title: Open Reduction Internal Fixation of Posterior Malleolus Fractures and Iatrogenic Injuries: A Cadaveric Study.
abstract: Open reduction internal fixation of posterior malleolus fractures from a posterior approach is gaining popularity. One concern that has not been studied is the risk of iatrogenic injury to anatomical structures on the anterior ankle. The purpose of this study is to determine the proximity of these anterior structures with relation to K-wires advanced through the anterior cortex. A total of 10 cadaver ankles were utilized in the study. A posterolateral approach to the ankle was used. K-wires were advanced at varying levels above the articular surface, and then, the proximity of the wires to the following structures was determined: the neurovascular bundle, tibialis anterior (TA), and extensor hallucis longus. Overall, the structure most in danger of being injured was the TA (P < .001). This tendon was injured by 52% of all K-wires. These data suggest that K-wires should be advanced under direct fluoroscopic visualization to minimize the risk of iatrogenic injury.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Orthopaedic Surgery (JAK, AB, PKG), University of Massachusetts Medical School, Worcester, Massachusetts.|Department of Orthopaedics and Physical Rehabilitation (ARP), University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: John A
authors.initials: JA
authors.lastname: Karbassi
authors.affiliation: Department of Orthopaedic Surgery (JAK, AB, PKG), University of Massachusetts Medical School, Worcester, Massachusetts.|Department of Orthopaedics and Physical Rehabilitation (ARP), University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Andrew
authors.initials: A
authors.lastname: Braziel
authors.affiliation: Department of Orthopaedic Surgery (JAK, AB, PKG), University of Massachusetts Medical School, Worcester, Massachusetts.|Department of Orthopaedics and Physical Rehabilitation (ARP), University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Garas
authors.affiliation: Department of Orthopaedic Surgery (JAK, AB, PKG), University of Massachusetts Medical School, Worcester, Massachusetts.|Department of Orthopaedics and Physical Rehabilitation (ARP), University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Abhay R
authors.initials: AR
authors.lastname: Patel
keywords: ankle injuries; diagnostic and therapeutic techniques; external and internal fixation; foot surgery techniques; general disorders; heel-rearfoot-ankle; surgical complications