Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle

Jae Sung Lee; Soo Yong Kang; Han Jun Lee; Young Bong Ko

doi:10.12671/jkfs.2009.22.2.98

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Lee, Kang, Lee, and Ko: Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle

Original Article

Journal of the Korean Fracture Society 2009; 22(2): 98-103.

Published online: 30 April 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.2.98

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., 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, sooykang@hitel.net

Received 1 August 2008 Revised 27 October 2008 Accepted 27 February 2009

(open-access):

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 and Tables

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.

Table 1

Summary of results

^*Type I: Posterolateral type, ^†Type II-A: Posteromedial type (involved to anterior colliculus), ^‡Type II-B: Posteromedial type (involved to posterior colliculus), ^§Type III: Shell type

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