Ankle Fracture Associated with Tibia Shaft Fractures

Ji Wan Kim; Hong Joon Choi; Dong Hyun Lee; Young Chang Kim

doi:10.12671/jkfs.2014.27.2.136

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Kim, Choi, Lee, and Kim: Ankle Fracture Associated with Tibia Shaft Fractures

Original Article

Journal of the Korean Fracture Society 2014; 27(2): 136-143.

Published online: 18 April 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.2.136

Ankle Fracture Associated with Tibia Shaft Fractures

Ji Wan Kim, M.D., Hong Joon Choi, M.D., Dong Hyun Lee, M.D., Young Chang Kim, M.D.

Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Ji Wan Kim, M.D. Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, 875 Haeundaero, Haeundae-gu, Busan 612-862, Korea. Tel: 82-51-797-0990, Fax: 82-51-797-0991, bakpaker@hanmail.net

Received 19 August 2013 Revised 12 November 2013 Accepted 29 January 2014

(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 is to evaluate the incidence of ankle injury in ipsilateral tibial shaft fractures and to assess the risk factors for ankle injury associated with tibial shaft fractures.

Materials and Methods

Sixty patients with tibial shaft fractures were enrolled in this retrospective study. The incidence and characteristics of ankle injury were evaluated, and fracture classification, fracture site, and fracture pattern of the tibial shaft fractures were analyzed for assessment of the risk factors for ankle injury combined with tibial shaft fractures.

Results

Ankle injury occurred in 20 cases (33%). There were four cases of lateral malleolar fracture, four cases of posterior malleolar fracture, two cases of distal tibiofibular ligament avulsion fracture, and 10 cases of complex injury. Fourteen cases (70%) of 20 cases of ankle injury were diagnosed from x-ray films, and the other six cases were recognized in ankle computed tomography (CT). Ankle injury occurred in 45.1% of distal tibial shaft fractures and found in 41.4% of A type, but there was no statistical significance. Ankle injury was observed in 54% of cases of spiral pattern of tibial shaft fracture and the incidence was statistically higher than 19% of cases of non-spiral pattern tibial shaft fracture.

Conclusion

Ankle injury was observed in 33% of tibial shaft fractures; however, only 70% could be diagnosed by x-ray. Ankle injury occurred frequently in cases of spiral pattern of tibial shaft fracture, and evaluation of ankle injury with CT is recommended in these cases.

Keywords: Tibia, Tibia shaft fracture, Ankle fracture, Diagnosis

Figures and Tables

Fig. 1

(A) Initial tibia anteroposterior (AP) and lateral image of a 63-year-old female showing a spiral fracture at the distal third of the tibia shaft. (B) Initial ankle lateral image showing lateral and posterior malleolar fracture. (C) Axial image of ankle computed tomography showing a minimally displaced posterior malleolar fracture. (D) Postoperative tibia AP and lateral image demonstrating articular congruency after screw fixation for a posterior malleolar fragment.

Fig. 2

(A) Initial tibia anteroposterior (AP) and lateral image of a 41-year-old female showing a spiral fracture at the distal third of the tibia shaft. (B) Initial ankle lateral image showing no evidence of any articular disruption of the ankle. (C) Ankle axial computed tomography image showing a non-displaced posterior malleolar fracture. (D) Postoperative tibia AP and lateral image showing articular congruency without fixation for a posterior malleolar fragment after intramedullary nailing. (E) The tibia AP and lateral image at postoperative six months demonstrating fracture healing and no displacement of the posterior malleolar fracture.

Table 1

Demographics and Mechanism of Injury

Values are presented as median (range) or number.

Table 2

Incidence Rates of Ankle Injury Combined with Tibial Shaft Fractures

Values are presented as number (%).

Table 3

Summary of Tibial Shaft Fractures Combined with Ankle Injury

MM: Medial malleolus, LM: Lateral malleolus, PM: Posterior malleolus, ATFL: Anterior talofibular ligament, Fx: Fracture, AITFL: Anteroinferior tibiofibular ligament, PITFL: Posterior inferior tibiofibular ligament.

Table 4

Distribution of Ankle Injury and Applied Operation

ATFL: Anterior talofibular ligament, AITFL: Anteroinferior tibiofibular ligament, PITFL: Posterior inferior tibiofibular ligament.

Notes

Financial support: None.

Conflict of interest: None.

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