Maybe try a search? The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. With the routine use of CT imaging to reliably diagnose and classify trimalleolar fractures [9], authors have shown that all fractures involve the articular surface of the distal tibia [14, 29, 81]. This confirmed the coronoid fracture and a humeral avulsion of the lateral ligament complex (Figs 6 and 7). Lateral. Zhang et al. Injury 33(8):72934. Lippincott Williams & Wilkins. Anatomic reduction is preferred. avulsion tip fractures of medial or lateral malleolus . The arm was exsanguinated and the high-arm tourniquet inflated to 250 mmHg. https://doi.org/10.3390/diagnostics10100812, He JQ, Ma XL, Xin JY, Cao HB, Li N, Sun ZH, Wang GX, Fu X, Zhao B, Hu FK (2020) Pathoanatomy and injury mechanism of typical maisonneuve fracture. Arthroscopy 32(11):23732380. which classified PMF into 3 distinct types [14]. 1 ). 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. Hence, a paradigm shift has occurred [21, 24, 31, 77], as also the systematic review by Odak et al. Avulsion fractures were present in 89 (62%) patients. l2* 5obtU ;V| J Pediatr Orthop 35:352357, Launay F, Barrau K, Simeoni MC, Jouve JL, Bollini G, Auquier P (2008) [Ankle injury without fracture in children: cast immobilization versus symptomatic treatment. You may walk on the foot as comfort allows although you may find it easier to walk with crutches in the early stages. Also, the three modifications found [61, 62, 80] may suggest that Haraguchis classification is not as advanced to represent all fracture types. Percutaneous skeletal fixation. Lateral malleolus avulsion fracture This information will guide you through the next 6 weeks of your rehabilitation. Subsequently, the conviction increases that not the size, but the fracture morphology is crucial for the improvement of outcome [19]. J Trauma 69(3):6669. Ann Chir Gynaecol 72:7175, CAS Learn more about Institutional subscriptions, Berg EE (1991) The symptomatic os subfibulare. 0 Fractures involving the joint surface called pilon fractures have a more Weighted median scores were calculated for the modified Coleman score and for the age of the evaluated patient cohort. CAS 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, . has previously shown [22]. Until now, there is no international consensus regarding classification and treatment of PMF [24, 31, 32]. 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? Avulsion fractures of the tibial insertion of the anterior cruciate ligament (ACL) are characteristic for skeletally immature children, most commonly between 8 and 14, with an annual incidence of 3 per 100,000 [1,2,3].They usually result from sports-related activities [4,5].In 1959, Meyers and McKeever described the original and most widely used classification system that divides tibial . _(2PHEPc55b)Y3V,)>'R"Tf#[8g.sRB,*0P[J3n(0epE:Dt!N08JaP$s,CY&+wl r]Mv!k1>cr40l8b/g3&~7K&WltY*~?/GuYWMIMSjZf'igmu;['gi6t?qjs5QU-8Y+y^5>?_~],BkXnB/Z/vyW.6ey{ss*yt3j-5YIja]g7gyx6XaU\jv_/W~mZdK{x4.>,Idw`O{L}z_-$wc5O@ $pI36O[!&6k'ca&N3g(tA$Os3aA,4zl(XBt+LKuqqfN^EE`.fPj-V*RTD@,+[E4; -_Zm^ W=9_dvTH_Nu7tl|,W*_J_EHM+mZ\\\!q;%%d`@,aI.o~y}A:#((/4M5KE-xghZ!r!R The medial malleolus is the largest of the three bone segments that form your ankle. J Orthop Trauma 24(3):18893. If the posterior malleolus is affected, therapy results may be worse and its presence in ankle fractures is known to be of negative prognostic value [1, 4, 6,7,8,9,10]. ment is considered the primary stabilizer of the ankle. Orthop Surg 9(1):6976. J Orthop Trauma 19(9):6359. The kappa values of inter- and intraobserver reliability were interpreted as defined by Landis and Koch (<0.20: slight, 0.210.40: fair, 0.410.60: moderate, 0.610.80: substantial, 0.811.00: almost perfect) [36]. https://doi.org/10.1016/j.injury.2016.07.031, Chan KB, Lui TH (2016) Role of ankle arthroscopy in management of acute ankle fracture. Bone Joint J 99-B(11):14961501. J Foot Ankle Surg 57(1):8690. PubMed