title: Concomitant tibial shaft and posterior malleolar fractures can be readily diagnosed from plain radiographs: A retrospective study.
abstract: BACKGROUND
  Concomitant tibial shaft and posterior malleolar fractures (PMFs) are often encountered in clinical settings. Plain films were reviewed for concomitant PMF, and fracture patterns were analyzed by focusing on the integrity of the fibula and the location of the fibular fracture.
  
  
  METHODS
  A retrospective review of patients who presented with tibial shaft fractures between January 2005 and January 2010 was performed. Patients were included if they were at least 18 years of age and had a tibial diaphyseal fracture. Exclusion criteria were age less than 18 years, previous surgery on the same leg, and pathological fractures. Medical records were reviewed for information on injury mechanisms. Pre- and post-operative radiographs were analyzed for PMFs, tibial fracture pattern, fibular integrity, fibular fracture pattern, treatment type, and time to fracture union. Descriptive statistical tests were used.
  
  
  RESULTS
  Among 240 patients, there were 20 cases (15 male and 5 female) of concomitant PMF, all detected in lateral radiograph views. The incidence of PMF was 8.3%. Most patients had a motorcycle injury (n = 15, 75%). Distal tibia spiral fracture was the most common fracture pattern (85%) and there was no proximal tibia fracture (0%). Combined fibular fractures were found in 17 patients (85%). There were nine proximal fibular fractures (45%). Intact fibulas were found in three patients (15%). Only one PMF was treated with screw fixation. All PMFs showed radiographic evidence of healing within 5 months post-operatively.
  
  
  CONCLUSIONS
  We recommend careful radiographic examination to evaluate PMF, especially in patients with distal tibial spiral fractures combined with proximal fibular fractures or intact fibulas.
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chuan-En
authors.initials: CE
authors.lastname: Tsai
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yu-Ping
authors.initials: YP
authors.lastname: Su
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chi-Kuang
authors.initials: CK
authors.lastname: Feng
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Surgery and Institute of Clinical Medicine School, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: chen9005@gmail.com.
authors.forename: Chuan-Mu
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Surgery and Institute of Clinical Medicine School, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Fang-Yao
authors.initials: FY
authors.lastname: Chiu
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Surgery and Institute of Clinical Medicine School, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Liu
mesh_terms: D000328:Adult; D064386:Ankle Fractures; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging / Q000293:injuries*
keywords: posterior malleolar fracture; proximal fibular fracture; tibial shaft fracture