Palmanovich et al. 56MWy52>(9a5.U,`u*wC7By*RCfoiEGH{"+r7TYL'J'W|Y*,qL"|!^'3S NSy+e |`> The Bartonek/Rammelt classification has been found 46 times in the literature, of these, 21 studies have used it as a classification system, which were included in this study and are shown in Table 5. Archives of Orthopaedic and Trauma Surgery Knee Surg Sports Traumatol Arthrosc 27, 27742780 (2019). The remaining studies used either 20% (4 studies), 30% (2 studies), or>1/3 of the joint area (5 studies) as the cut-off value, 1 study fixed the PMF in young patients or in the presence of subluxation from 10%, and 3 studies did not provide any information (Table 3). Consequently, with regard to the proportion of the affected joint surface and recommendation for surgical fixation of PMF, there is a shift away from the 1/3 dogma [7, 17, 22,23,24,25,26,27,28]. A lateral malleolus fracture can happen at several different levels. 2% (44/2332) 5. Raeder BW, Andersen MR, Madsen JE, Jacobsen SB, Frihagen F, Figved W (2021) Prognostic value of the Haraguchi classification in posterior malleolar fractures in A0 44-C type ankle fractures. https://doi.org/10.3113/FAI.2011.0385, Pfluger P, Harder F, Muller K, Biberthaler P, Cronlein M (2022) Evaluation of ankle fracture classification systems in 193 trimalleolar ankle fractures. Arch Orthop Trauma Surg 140(2):187195. Other excluded classifications were sub-entities of PMF fractures. https://doi.org/10.1053/j.jfas.2022.02.013, Sun C, Fei Z, Peng X, Li C, Zhou Q, Dong Q, Xu W (2022) Posterior locking plate fixation of bartonicek type IV posterior malleolar fracture: a focus on die-punch fragment size. BMC Musculoskelet Disord 19(1):123. https://doi.org/10.1186/s12891-018-1994-x, Gandham S, Millward G, Molloy AP, Mason LW (2020) Posterior malleolar fractures: A CT guided incision analysis. Gandham et al. 7. (2022)Cite this article. https://doi.org/10.5505/tjtes.2016.44844, Heim D, Niederhauser K, Simbrey N (2010) The Volkmann dogma: a retrospective, long-term, single-center study. Furthermore, reference lists of relevant reviews and included articles were screened for additional articles. @$ ! Foot Ankle Int 41(10):12341239. A total of 143 patients with a median age of 9 (range 612) years were analyzed. When is reduction (non-operative and operative) required? Surg Gynecol Obstet 71:509514, Mingo-Robinet J, Lopez-Duran L, Galeote JE, Martinez-Cervell C (2011) Ankle fractures with posterior malleolar fragment: management and results. 20cm proximal to medial malleolus 29.5 29.5 - . The purpose of this study was to clarify radiographic and clinical outcomes, as well as their association, of ankle sprain in children. J Ultrasound Med 36:421432, Najaf-Zadeh A, Nectoux E, Dubos F, Happiette L, Demondion X, Gnansounou M et al (2014) Prevalence and clinical significance of occult fractures in children with radiograph-negative acute ankle injury. developed a CT-based classification of PMF ascending in severity of injury [30]. has previously shown [22]. Google Scholar, Choi JY, Kim JH, Ko HT, Suh JS (2015) Single oblique posterolateral approach for open reduction and internal fixation of posterior malleolar fractures with an associated lateral malleolar fracture. This study was supported by the Research Grant of the Japanese Orthopaedic Surgery for Sports Medicine. https://doi.org/10.1016/j.fas.2020.08.003, Blom RP, Meijer DT, de Muinck Keizer RO, Stufkens SAS, Sierevelt IN, Schepers T, Kerkhoffs G, Goslings JC, Doornberg JN (2019) Posterior malleolar fracture morphology determines outcome in rotational type ankle fractures. When a medial malleolus fracture occurs by. J Foot Ankle Surg 44(3):2117. J Orthop Sci 18:298320, Noh JH, Yang BG, Yi SR, Lee SH, Song CH (2010) Outcome of the functional treatment of first-time ankle inversion injury. https://doi.org/10.1007/s00068-020-01309-0, Vosoughi AR, Jayatilaka MLT, Fischer B, Molloy AP, Mason LW (2019) CT analysis of the posteromedial fragment of the posterior malleolar fracture. PubMed Central 21 (1), 2020, 276. https://doi.org/10.1177/1071100717732746, Bartonicek J, Rammelt S, Tucek M, Nanka O (2015) Posterior malleolar fractures of the ankle. The study protocol was registered in the PROSPERO database (CRD42021264268). Injury 50(7):13921397. 