Abstract
BackgroundFracture of the medial malleolus is one of the most frequent injuries treated surgically; however, the classification of the fracture has not attracted much attention and a good classification system is still lacking.MethodsConsecutive cases of medial malleolus fractures were prospectively enrolled. Based on the 3-D reconstruction CT morphology and centered on the posterior colliculus of the medial malleolus, we classified the fractures into 4 types: type 1 with no involvement of the posterior colliculus, type 2 with partial involvement of posterior colliculus, type 3 with the entire involvement of posterior colliculus, and type 4 with the fracture line 4 vertically extended from the intercollicular groove to the comminuted fracture of the posterior malleolus. Statistical analyses were performed to evaluate the clinical significance of the classification.ResultsThere were 273 cases prospectively enrolled. The distribution of the cases was type 1 of 12.1%, type 2 of 41.0%, type 3 of 30.0%, and type 4 of 16.8%. Statistics showed that the new classification had significant associations but did not totally depend on the classical ankle fracture classifications. Results showed that the new classification had implications in the severity of ankle fractures. From type 1 to type 4, the ankle joint was more and more unstable. Furthermore, comminuted medial malleolar fractures could be subdivided, and the new classification could provide useful information for surgical decision-making.ConclusionsThe novel classification was a useful system to describe the 3-D geometry of the fractured medial malleolus.
Highlights
Fracture of the medial malleolus is one of the most frequent injuries treated by the orthopedic surgeon [1]
Either in isolation or in conjunction with fractures of the lateral and posterior malleolus, displaced medial malleolar fracture has been recommended for operative management [2, 3]; the classification of the fracture has not been paid much attention by the orthopedic surgeon
The Pankovich system [9, 10] and the modified Pankovich system [11] are based on the location of the medial malleolar fracture and the competency of the deltoid ligament and divided the fractures into 6 groups
Summary
Fracture of the medial malleolus is one of the most frequent injuries treated by the orthopedic surgeon [1]. Either in isolation or in conjunction with fractures of the lateral and posterior malleolus, displaced medial malleolar fracture has been recommended for operative management [2, 3]; the classification of the fracture has not been paid much attention by the orthopedic surgeon. The Ebraheim system [12, 13] is based on the level and location of the medial malleolar fracture and classified into 4. Fracture of the medial malleolus is one of the most frequent injuries treated surgically; the classification of the fracture has not attracted much attention and a good classification system is still lacking
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