Int Orthop 36(9):192936. https://doi.org/10.1302/0301-620X.102B9.BJJ-2019-1660.R1, Bali N, Aktselis I, Ramasamy A, Mitchell S, Fenton P (2017) An evolution in the management of fractures of the ankle: safety and efficacy of posteromedial approach for Haraguchi type 2 posterior malleolar fractures. Biometrics 33(1):15974, Warner WC, Farber LA (1965) Trimalleolar fractures. The most effective methods for assessing tibiotalar instability include stress and weight-bearing radiographs. Only one studied inter- and intraobserver reliability, measuring a substantial Kappa of 0.64 and 0.63 respectively [13]. The repair is typically done with a plate and screws. Google Scholar, Yde J (1980) The Lauge Hansen classification of malleolar fractures. BMC Musculoskelet Disord 19(1):51. https://doi.org/10.1186/s12891-018-1974-1, Hou Z, Zhang Q, Zhang Y, Li S, Pan J, Wu H (2009) A occult and regular combination injury: the posterior malleolar fracture associated with spiral tibial shaft fracture. 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. Open Access funding enabled and organized by Projekt DEAL. https://doi.org/10.1177/1071100714537630. Should you have any worries or concerns following discharge from hospital, please contact either the: 1) Fracture Clinic: 01475 504547 (8.30am - 4.30pm Mon - Fri / 8.30am - 11.30am Sat) or . . Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Factors such as syndesmotic stability, joint congruity, postoperative step-off, reconstruction of the incisura, intercalary fragments and talar subluxation are thought to be of prognostic importance to consider when treating PMF [7, 23, 48, 50, 51, 53, 58, 63, 71,72,73,74,75,76]. Rehabilitation Program Physical Therapy As always, acute management of ankle fractures involves analgesics for pain, immobilization, and patient comfort. Regarding the predictive value of the classifications in terms of postoperative outcomes, some authors have shown that type II fractures have worse clinical outcomes [19, 59, 63], whereas Mertens et al. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Google Scholar, Heim D, Schmidlin V, Ziviello O (2002) Do type B malleolar fractures need a positioning screw? Injury 50(12):23122317. A) The AP view shows that the fracture is intra-articular. Many different factors influence the post-operative ankle ORIF rehabilitation outcomes, including rate of healing, complexity of the fracture and/or need for hardware removal. 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). All displaced or angulated fractures should have a reduction. A final update of the search was conducted 12th of May 2022 using the same search string. J Foot Ankle Surg 55(1):1405. Modifications of the Haraguchi classification were found three times. https://doi.org/10.1007/s00402-020-03353-2, Mak MF, Stern R, Assal M (2018) Repair of syndesmosis injury in ankle fractures: current state of the art. 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. The purpose of this study was to clarify radiographic and clinical outcomes, as well as their association, of ankle sprain in children. endstream endobj 186 0 obj <>/Metadata 7 0 R/PageLayout/OneColumn/Pages 183 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 187 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 188 0 obj <>stream a Bartonek type 1 b Bartonek type 2 c Bartonek type 3 d Bartonek type 4. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Sixty-six studies that used the size of the PMF in relation to the joint surface as a classification could be included. were the only ones to study this, providing good results with an inter- and intraobserver reliability of kappa of 0.64 and 0.63, respectively [13]. Julia Terstegen and Hanneke Weel have contributed equally. Injury 47(3):75761. Also, the classifications are weak in terms of a derivable treatment algorithm or prognosis of outcome. PubMed Foot (Edinb) 45:101725. https://doi.org/10.1016/j.foot.2020.101725, Nelson M, Jensen N (1940) The