Results of ankle fractures with involvement of the posterior tibial margin.
BACKGROUND
Ankle fractures have a significantly worse functional outcome when they include a posterior tibial fragment. In 57 trimalleolar fractures, the effect of size, internal fixation, and anatomic reduction of the posterior fragment on the prognosis was evaluated.


METHODS
A modified Weber protocol was used, providing a rating system for subjective, objective, and radiographic results. A visual analogue scale for subjective actual pain was also scored.


RESULTS
The involvement of the articular surface ranged from 8% to 55%. Size or fixation of the fragment did not influence prognosis. Joint congruity in fragments >or= 10% of the articular surface was a significant factor influencing prognosis. Overall, the modified Weber protocol result was excellent in 10%, good in 15%, fair in 25%, and poor in 50% of patients. However, the low average visual analogue scale of 3.0 in the whole group does not appear representative of 50% poor results, indicating that the modified Weber protocol is fairly strict and overestimates the number of poor results.


CONCLUSIONS
Joint congruity with or without fixation was a significant factor influencing prognosis. Congruity should be achieved for fragments >or= 10% of the tibial articular surface.
Department of General Surgery, St. Lucas Andreas Hospital, Amsterdam, The Netherlands.
Johan F
JF
Langenhuijsen
Martin J
MJ
Heetveld
Jan M
JM
Ultee
E Philip
EP
Steller
Rudi M J M
RM
Butzelaar
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D013639:Tarsal Bones / Q000293:injuries*; D013978:Tibial Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome