduction (P = 0.022), osteoarthritis grade (> 1,  ≤ 1; P = 0.027), EQ-5D VAS score (P = 0.031), and AOFAS score (P = 0.047) between the subgroups.

Conclusion

The incidence of IAIF is associated with the area of the posterior malleolar fragment. Articular malreduction can lead to post-traumatic osteoarthritis, while IAIF is an important element for the quality of reduction, which is more likely to lead to articular malreduction. IAIF should be reduced if AIAIF is over 40 mm2. Otherwise, the patient will suffer a poor prognosis and post-traumatic osteoarthritis. Therefore, ankle fractures with PMF should undergo a CT scan preoperatively in order for providers to optimal treatment protocols.

Level of evidence

Level III.

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Acknowledgements

We thank YQ and BYZ for their support, which is essential for this work.

Funding

1. Capital’s Funds for Health Improvement and Research (Number 2020-2-4086). 2. The Beijing Municipal Science and Technology Project, Z181100001718159. 3. Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education.

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Author notes

  1. Wenyong Xie, Hao Lu, Sizheng Zhan contributed equally to this article.

Authors and Affiliations

  1. Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, 100044, China

    Wenyong Xie, Hao Lu, Sizheng Zhan, Yijun Liu, Hailin Xu, Zhongguo Fu, Dianying Zhang & Baoguo Jiang

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  1. Wenyong Xie
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  2. Hao Lu
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Contributions

WYX, HL and SZZ performed data analysis, as well as writing the manuscript. YJL, ZGF, DYZ and BGJ contributed to the collection of data and manuscript editing. HLX and HL edited the manuscript and HLX was the guarantor of this article.

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Correspondence to Hailin Xu.

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The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Ethical approval

The ethics committee of our institution has approved this study (2020PHB072-01).

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Informed consent was obtained from all individual participants included in the study by giving all patients the possibility to object by letter/e-mail.

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Xie, W., Lu, H., Zhan, S. et al. Outcomes of posterior malleolar fractures with intra-articular impacted fragment. Arch Orthop Trauma Surg 143, 141–147 (2023). https://doi.org/10.1007/s00402-021-04002-y

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