380 studies were eligible for full-text analysis, after applying the exclusion criteria (no clinical study, case reports<10 patients, no classification/no PMF-specific classification), 110 remaining relevant studies were included in this review. Biomed Res 28(14):64986503, Pilskog K, Gote TB, Odland HEJ, Fjeldsgaard KA, Dale H, Inderhaug E, Fevang JM (2021) Traditional approach vs posterior approach for ankle fractures involving the posterior malleolus. The databases PubMed and Scopus were searched without time limits. https://doi.org/10.12669/pjms.36.3.1671, Martin KD, Tripp CT, Huh J (2021) Outcomes of posterior arthroscopic reduction and internal fixation (PARIF) for the posterior malleolar fragment in trimalleolar ankle fractures. J Foot Ankle Surg 61(1):109116. A type 3 fracture is characterized by a coronal fracture line that involves the entire posterior plafond due to an axial loading of a plantarflexed talus (Fig. H\n e{ ND!o?U'
&. observed an improving AOFAS score from type I to type III [65], Xie et al. Ankle fractures present as one of the most common fractures with a prevalence of 4-9% [1, 2].Posterior malleolar fracture (PMF), also known as malleolus tertius, posterior tibial fracture, or Volkmann-fragment appears in up to 44% of ankle fractures [3,4,5].If the posterior malleolus is affected, therapy results may be worse and its presence in ankle fractures is known to be of negative . 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Two studies reported reliability of the classification, both showing substantial interobserver reliability (Fleiss kappa 0.78/Cohens kappa 0.744) and almost perfect intraobserver reliability (Fleiss kappa 0.81/Cohens kappa 0.936) [24, 32]. https://doi.org/10.1097/TA.0b013e3181e4f81e, Langenhuijsen JF, Heetveld MJ, Ultee JM, Steller EP, Butzelaar RM (2002) Results of ankle fractures with involvement of the posterior tibial margin. The modified Coleman score was applied by two independent reviewers (HW, JT) (Online Resource 1). https://doi.org/10.1016/j.injury.2022.02.046. Eur J Orthop Surg Traumatol 29(6):13251330. Diagnosis of avulsion fractures of the distal fibula after lateral ankle sprain in children : a diagnostic accuracy study comparing ultrasonography with radiography. The earliest and most commonly used classification was the PMF Classification according to fracture size as first specified by Nelson and Jensen, who postulate a recommendation for treatment of PMF with a fragment size exceeding more than 1/3 of the articular surface on lateral radiographs based on a study sample consisting of 8 patients [45]. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. J Orthop Trauma 19(9):6359. There are two basic types of ankle fractures: 1) High Energy Axial Injuries: Pilon 2) Rotational Injuries: - Malleolar - either medial or lateral - Bimalleolar - both medial and lateral - Trimalleolar - includes posterior malleolus The direction of the force determines the fracture pattern - external rotation, abduction, adduction. Google Scholar, Heim D, Schmidlin V, Ziviello O (2002) Do type B malleolar fractures need a positioning screw? This may persist for several months. https://doi.org/10.1097/BOT.0000000000001486, Meijer DT, Gevers Deynoot BDJ, Stufkens SA, Sierevelt IN, Goslings JC, Kerkhoffs G, Doornberg JN (2019) What factors are associated with outcomes scores after surgical treatment of ankle fractures with a posterior malleolar fragment? https://doi.org/10.3113/FAI.2010.0959, Purnell GJ, Glass ER, Altman DT, Sciulli RL, Muffly MT, Altman GT (2011) Results of a computed tomography protocol evaluating distal third tibial shaft fractures to assess noncontiguous malleolar fractures. In the matter of inter- and intraobserver reliability, the available evidence is also meager, Bchler et al. Maybe try a search? J Trauma 66(5):138590. BMC Musculoskelet Disord. In multivariate logistic regression analysis, avulsion fracture was independently associated with recurrent sprain (P=0.027). or the fibular avulsion fracture was so large that the FOT was . J Foot Ankle Surg 55(1):1405. All Rights Reserved. The plaster was used for the first 2 weeks. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in J Foot Ankle Surg 57(1):8690. Most of the classifications are insufficient in terms of a derivable treatment algorithm or a prognosis with regard to outcome. The Bartonek/Rammelt classification was developed on the basis of a larger patient population. All authors declare that they have no conflict of interest. Avulsion fractures are frequently missed on standard anteroposterior and lateral radiographs of the ankle [13, 18]. 0
