title: Posterior Malleolar Fracture Patterns.
abstract: OBJECTIVE
  To characterize posterior malleolar fracture morphology using Cole fracture mapping and to study reliability of quantification of 3-dimensional computed tomography (CT)-modeling for posterior malleolar fractures with respect to quantification of fragment size (in cubic millimeter) and true articular involvement (in square millimeter).
  
  
  METHODS
  CT scans of a consecutive series of 45 patients with an ankle fracture involving the posterior malleolus were reconstructed to calculate (1) fracture maps, (2) fragment volume, (3) articular surface of the posterior malleolar fragment, (4) articular surface of intact tibia, and (5) articular surface of the medial malleolus by 3 independent observers. Three-dimensional animation of this technique is shown on www.traumaplatform.org.
  
  
  RESULTS
  Fracture mapping revealed (1) a continuous spectrum of posterolateral oriented fracture lines and (2) fragments with posterolateral to posteromedial oriented fracture lines extending into the medial malleolus. Reliability of measurements of the volume and articular surface of posterior malleolar fracture fragments was defined as almost perfect according to the categorical system of Landis (interclass coefficient, range, 0.978-1.000).
  
  
  CONCLUSIONS
  Mapping of posterior malleolar fractures revealed a continuous spectrum of Haraguchi III to I fractures and identified Haraguchi type II as a separate pattern. Quantification of 3-dimensional CT-modeling is reliable to assess fracture characteristics of posterior malleolar fracture fragments. Morphology might be more important than posterior malleolar fracture size alone for clinical decision making.
authors.affiliation: *Orthotrauma Research Center Amsterdam, Academic Medical Center Amsterdam, Amsterdam, the Netherlands; †University of Amsterdam Orthopaedic Residency Program (PGY5), Amsterdam, the Netherlands; ‡Trauma Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA; §Department of Surgery, Sint Lucas Andreas Ziekenhuis, Amsterdam, the Netherlands; ‖Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Amsterdam, the Netherlands; and ¶University of Amsterdam Orthopaedic Residency Program (PGY4), Amsterdam, the Netherlands.
authors.forename: Lukas
authors.initials: L
authors.lastname: Mangnus
authors.forename: Diederik T
authors.initials: DT
authors.lastname: Meijer
authors.forename: Sjoerd A
authors.initials: SA
authors.lastname: Stufkens
authors.forename: Jos J
authors.initials: JJ
authors.lastname: Mellema
authors.forename: Ernst Ph
authors.initials: EP
authors.lastname: Steller
authors.forename: Gino M M J
authors.initials: GM
authors.lastname: Kerkhoffs
authors.forename: Job N
authors.initials: JN
authors.lastname: Doornberg
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013639:Tarsal Bones / Q000000981:diagnostic imaging* / Q000293:injuries*; D013977:Tibia / Q000000981:diagnostic imaging* / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000379:methods*