Posterior malleolus fracture: a mid-term follow-up

Journal of Orthopaedic Surgery and Research

Research Article

Hao Lu¹  Chunlong Zhang¹  Yuan Quan¹  Hailin Xu¹  Boyu Zhang¹  Songyao Tian²  Jiantao Liu³  Peng Qi⁴ 

[1] Orthopaedic and Traumatology, Peking University People’s Hospital, 100044, Beijing, China;Orthopaedic, Beijing Daxing District Hospital of Integrated Chinese and Western Medicine, Beijing, China;Orthopaedic, Luanzhou People’s Hospital, Hebei, China;Orthopaedic, Qingdao Women and Children’s Hospital, Shandong, China;

关键词: Posterior malleolar fracture;    Surgical fixation;    Fracture morphology;   

DOI  :  10.1186/s13018-022-03488-5

 received in 2022-09-02, accepted in 2022-12-30,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe treatment of posterior malleolar fractures is changing rapidly, and the evidence base is still catching up. This study aimed to assess the mid-term prognosis of posterior malleolar fractures based on different morphological types and provides evidence for the treatment of posterior malleolar fractures.MethodsWe retrospectively analyzed the data of inpatients with posterior malleolar fractures from 1 January 2012 to 31 December 2019 at one high-volume tertiary trauma center. Fracture morphology was classified into small-shell fragment, single-fragment (small-fragment and large-fragment) and multifragment (double-fragment and compressive-fragment) by computed tomography according to our previous study. All patients were followed up at an average of 5.06 (range, 2.21–8.70) years. The Olerud-Molander Ankle Score (OMAS), EuroQol-5 Dimensions (EQ-5D) and American Orthopedic Foot and Ankle Society (AOFAS) score were recorded.ResultsSeventy-nine patients were included, and 7 patients were classified into the small-shell group, 52 patients into the single-fragment group and 20 patients into the multifragment group. Of all the patients, the average OMAS, EQ-5D and AOFAS scores were 85.9, 82.8 and 92.5, respectively. In the single-fragment group, patients who underwent surgical fixation in the posterior malleolus had significantly better scores (P = 0.037, 0.033 and 0.027). Among the patients with small fragments, the surgical fixation group also had higher OMAS (93.1 ± 7.5 vs. 83.5 ± 19.5, P = 0.042) and AOFAS scores (98.1 ± 3.1 vs. 91.0 ± 14.1, P = 0.028). The mean OMAS, EQ-5D and AOFAS scores were 85.5, 85.7 and 91.7, respectively, in patients with multiple fragments who underwent surgical fixation.ConclusionThis study shows that in fractures with a single fragment, surgical fixation of the posterior malleolar fragment led to a better prognosis in the midterm. All single fragments should be fixed regardless of size. Fixation of the posterior region in all single- and multi-fragments in posterior malleolar fractures led to satisfactory outcomes.Level of EvidenceLevel III, follow-up study.

【 授权许可】

CC BY   
© The Author(s) 2023

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