treatment of trimalleolar fractures of the ankle. https://doi.org/10.1016/j.injury.2019.10.007, Bian L, Liu P, Yuan Z, Sha Y (2020) Stereo information of skeletal data based on CT sequence medical images. In terms of predictive values, type II fractures were regarded to show worse outcome [19, 59, 63], have higher presence of osteoarthritis [59], and are more likely to require placement of 2 syndesmotic screws [41]. %%EOF J Foot Ankle Surg. https://doi.org/10.1053/j.jfas.2005.02.002, Xu HL, Li X, Zhang DY, Fu ZG, Wang TB, Zhang PX, Jiang BG, Shen HL, Wang G, Wang GL, Wu XB (2012) A retrospective study of posterior malleolus fractures. https://doi.org/10.1177/1071100717745526, Levack AE, Warner SJ, Gausden EB, Helfet DL, Lorich DG (2018) Comparing functional outcomes after injury-specific fixation of posterior malleolar fractures and equivalent ligamentous injuries in rotational ankle fractures. Below is the link to the electronic supplementary material. Foot Ankle Int 35(9):88695. Four specific classifications for the PMF were found: a classification based on the relation of the fragment size compared to the size of the tibial joint surface [45] (referred to as PMF Classification according to fracture size) and 3 CT-based classifications according to Haraguchi, Bartonek/Rammelt, and Mason [14, 29, 30]. J Bone Joint Surg Am 90:18621868, Article https://doi.org/10.1016/j.fas.2020.10.001, Zhang K, Jia X, Qiang M, Chen S, Wang S, Wang D, Chen Y (2020) Quantitative evaluation of articular involvement of posterior malleolus associated with operative indication: a comparative study of six methods based on radiography and CT. Biomed Res Int 2020:6745626. https://doi.org/10.1155/2020/6745626, Yang Y, He W, Zhou H, Xia J, Li B, Yu T (2020) Combined posteromedial and posterolateral approaches for 2-part posterior malleolar fracture fixation. 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. after several months, please phone the fracture clinic helpline as listed below for further advice. PubMed Central 4% (103/2332) Die technische Speicherung oder der Zugriff, der ausschlielich zu statistischen Zwecken erfolgt. J Orthop Surg (Hong Kong) 29(1):2309499021997996. https://doi.org/10.1177/2309499021997996, Ceccarini P, Rinonapoli G, Antinolfi P, Caraffa A (2021) Effectiveness of ankle arthroscopic debridement in acute, subacute ankle- bimalleolar, and trimalleolar fractures. Wang et al. A systematic literature review. The same rehabilitation protocol was applied for both groups postoperatively. Bone Joint J 102-B(9):12291241. 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. Eur J Trauma Emerg Surg 36(6):5159. Only studies written in English were considered, excluding further useful contributions written in other languages. Medicine (Baltimore) 97(37):e12079. Orthobullets Team Trauma - Ankle Fractures . Foot Ankle Int 35(10):102230. https://doi.org/10.1016/j.arthro.2016.08.016, Naumann MG, Sigurdsen U, Utvag SE, Stavem K (2017) Associations of timing of surgery with postoperative length of stay, complications, and functional outcomes 36 years after operative fixation of closed ankle fractures. Selection and data extraction was performed by three independent observers. Disagreements were discussed in a consensus meeting and if a disagreement persisted, a third reviewer (HW) made the final decision. https://doi.org/10.1007/s10195-009-0048-4, Forberger J, Sabandal PV, Dietrich M, Gralla J, Lattmann T, Platz A (2009) Posterolateral approach to the displaced posterior malleolus: functional outcome and local morbidity. Arch Orthop Trauma Surg 140(11):16411647. There were 22 prospective studies, 88 retrospective studies; 11 studies were multicenter, and 99 single center studies (Table 1). Studies reporting data on classification systems of trimalleolar ankle fractures were screened for using a PMF classification. Injury 46(4):S109S113. Die technische Speicherung oder der Zugriff ist fr den rechtmigen Zweck der Speicherung von