Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2009 Apr;22(2):98-103. Korean.
    Published online Apr 30, 2009.
    https://doi.org/10.12671/jkfs.2009.22.2.98
    Copyright © 2009 The Korean Fracture Society. All rights reserved.
    Original Article

    Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle

    Jae Sung Lee, M.D., Soo Yong Kang, M.D., Han Jun Lee, M.D. and Young Bong Ko, M.D.
      • Department of Orthopaedic Surgery, Yong-San Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
    • Address reprint requests to: Soo Yong Kang, M.D. Department of Orthopaedic Surgery, Yong-San Hospital, Chung-Ang University College of Medicine, 65-207, Hangang-ro 3ga, Yongsan-gu, Seoul 140-757, Korea. Tel: 82-2-748-9848, Fax: 82-2-793-6634, Email: sooykang@hitel.net
    Received August 01, 2008; Revised October 27, 2008; Accepted February 27, 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

    The purpose of this study was to classify posterior malleolar fractures according to the position of fragments and to analyze radiologic features of each type.

    Materials and Methods

    We analyzed forty-six patients of ankle fractures involving a posterior malleolus who were treated between January 2004 and December 2007. The posterior malleolar fractures were categorized into three types (posterolateral, posteromedial, shell) based on the major fracture line. In each type, we analyzed amount of displacement, involvement of articular surface, existence of subluxation and osteochondral impacted fragments.

    Results

    The forty-six patients were categorized into three types: Posterolateral (PL) type (33 cases, 72%), Posteromedial (PM) type (8 cases, 17%), shell type (5 cases, 11%). Of the 8 cases with PM type, 7 cases showed displacement more than Grade II, 4 cases showed subluxation of ankle joint, and 3 cases showed osteochondral impacted fragment. Average involvement of articular surface of PM type is 35% (15~65%).

    Conclusion

    Posterior malleolar fractures with medial extension tended to have adverse effect on ankle stability and Preoperative CT scan is essential for evaluation of fracture type and determination of appropriate surgical approach.

    Keywords
    Ankle joint; Posterior malleolar fracture; Radiologic analysis

    Figures

    Fig. 1
    Transverse CT scans showing a type of the posterior malleolar fractures.

    (A) Type I fracture of the posterior malleolar, with triangular fragment involving the posterolateral corner of the tibial plafond.

    (B) Type II-A fracture of the posterior malleolus with extension of the fracture line to the anterior part of the medial malleolar (anterior colliculus).

    (C) Type II-B fracture of the posterior malleolar, with extension of the fracture line to the posterior colliculus.

    (D) Type III fracture of the posterior malleolar, with small shell-shaped fragments at the posterior lip of the tibial plafond.

    Fig. 2
    (A) A 62 years old woman had a posterior malleolar fragment. The fracture line extends to the anterior part of the medial malleolar (anterior colliculus).

    (B) Access between medial malleolar and the posteromedial fragment (arrow). The posteromedial fragment was fixed with buttress plate, and posterolateral fragment was fixed with cannulated screw.

    Fig. 3
    (A) A 65 years old woman had a trimalleolar fracture. The medial double contour is well visible (arrow). The posterior malleolar fracture line extends to the posterior colliculus.

    (B) Access between achilles tendon and the peroneus tendon (arrow). The posterior malleolar was fixed with buttress plate, and impacted fragment was fixed with screw.

    Fig. 4
    Diagram of treatment of posterior malleolar fracture.

    Tables

    Table 1
    Summary of results

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    MeSH Terms
    Animals
    Ankle
    Ankle Joint
    Displacement (Psychology)
    Humans
    Metrics
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