Samuel Marinus Verhage1,2, Jochem Maarten Hoogendoorn3, Pieta Krijnen4, Inger Birgitta Schipper4. 1. Department of Surgery, HMC Westeinde, Secretariaat Heelkunde F1.31, Lijnbaan 12, 2512 VA, The Hague, The Netherlands. s.verhage@haaglandenmc.nl. 2. Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands. s.verhage@haaglandenmc.nl. 3. Department of Surgery, HMC Westeinde, Secretariaat Heelkunde F1.31, Lijnbaan 12, 2512 VA, The Hague, The Netherlands. 4. Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
OBJECTIVES: Whether or not and how to fixate the posterior malleolus fracture seems to depend on the fracture fragment size and its amount of dislocation, but clear guidelines for daily practice are lacking. In this review, we summarize the literature on preferred treatment of the posterior fragment in trimalleolar fractures. METHODS: A systematic review of publications between January 1995 and April 30 2017 on this topic in the PubMed, Embase, and Cochrane databases was performed according to the PRISMA statement. RESULTS: Seventeen (2 prospective and 15 retrospective) of the 180 identified studies were included. Six studies report on indications for fixation of posterior malleolus fracture fragments. Eleven studies compare different fixation approaches and techniques for the posterior fragment. Meta-analysis was not possible due to varying fixation criteria and outcomes. There was no clear association between posterior fragment size and functional outcome or development of osteoarthritis. The non-anatomical reduction of the fragment was of more influence on outcome. Radiological and functional outcome was better after open reduction and internal fixation via the posterolateral approach than after percutaneous anterior-to-posterior screw fixation. CONCLUSION: The posterior fragment size is not a clear indication for its fixation. A step-off, however, seems an important indicator for developing posttraumatic osteoarthritis and worse functional outcome. Posterior fragments involving the intra-articular surface need to be reduced and fixated to prevent postoperative persisting step-off. Furthermore, fixation of the posterior malleolus via an open posterolateral approach seems superior to percutaneous anterior-to-posterior fixation. However, these results need to be confirmed in a prospective comparative trial. LEVEL OF EVIDENCE: Therapeutic level II.
OBJECTIVES: Whether or not and how to fixate the posterior malleolus fracture seems to depend on the fracture fragment size and its amount of dislocation, but clear guidelines for daily practice are lacking. In this review, we summarize the literature on preferred treatment of the posterior fragment in trimalleolar fractures. METHODS: A systematic review of publications between January 1995 and April 30 2017 on this topic in the PubMed, Embase, and Cochrane databases was performed according to the PRISMA statement. RESULTS: Seventeen (2 prospective and 15 retrospective) of the 180 identified studies were included. Six studies report on indications for fixation of posterior malleolus fracture fragments. Eleven studies compare different fixation approaches and techniques for the posterior fragment. Meta-analysis was not possible due to varying fixation criteria and outcomes. There was no clear association between posterior fragment size and functional outcome or development of osteoarthritis. The non-anatomical reduction of the fragment was of more influence on outcome. Radiological and functional outcome was better after open reduction and internal fixation via the posterolateral approach than after percutaneous anterior-to-posterior screw fixation. CONCLUSION: The posterior fragment size is not a clear indication for its fixation. A step-off, however, seems an important indicator for developing posttraumatic osteoarthritis and worse functional outcome. Posterior fragments involving the intra-articular surface need to be reduced and fixated to prevent postoperative persisting step-off. Furthermore, fixation of the posterior malleolus via an open posterolateral approach seems superior to percutaneous anterior-to-posterior fixation. However, these results need to be confirmed in a prospective comparative trial. LEVEL OF EVIDENCE: Therapeutic level II.
Authors: Qi-Hang Su; Juan Liu; Yan Zhang; Jun Tan; Mei-Jun Yan; Kai Zhu; Jin Zhang; Cong Li Journal: World J Clin Cases Date: 2020-01-06 Impact factor: 1.337
Authors: Andrew F Tyler; Thomas Rose; Scott Day; Jessica Kenia; Annamarie D Horan; Samir Mehta; Derek J Donegan Journal: Foot Ankle Orthop Date: 2020-07-30