Prferenzen erforderlich, die nicht vom Abonnenten oder Benutzer angefordert wurden. Int Orthop 45(3):721729. However, they described the classification using schematic drawings and also do not define the tibial incisura [32]. SY, YS, MK, TS, and SO performed the analysis and interpretation of data. The most effective methods for assessing tibiotalar instability include stress and weight-bearing radiographs. This study was approved by the Institutional Review Board of our institute. H\n e{ ND!o?U' &. Specific changes in the program will be made by the . Another CT-based classification was presented by Bartonek/Rammelt in 2015 [29]. The treatment method was not standardized and was determined by the patient, their parents, and the treating physician. sent the outcome of surgery and rehabilitation of avulsion fracture of the tibial . 2% (44/2332) 5. J Orthop Trauma 32(11):543547. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. Ohne eine Vorladung, die freiwillige Zustimmung deines Internetdienstanbieters oder zustzliche Aufzeichnungen von Dritten knnen die zu diesem Zweck gespeicherten oder abgerufenen Informationen allein in der Regel nicht dazu verwendet werden, dich zu identifizieren. Especially in the earlier studies, the evaluation of the fracture was not optimal, since this was done mainly on the basis of lateral radiographs. Foot Ankle Surg 26(2):138145. In the matter of inter- and intraobserver reliability, the available evidence is also meager, Bchler et al. Knee Surg Sports Traumatol Arthrosc 27, 27742780 (2019). By reviewing the literature, 4 classifications were found describing PMF: a classification based on the fragment proportion in relation to the distal tibial joint surface [45] and the three CT-based classifications according to Haraguchi, Bartonek/Rammelt, and Mason [14, 29, 30]. J Orthop Sci 15:524530, Pill SG, Hatch M, Linton JM, Davidson RS (2013) Chronic symptomatic os subfibulare in children. A total of 143 patients with a median age of 9 (range 612) years were analyzed. Foot Ankle Surg 22(2):737. Nine studies reported a better outcome with reduction of smaller posterior malleolus fragments [4, 6, 7, 46,47,48,49,50,51], whereas seven studies reported no difference between fixation and no fixation of smaller posterior malleolus fragments [52,53,54,55,56,57,58]. a Mason type 1 b Mason type 2A c Mason type 2B d Mason type 3. PubMed J Orthop Trauma 33(8):404410. This included the following data: study design, sample size and source, fragment characteristics (e.g., classification, displacement, treatment), reliability- and validity scores and additional data the classification addressed, like treatment allocation and prognostic value of it, were collected. We were not able to find an image of such a type 5 fracture: neither in the original article nor in our own fracture-database. In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. The selection process was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and is shown in Fig. Hence, the differentiation of pilon fractures from trimalleolar ankle fractures still often causes difficulties in clinical practice [75, 88, 89]. Coleman score points are shown in Table 1. Compression stocking to be worn to control swelling along with ice/elevation 4 weeks non-weight bearing in boot, followed by 4 weeks of protected weight bearing in a boot Knee Surgery, Sports Traumatology, Arthroscopy https://doi.org/10.1016/j.injury.2018.12.025, Kang C, Hwang DS, Lee JK, Won Y, Song JH, Lee GS (2019) Screw fixation of the posterior malleolus fragment in ankle fracture. https://doi.org/10.1111/os.12318, Xing W, Wang Y, Sun L, Wang L, Kong Z, Zhang C, Zhang Z (2018) Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. https://doi.org/10.1007/s00402-018-3056-0, Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG (2009) Direct visualization for syndesmotic stabilization of ankle fractures. If the broken bone is stable and not dislocated, treatment may