Historic indications for fixation of posterior malleolus fractures- where did they come from and where are we now?

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of competing interest Dr. Julius Bishop receives royalties or licenses from Innomed and consulting fees from Stryker. He is treasurer of the Western Orthopaedic Association 10. Eur J Trauma Emerg Surg. 2015 Dec;41(6):587-600. doi: 10.1007/s00068-015-0560-6. Epub 2015 Aug 8. Posterior malleolar fractures of the ankle. Bartoníček J(1)(2), Rammelt S(3), Tuček M(4), Naňka O(5). Author information: (1)Department of Orthopaedics, First Faculty of Medicine, Charles University and Central Military Hospital Prague, U Vojenské nemocnice 1200, 169 02, Prague 6, Czech Republic. bartonicek.jan@seznam.cz. (2)Department of Anatomy, First Faculty of Medicine, Charles University Prague, U nemocnice 3, 120 00, Prague 2, Czech Republic. bartonicek.jan@seznam.cz. (3)University Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany. stefan.rammelt@uniklinikum-dresden.de. (4)Department of Orthopaedics, First Faculty of Medicine, Charles University and Central Military Hospital Prague, U Vojenské nemocnice 1200, 169 02, Prague 6, Czech Republic. (5)Department of Anatomy, First Faculty of Medicine, Charles University Prague, U nemocnice 3, 120 00, Prague 2, Czech Republic. Despite an increasing awareness of injuries to PM in ankle fracture-dislocations, there are still many open questions. The mere presence of a posterior fragment leads to significantly poorer outcomes. Adequate diagnosis, classification and treatment require preoperative CT examination, preferably with 3D reconstructions. The indication for surgical treatment is made individually on the basis of comprehensive assessment of the three-dimensional outline of the PM fracture and all associated injuries to the ankle including syndesmotic instability. Anatomic fixation of the avulsed posterior tibiofibular ligament will contribute to syndesmotic stability and restore the integrity of the incisura tibiae thus facilitating anatomic reduction of the distal fibula. A necessary prerequisite is mastering of posterolateral and posteromedial approaches and the technique of direct reduction and internal fixation. Further clinical studies with higher numbers of patients treated by similar methods and evaluation of pre- and postoperative CT scans will be necessary to determine reliable prognostic factors associated with certain types of PM fractures and associated injuries to the ankle. DOI: 10.1007/s00068-015-0560-6