When and how to operate the posterior malleolus fragment in trimalleolar fractures: a systematic literature review.

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Abstract

[Indexed for MEDLINE] 16. Chin Med J (Engl). 2013 Oct;126(20):3972-7. Advances and disputes of posterior malleolus fracture. Fu S(1), Zou ZY, Mei G, Jin D. Author information: (1)Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China. OBJECTIVE: The objective of this article is to summarize the development of evaluation and treatment of posterior malleolus fracture (PMF). DATA SOURCES: Data used in this review were mainly from English literature of PubMed data base. Study selection Articles were included in this review if they were related to the PMF or trimalleolar fracture. RESULTS: No consensus was found regarding what sizes of posterior malleolus fragments would lead to ankle instability thus affecting prognosis and should be fixed. X-ray measurement is unreliable, while CT scan is widely recommended and it can recognize the occult posterior malleolus fractures associated with tibia shaft fractures, which are always undetected previously. Direct posterior malleolus fixation is suitable to stabilize syndesmotic injury. The basic and clinical researches support direct reduction and buttress plate fixation of posterior malleolus fracture through the posterolateral approach. Operative indications and timing of weight bearing are still in discussion. CONCLUSIONS: Knowing whether ankle instability occurs and the proper methods to diagnose, evaluate, and operate can help manage the fracture. Further biomechanical research on ankle stability and clinical study to compare various treatment methods are required.