title: Concomitant Ankle Injuries Associated With Tibial Shaft Fractures.
abstract: BACKGROUND
  Ankle injuries associated with tibial shaft fractures can cause postoperative ankle pain and stiffness even when satisfactory bony union has been achieved. Although several previous studies have described these injuries, they have not been clearly defined or classified in terms of ankle injury type or need for surgical fixation.
  
  
  METHODS
  Seventy-one consecutive patients (mean ± SD age, 48.3 ± 16.7 years; 37 men and 34 women) with tibial shaft fractures who underwent computed tomography examination were included. Data were collected including age, sex, body mass index, fracture location of the tibia and fibula (in percentile of length), tibial fracture shape (spiral, oblique, transverse), presence and pattern of concomitant ankle injuries (on the distal tibial articular surface), and necessity for surgical fixation of ankle injuries. Factors associated with concomitant ankle injuries associated with tibial shaft fractures were analyzed by logistic regression analysis.
  
  
  RESULTS
  A total of 47 (64.7%) of the 71 tibial shaft fractures involved concomitant ankle injuries, including 8 cases of combined lateral malleolar fracture, posterior malleolar fracture, and anterior inferior tibiofibular ligament (AITFL) avulsion fracture; 9 cases of combined posterior malleolar fracture and AITFL avulsion fracture; 6 cases of combined lateral malleolar fracture and posterior malleolar fracture; 1 case of combined lateral malleolar fracture and AITFL avulsion fracture; 10 cases of posterior malleolar fracture; 7 cases of lateral malleolar fracture; 5 cases of AITFL avulsion fracture; and 1 unclassified fracture. Of these, 34 of the ankle injuries required surgical fixation. Spiral-type tibial shaft fracture was significantly associated with concomitant ankle injury (P = .001).
  
  
  CONCLUSIONS
  Orthopaedic surgeons should be aware that tibial shaft fractures, especially spiral-type fractures, are frequently associated with ankle injuries, such as lateral malleolar fractures, posterior malleolar fractures, and AITFL avulsion fractures. A considerable portion of these cases may necessitate surgical fixation. We recommend all spiral-type tibial shaft fractures routinely undergo computed tomography examination.
  
  
  METHODS
  Level III, comparative series.
authors.affiliation: Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Ki Jin
authors.initials: KJ
authors.lastname: Jung
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea.
authors.forename: Chin Youb
authors.initials: CY
authors.lastname: Chung
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea.
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea.
authors.forename: Myung Ki
authors.initials: MK
authors.lastname: Chung
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Dong Yeon
authors.initials: DY
authors.lastname: Lee
authors.affiliation: School of Mechanical Engineering, Chung-Ang University, Seoul, Korea.
authors.forename: Seungbum
authors.initials: S
authors.lastname: Koo
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea oasis100@empas.com.
authors.forename: Kyoung Min
authors.initials: KM
authors.lastname: Lee
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: computed tomography; concomitant ankle injuries; spiral fracture; tibial shaft fracture