https://doi.org/10.1097/MD.0000000000012079, Baek JH, Kim TY, Kwon YB, Jeong BO (2018) Radiographic change of the distal tibiofibular joint following removal of transfixing screw fixation. Injury 22(5):4036. Bidirectional citation search was used including backward and forward citation search methods [34]. The treatment method was not standardized and was determined by the patient, their parents, and the treating physician. Google Scholar, Boutis K, Komar L, Jaramillo D, Babyn P, Alman B, Snyder B et al (2001) Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study. There are still controversial opinions for osteosynthetic treatment of PMF [69]: McDaniel and Wilson demonstrated, that if a PMF of less than 25% of the tibial joint area was not reduced, it did not significantly affect the overall outcome [58]. Foot Ankle Int 36(6):6738. https://doi.org/10.3113/FAI.2009.0309, Hong-Chuan W, Shi-Lian K, Heng-Sheng S, Gui-Gen P, Ya-Fei Z (2010) Immediate internal fixation of open ankle fractures. Injury 50(12):23122317. https://doi.org/10.1097/BOT.0000000000001605, Kellam PJ, Haller JM, Rothberg DL, Higgins TF, Marchand LS (2019) Posterior malleolar fracture morphology in tibial shaft versus rotational ankle fractures: the significance of the computed tomography scan. In addition, there are studies showing that posterior pilon fractures are a separate entity due to morphological differences [61, 94]. South Med J 58(10):12925. Minimally displaced or stable fractures: This type of fracture is barely out of place. Foot Ankle Surg 26(2):138145. 4). The score is composed of two parts. Bone Joint J 99-B(11):14961501. Rotational forces applied to a loaded foot result in a type 2A fracture in form of a primary triangular posterolateral fragment. Br J Sports Med 51:485486, van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM (2008) What is the clinical course of acute ankle sprains? Pediatrics 119:e1256e1263, Busconi BD, Pappas AM (1996) Chronic, painful ankle instability in skeletally immature athletes. They have also introduced treatment recommendations based on their classification. Detailed information about patient demographics is demonstrated in Table 2. https://doi.org/10.1016/j.jiph.2019.06.022, Amorosa LF, Brown GD, Greisberg J (2010) A surgical approach to posterior pilon fractures. *f}]_>BSmIG#\sg.i56x%)@e Google Scholar, Yde J (1980) The Lauge Hansen classification of malleolar fractures. Wir verwenden Cookies, um unsere Website und unseren Service zu optimieren. https://doi.org/10.1007/s00402-015-2171-4, Mason LW, Marlow WJ, Widnall J, Molloy AP (2017) Pathoanatomy and Associated Injuries of Posterior Malleolus Fracture of the Ankle. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. trevor lawrence passing yards . PubMed Ankle Fracture Post-op Rehabilitation Protocol This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. A few more limitations are worth noting, with majorly the limited quality of the included studies. Introduction:Traumatic rupture of posterior tibialis tendon in association with medial malleolus fracture is extremely rare.Case Presentation:We demonstrate our experience in the management of a co. Clinical studies were included for data extraction. 2022 Springer Nature Switzerland AG. The symptoms of a medial malleolus fracture are fairly predictable: Pain on the inner side of the ankle, swelling and bruising, and difficulty walking. https://doi.org/10.1016/j.fas.2015.05.003, Abdelgawad AA, Kadous A, Kanlic E (2011) Posterolateral approach for treatment of posterior malleolus fracture of the ankle. This includes the AO classification originally published in 1987 by Mller/AO, being a universal classification depicting all skeletal injuries. https://doi.org/10.1007/s00264-020-04882-6, Black AT, Stowers JM, Tenley J, Hu CY, Eshetu T, Spielfogel WD, Katchis SD, RahnamaVaghef A, Weiner LS (2021) The association between lateral radiographs and axial computed tomography of posterior malleolar fractures as a tool for predicting medial malleolar extension: a multi-center retrospective analysis. So far, Haraguchi's classification has been mentioned in 101 studies and was applied in 44 of them, which were, therefore, included and can be seen in Table 4. https://doi.org/10.1007/s40273-014-0205-3, Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. However, as the Bartonek/Rammelt classification has the greatest potential due to its treatment algorithm, its reliability in combination with consistent predictive values, its usage in clinical practice and research appears advisable. J Orthop Trauma 32(11):543547. Stress placed on the bone by a tendon or ligament causes the fracture. Advanced exercises for sports rehabilitation . https://doi.org/10.1016/j.fas.2021.02.009, Article hb```)b eaXp09im4)NEPHv@9P]H@b(xGGTybM7Y```|-b4L [1] Ankle injuries resulting in an avulsion fracture frequently happen during sudden movements and changes in direction. https://doi.org/10.1111/os.12308, Zhou Q, Lu H, Wang Z, Yu S, Zhang H (2017) Posterolateral approach with buttress plates and cannulated screw fixation for large posterior malleolus fractures. Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw . The boot you have been given is not needed to aid fracture healing but will help with your symptoms and should be worn whenever you're walking. 1 These breaks are the most common type of ankle fracture. Talus fractures usually occur due to high-impact injuries such as car accidents. which classified PMF into 3 distinct types [14]. https://doi.org/10.1016/j.injury.2015.07.019, Stringfellow TD, Walters ST, Nash W, Ahluwalia R, Posterior Malleolus Study G (2021) Management of posterior malleolus fractures: a multicentre cohort study in the United Kingdom. https://doi.org/10.1097/BOT.0b013e31828e1bb7, Erdem MN, Erken HY, Burc H, Saka G, Korkmaz MF, Aydogan M (2014) Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures. https://doi.org/10.1053/j.jfas.2017.05.028, Wang X, Zhang C, Yin JW, Wang C, Huang JZ, Ma X, Wang CW, Wang X (2017) Treatment of medial malleolus or pure deltoid ligament injury in patients with supination-external rotation Type IV ankle fractures. C-@9d[&qC~t`>#BsGhZg=oSI J Orthop Trauma 33(12):e452e458. J Am Podiatr Med Assoc. Google Scholar, Janssen KW, van Mechelen W, Verhagen EA (2014) Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. https://doi.org/10.1007/s00167-018-5055-7. Some objections against Haraguchis classification have arisen with the time. Kumar et al. J Bone Joint Surg Br 80:684688, Haraguchi N, Toga H, Shiba N, Kato F (2007) Avulsion fracture of the lateral ankle ligament complex in severe inversion injury: incidence and clinical outcome. Foot Ankle Int 39(1):99104. Cadaveric studies, review articles, case reports with fewer than 10 cases, studies that did not include a posterior malleolus specific classification, and studies not written in English, were excluded. Summarizing all of the previously described points, we believe that, to date, no classification is able to adequately describe the complexity of the PMF. Avulsion fractures are breaks or splits in the bone. Subsequently, the conviction increases that not the size, but the fracture morphology is crucial for the improvement of outcome [19]. https://doi.org/10.1016/j.fas.2019.08.007, Wang J, Wang X, Xie L, Zheng W, Chen H, Cai L (2020) Comparison of radiographs and CT features between posterior Pilon fracture and posterior malleolus fracture: a retrospective cohort study. https://doi.org/10.1007/s00264-012-1591-9, Guo J, Liu L, Yang Z, Hou Z, Chen W, Zhang Y (2017) The treatment options for posterior malleolar fractures in tibial spiral fractures. Ununited osteochondral fractures of the distal fibula. PubMed Meine Story | AGB | Impressum | Datenschutz. Lateral malleolus - end of the fibula The tibia and fibula form the ankle joint with structure and stability provided by the following connective tissues: Interosseous membrane Anterior, posterior, and transverse tibiofibular ligaments The collateral ligaments stabilize the joint against abduction and adduction forces. If the broken bone is stable and not dislocated, treatment may just. Eur J Trauma Emerg Surg 41(6):587600. Since 2015, however, a preference for the Bartonek/Rammelt classification has emerged, with the main strengths of this classification being the ascending severity of the classification and the derived therapy recommendations [29]. J Orthop Trauma 32(Suppl 1):S1S170. The ST portal was located with the ankle in extension at about 2.5 cm anterior and inferior the tip of the lateral malleolus in the sinus tarsi, . SY, RA, YS, MK, TS, and SO were involved in the conception and design of the study. Until now, there is no international consensus regarding classification and treatment of PMF [24, 31, 32]. 1 [33]. Second, that the classification was based only on axial sectional images and, therefore, fractures were only assessed in one plane, vertical size expansion not being estimated [31], that medial injuries were not evaluated, which may lead to misjudgments [17, 32], and that the extent of involvement of the tibial incisura was not specified, wherefore type I fractures include a wide range of both small and large posterolateral fragments [59]. A type 2B fracture with a secondary posteromedial fragment, usually angled at 45 to the primary fragment, occurs when the talus continues to rotate in the mortise. https://doi.org/10.1007/s00402-022-04643-7, DOI: https://doi.org/10.1007/s00402-022-04643-7. 