Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2009 Jan;22(1):19-23. Korean.
    Published online Jan 31, 2009.
    https://doi.org/10.12671/jkfs.2009.22.1.19
    Copyright © 2009 The Korean Fracture Society. All rights reserved.
    Original Article

    The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique

    Jae-Sung Lee, M.D., Han-Jun Lee, M.D., Jae-Hyun Yoo, M.D. and Hee-Chun Kim, M.D., Ph.D.*
      • Department of Orthopaedic Surgery, Yong-San Hospital, College of Medicine, Chung-Ang University, Seoul, Korea.
      • *Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.
    • Address reprint requests to: Han-Jun Lee, M.D. Department of Orthopaedic Surgery, Yong-San Hospital, College of Medicine, Chung-Ang University, 65-207, Hangang-ro 3ga, Yongsan-gu, Seoul 140-757, Korea. Tel: 82-2-748-9774, Fax: 82-2-793-6634, Email: gustinolhj@hanafos.com
    Received September 25, 2008; Revised November 06, 2008; Accepted January 03, 2009.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    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.

    Keywords
    Percutaneous reduction; Trimalleolar fracture; Posterior malleolar fracture

    Figures

    Fig. 1
    CT image shows large non-comminuted posterior malleolar fragment.

    Fig. 2
    Percutaneous K-wire location is confirmed by C-arm image. Post-reduction image (A) is taken by C-arm image intensifier and the schematic image is shown (B).

    Fig. 3
    Additional K-wire is inserted to maintain the reduction status.

    Fig. 4
    A guide wire is inserted from anteromedial to posterior direction under the C-arm monitoring.

    Fig. 5
    This photo shows completion of definite fixation. The medial malleolar fracture was reduced by non absorbable suture.

    Tables

    Table 1
    Result clinical assessment (by Baird and Jackson)

    Table 2
    The results of radiological assessment (intra-articular step-off of the distal tibia)

    References

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    MeSH Terms
    Animals
    Ankle
    Ankle Joint
    Follow-Up Studies
    Humans
    Metrics
    Share
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