Posterior Malleolar Fractures Associated With Tibial Shaft Fractures and Sequence of Fixation

作者：Harish Kempegowda, Hemil Maniar, Raveesh D. Richard, Akhil Tawari, Graham Jove, Michael Suk, Michael J. Beebe, C F Han, Paul Tornetta, Erik N. Kubiak, Daniel S. Horwitz · 发表于：Journal of Orthopaedic Trauma · 年份：2016 · DOI：10.1097/bot.0000000000000629 · 被引用次数：56 · 研究领域：Bone fractures and treatments、Foot and Ankle Surgery、Reconstructive Surgery and Microvascular Techniques

OBJECTIVES: The purpose of this study was to evaluate posterior malleolar injuries associated with nailed tibial fractures and to determine the quality of reduction based on the sequence of fixation in associated fracture patterns. DESIGN: Retrospective cohort study. PATIENTS: 1113 tibia fractures treated with an intramedullary nail at 3 level I trauma centers. INTERVENTION: Tibial shaft fractures with posterior malleolar injury were analyzed regarding type of fracture, mechanism of injury, energy of injury, fracture characteristic, surgical characteristics including sequence of fixation, obvious intraoperative displacement of the posterior malleolar fragment, and the quality of reduction. One group ("malleolus-first") consisted of patients in whom the posterior malleolus was fixed before tibial nailing and the other group ("tibia-first") included patients in whom tibial nailing was done before posterior malleolus fixation. OUTCOMES MEASURED: Intraoperative displacement, quality of reduction. RESULTS: Ninety-six of 1113 (9%) nailed tibial shaft fracture patients had a concomitant posterior malleolus fracture (9%). Of the 96 posterior malleolar fracture patients, 70 patients were operatively treated (73%). In the malleolus-first group (54 patients), intraoperative displacement of the posterior malleolar fragment was observed in 1 patient, and 1 case of poor reduction of the posterior malleolar fragment was observed (2%). In the tibia-first group (16 patients), obvious intraope...