2022 Springer Nature Switzerland AG. 5.963 patients were female and 5.231 male, 11 studies did not report gender distribution [6, 20, 24, 37,38,39,40,41,42,43,44]. Only one studied inter- and intraobserver reliability, measuring a substantial Kappa of 0.64 and 0.63 respectively [13]. They can happen when you take an awkward or uneven step that causes you to twist or roll your ankle. J Foot Ankle Surg 56(6):11731179. https://doi.org/10.1177/1071100719830999, Mason LW, Kaye A, Widnall J, Redfern J, Molloy A (2019) Posterior malleolar ankle fractures: an effort at improving outcomes. https://doi.org/10.1007/s00402-021-03875-3, Article None of the reviewed PMF classifications has been able to establish itself decisively in the literature. It also includes a treatment algorithm. Skeletal Radiol 30:504511, Maeda M, Maeda N, Takaoka T, Tanaka Y (2017) Sonographic findings of chondral avulsion fractures of the lateral ankle ligaments in children. ), Seo J, Yang KH, Shim DW, Cho H, Park YC (2022) Marginal impaction associated with posterior malleolar fracture in rotational ankle injury. PubMed Acta Orthop 85:518524, Niki H, Tatsunami S, Haraguchi N, Aoki T, Okuda R, Suda Y et al (2013) Validity and reliability of a self-administered foot evaluation questionnaire (SAFE-Q). Complex ankle fractures frequently involve the posterior malleolus. A talus fracture is a broken bone in your ankle. This study did not involve human participants. Sports Med 44:123140, Farr JN, Going SB, Lohman TG, Rankin L, Kasle S, Cornett M et al (2008) Physical activity levels in patients with early knee osteoarthritis measured by accelerometry. Classifications of posterior malleolar fractures: a systematic literature review. Biometrics 33(1):15974, Warner WC, Farber LA (1965) Trimalleolar fractures. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 2). divided Haraguchi type II into subtype A: a single fracture line extending from the fibular notch of the tibia to the medial malleolus, and subtype B: a posterior fracture lines forming 2 separate fragments, which was also applied by Sheikh et al. and Xu et al. SLACK Incorporated Thorofare, NJ. JB JS Open Access 4(2):e0058. Switaj PJ, Weatherford B, Fuchs D, Rosenthal B, Pang E, Kadakia AR (2014) Evaluation of posterior malleolar fractures and the posterior pilon variant in operatively treated ankle fractures. As the bone breaks, the part of the bone that is attached to the tendon or ligament pulls away from the rest of the bone. J Orthop Trauma 30(12):670675. The data were processed descriptively, therefore, no meta-analysis was performed. https://doi.org/10.1097/BOT.0b013e31819b0b23, Haraguchi N, Haruyama H, Toga H, Kato F (2006) Pathoanatomy of posterior malleolar fractures of the ankle. CAS The classification used in the majority of studies is the one proposed by Haraguchi [14]. Classification systems of posterior pilon fractures were also considered to be non-PMF-specific. endstream
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Int Orthop 36(9):192936. BMC Musculoskelet Disord 18(1):109. https://doi.org/10.1186/s12891-017-1475-7, Zhong S, Shen L, Zhao JG, Chen J, Xie JF, Shi Q, Wu YH, Zeng XT (2017) Comparison of posteromedial versus posterolateral approach for posterior malleolus fixation in trimalleolar ankle fractures. found most intercalary fragments (more than 2/3) in type I fractures [28], and Kang et al. Google Scholar, Papachristou G, Efstathopoulos N, Levidiotis C, Chronopoulos E (2003) Early weight bearing after posterior malleolar fractures: an experimental and prospective clinical study. Foot Ankle Surg 26(6):676680. Br J Radiol 93(1110):20191030. https://doi.org/10.1259/bjr.20191030, Palmanovich E, Ohana N, Yaacobi E, Segal D, Iftach H, Sharfman ZT, Vidra M, Atzmon R (2020) Preoperative planning and surgical technique for optimizing internal fixation of posterior malleolar fractures: CT versus standard radiographs. https://doi.org/10.1053/j.jfas.2010.12.013, Evers J, Barz L, Wahnert D, Gruneweller N, Raschke MJ, Ochman S (2015) Size matters: the influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures.
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