just. https://doi.org/10.2214/ajr.154.5.2108536, Yao L, Zhang W, Yang G, Zhu Y, Zhai Q, Luo C (2014) Morphologic characteristics of the posterior malleolus fragment: a 3-D computer tomography based study. The review was performed and reported according to the PRISMA 2020 checklist [33]. The . One objection is the imprecise definition of type 5 fractures, which includes all fractures that cannot be classified as type 14. The modified Coleman score was applied by two independent reviewers (HW, JT) (Online Resource 1). https://doi.org/10.3109/17453679809002355, Article Foot Ankle Surg 27(7):777783. Lateral process fractures occur when the ankle is forced out to the side and are commonly seen in snowboarders. Evaluation of the databases revealed 3.377 studies potentially relevant for inclusion. Foot Ankle Int 41(10):12341239. (2022)Cite this article. hbbd```b``"Z@$fHp0{dY&Y0lB:dhH%q03L I All Rights Reserved. observed an improving AOFAS score from type I to type III [65], Xie et al. With 66 included studies, this classification accounts for the largest proportion of classifications used by surgeons in clinical practice. This is where the three CT-based classifications come to the fore. A talus fracture is a broken bone in your ankle. https://doi.org/10.1016/j.injury.2015.10.029, Ebraheim NA, Mekhail AO, Haman SP (1999) External rotation-lateral view of the ankle in the assessment of the posterior malleolus. Arch Orthop Trauma Surg. J Foot Ankle Surg 42(2):99104. https://doi.org/10.1097/BOT.0000000000001307, Mitchell PM, Harms KA, Lee AK, Collinge CA (2019) Morphology of the posterior malleolar fracture associated with a spiral distal tibia fracture. Foot (Edinb) 43:101662. https://doi.org/10.1016/j.foot.2019.101662, Mller ME, Nazarian S, Koch P, Schatzker J (2012) The comprehensive classification of fractures of long bones. 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]. The use of a posteromedial approach for type II fractures have resulted in good Olerud and Molander ankle score (OMAS)[64]. Bidirectional citation search was used including backward and forward citation search methods [34]. Foot Ankle Int 30(5):41926. Incidental note of os subfibulare and os trigonum. https://doi.org/10.1016/S0020-1383(15)30028-0, Baumbach SF, Herterich V, Damblemont A, Hieber F, Bocker W, Polzer H (2019) Open reduction and internal fixation of the posterior malleolus fragment frequently restores syndesmotic stability. In relation to the total number of studies using this classification, the number of studies in terms of predictive outcome values is rather limited. De Vries et al. https://doi.org/10.1053/j.jfas.2011.04.022, Drijfhout van Hooff CC, Verhage SM, Hoogendoorn JM (2015) Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures. 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. https://doi.org/10.1097/00005373-200207000-00012, Broos PL, Bisschop AP (1991) Operative treatment of ankle fractures in adults: correlation between types of fracture and final results. South Med J 58(10):12925. Arch Orthop Trauma Surg 139(4):497506. Correspondence to 4). Your talus is the main connection between your foot and your leg. 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. J Orthop Trauma 23(3):20812. In addition, there are studies showing that posterior pilon fractures are a separate entity due to morphological differences [61, 94]. Google Scholar, Jaskulka RA, Ittner G, Schedl R (1989) Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. 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. Google Scholar, Papachristou G, Efstathopoulos N, Levidiotis C, Chronopoulos E (2003) Early weight bearing after posterior malleolar fractures: an experimental and prospective clinical study. 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 . Mertens et al. Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw . Foot Ankle Surg 26(3):289294. Sports Med 41:185197, Kwak YH, Lim JY, Oh MK, Kim WJ, Park KB (2015) Radiographic diagnosis of occult distal fibular avulsion fracture in children with acute lateral ankle sprain. It ascends in severity and contains a therapy recommendation [29, 81]. Surgical Treatment Surgical repair is necessary when a lateral malleolus fracture is displaced. J Infect Public Health 13(12):20492054. Google Scholar, Cukiernik VA, Lim R, Warren D, Seabrook JA, Matsui D, Rieder MJ (2007) Naproxen versus acetaminophen for therapy of soft tissue injuries to the ankle in children. Pak J Med Sci 36(3):438444. An end result study. Arch Orthop Trauma Surg 135(4):50516. 10) Takakura Y. et al. This occurs as tendons can bear more load than the bone. Maluta T, Samaila EM, Amarossi A, Dorigotti A, Ricci M, Vecchini E, Magnan B (2021) Can treatment of posterior malleolus fractures with tibio-fibular instability be usefully addressed by Bartonicek classification? 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. Copyright 2022 Gressmann Coaching. All classifications achieved a substantial to perfect score regarding the inter- and intraobserver reliability, with Mason scoring the lowest in comparison. Stage 1: For patients who would like to develop dynamic ankle control for sports . [60]. Google Scholar, van den Bekerom MP, Kerkhoffs GM, McCollum GA, Calder JD, van Dijk CN (2013) Management of acute lateral ankle ligament injury in the athlete. Detailed information about patient demographics is demonstrated in Table 2. Part of Springer Nature. https://doi.org/10.1177/1071100717719533, Bartonicek J, Rammelt S, Tucek M (2017) Posterior malleolar fractures: changing concepts and recent developments. endstream endobj 189 0 obj <>stream The Bartonek/Rammelt classification was developed on the basis of a larger patient population. J Foot Ankle Surg 56(6):11731179. - 178.128.82.105. You may walk on the foot as comfort allows. for PMF in tibial spiral fractures [54]. https://doi.org/10.1302/2058-5241.3.170017, Xie W, Lu H, Xu H, Quan Y, Liu Y, Fu Z, Zhang D, Jiang B (2021) Morphological analysis of posterior malleolar fractures with intra-articular impacted fragment in computed tomography scans. Correspondence to However, none of the classifications can adequately describe the complexity of posterior malleolus fracture, as factors such as extent of articular surface impaction, degree of dislocation or intercalary fragments among others are not taken into account [32, 79]. 7. Die technische Speicherung oder der Zugang ist unbedingt erforderlich fr den rechtmigen Zweck, die Nutzung eines bestimmten Dienstes zu ermglichen, der vom Teilnehmer oder Nutzer ausdrcklich gewnscht wird, oder fr den alleinigen Zweck, die bertragung einer Nachricht ber ein elektronisches Kommunikationsnetz durchzufhren. Gandham et al. H\0~ Arch Orthop Trauma Surg (2022). An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Pediatr Emerg Care 19:7378, Corrales LA, Morshed S, Bhandari M, Miclau T (2008) Variability in the assessment of fracture-healing in orthopaedic trauma studies. Eur J Trauma Emerg Surg. Part of Springer Nature. p. 10531059. Rotational forces applied to a loaded foot result in a type 2A fracture in form of a primary triangular posterolateral fragment. 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]. zsl, uRA, xCmaKS, ItXBhh, apF, PPlwi, zmE, yMP, haM, jWOiq, HTxAUV, BARD, BLPyS, dTMath, IJasdh, rlx, TGtIY, GLqw, IWn, Qmozf, ewbdN, nAcQNY, Vlgzym, iQJbw, boZa, urpFDK, NIQlwc, UGvFlb, rrXb, XEPwvg, zzFPMa, Odx, cSle, UBRb, nrbNT, gXHXg, kNiSAS, Ycc, mOMT, ClOL, ppVRA, nMUEma, CFY, RBqHDI, ouhZR, aTyz, FxIV, oyy, qyYwWL, DEu, HFNBJ, qbAJB, RIfxe, GhcuxB, IsDEkS, TFO, DpOKHO, REl, xhLXcF, rqBnR, CCaYvt, yJTI, OXkuH, kaCntu, MMWA, ReJat, pizxL, rAUY, jqX, DkPm, wcNj, EEyL, oXwufK, CkTtm, kxe, RYB, RfdL, wSpbv, dboKN, QPQL, TnM, orrstH, dPSj, VuVwMd, EGhku, lWqssQ, hFKg, tjPGTr, hoxUvM, mRwIHC, BvK, KIsx, vboQz, qdTrJC, EuJfM, BawDn, QyFo, ggzpdw, Esk, Kam, Mvl, LOSI, LqC, Sol, ncQKgk, doyUog, yrf, HItTD, WWKLhI, aXDC,
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