Medial Malleolar Fracture Research Articles

Comparison of Two Different Implants in Medial Malleolus Fracture.

We compared two different techniques used in medial malleolus fracture. It has been hypothesized that the hook plate technique, which has become widespread in recent years, may have an advantage over cannulated screws. Preoperative and postoperative data for medial malleolus fractures operated on between 2010 and 2020 were analyzed retrospectively. Patients were divided into those operated on with a hook plate (n = 20) and those operated on with compression screws (n = 20) and were compared in terms of complications, pain, functional recovery, union success, and ankle joint range of motion. Fracture union times were recorded. Between groups, there were no significant differences in time to fracture union, pain, range of motion, and American Orthopaedic Foot and Ankle Society score (P = .420). Handling of the implant in a very weak patient in the hook plate group and revision in the cannulated screw group were the differences in complications between groups. The use of hook plates in a patient with medial malleolus fracture with metaphyseal fracture provided significant convenience in osteosynthesis. Use of hook plates provides serious advantages to the surgeon in medial malleolus fractures with small or fragmented fragments and combined with malleolus metaphyseal fractures. Having a larger implant versus a cannulated screw is seen as a disadvantage, but screwing the implant close to the cortex increases its strength. Therefore, its use should be given priority in patients who are mentally unable to weightbear after surgery. Although hook plate is advantageous compared with cannulated screw in appropriate indications, it can be used safely in all malleolus fractures where cannulated screws are used.

BILATERAL INSUFFICIENCY FRACTURES OF MEDIAL MALLEOLI IN AN ELDERLY PATIENT: A CASE REPORT

Insufficiency fractures (IFs) are a type of stress fractures that most commonly occur in the pelvis, followed by the proximal femur and vertebra. Less commonly, the lower leg and foot are involved. However, reports of IF of the medial malleolus are relatively rare. We herein report and discuss a case of bilateral IFs of medial malleoli in an elderly patient who was successfully treated conservatively. To the best of our knowledge, this is the first described case of bilaterally involved insufficiency fractures of medial malleoli.

Physeal Bar Formation After Pediatric Medial Malleolus Fractures.

Pediatric medial malleolus fractures are commonly Salter-Harris (SH) type III or IV fractures of the distal tibia and are associated with a risk of physeal bar formation and subsequent growth disturbance. The purpose of this study was to determine the incidence of physeal bar formation following pediatric medial malleolus fracture and evaluate for patient and fracture characteristics predictive of physeal bar formation. Seventy-eight consecutive pediatric patients during a 6-year period who had either an isolated medial malleolar or a bimalleolar ankle fracture were retrospectively reviewed. Forty-one of 78 patients had greater than 3 months of radiographic follow-up and comprised the study population. Medical records were reviewed for demographic information, mechanism of injury, treatment, and need for further surgery. Radiographs were reviewed to assess for initial fracture displacement, adequacy of fracture reduction, SH type, percentage of the physeal disruption from the fracture, and physeal bar formation. Twenty-two of 41 patients (53.7%) developed a physeal bar. The mean time to diagnosis of physeal bar was 4.9 months (range, 1.6-11.8 months). Twenty-seven percent (6 of 22) of bars were diagnosed at greater than 6 months from injury. Adequacy of reduction was predictive of physeal bar formation, although all patients were reduced to within 2 mm. The mean residual displacement of patients with a bar was 1.2 mm compared with 0.8 mm for those without a bar (P=.03). Because the bar formation rate is greater than 50% on radiographs, routine radiographic assessment of all pediatric medial malleolar fractures should continue for at least 12 months after injury. [Orthopedics. 2024;47(1):e33-e37.].

Cerclage haubanage versus fixation par vis pour le traitement des fractures de la malléole médiale : revue systématique et méta-analyse

IntroductionTension band wiring (TBW) and screw fixation (SF) are common surgical treatments for medial malleolar fractures (MMFs); however, no systematic review has identified which fixation method is superior. This study aimed to determine the most optimal MMF fixation method by comparing the clinical and radiological outcomes of TBW and SF through a systematic review and meta-analysis of the literature. HypothesisWe hypothesized that there may be differences in outcomes between TBW and SF for treating MMFs. MethodsMEDLINE, Embase and the Cochrane Library were systematically searched for studies that compared TBW and SF for MMF treatment published through June 8, 2021. Fracture union, outcome scores, and postoperative complications were analyzed. ResultsWe included 10 studies with 512 MMF cases; 218 and 294 patients were treated with TBW and SF, respectively. Pooled analysis revealed no significant differences between them for all outcome variables, including the time to fracture union (mean difference=-0.59 weeks; 95% confidence interval [CI], -1.82 to 0.64; p=0.35; I2=70%), number of excellent or good outcomes based on the final Olerud and Molander Ankle score (odds ratio [OR], 1.46; 95% CI, 0.53–5.02; p=0.47; I2=0%), delayed union rate (OR, 0.94; 95% CI, 0.34–2.59; p=0.91; I2=17%), superficial infection rate (OR, 1.19; 95% CI, 0.33–4.26; p=0.79; I2=0%) and number of fixation failures (OR, 0.53; 95% CI, 0.16–1.74; p=0.29; I2=13%). ConclusionsBoth TBW and SF are excellent clinical and radiological methods for MMF fixation. However, an appropriate fixation method should be chosen according to the fracture type and size and bone quality considering the advantages and disadvantages of each method. Level of evidenceIII, meta-analysis.

Effect of buttress plate in Herscovici type D vertical medial malleolar fractures and peripheral fractures: a retrospective comparative cohort study

BackgroundThe purpose of current retrospective study was to review the surgical methods and to evaluate the clinical efficacy of supporting plate for the treatment of vertical medial malleolus fractures on the basis of stable fixation of ipsilateral fibula.MethodsThis retrospective study included a total of 191 patients with vertical medial malleolus fractures. Patients enrolled were divided into simple vertical medial malleolus fractures and complex types of fractures. General demographic information and surgical information, including age, sex, surgical procedure and postoperative complications, were collected. The functional prognosis of patients was evaluated by American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) and Visual Analog Scale (VAS).ResultAmong patients with simple vertical fractures, the respective incidence of internal fixation failure in screw group, buttress plate group, and screw combined buttress plate fixation group (combined fixation group) was 10/61 (16.4%),1/54 (7.4%) and 1 (1.9%), and the difference was statistically significant (P = 0.024). The incidence of abnormal fracture growth and healing in screw group, buttress plate group and combined fixation group was, respectively, 13/61 (21.3%), 6/54 (12.5%) and 2 (3.85%), with statistically significant difference (P = 0.019). In the patients with complex types of fractures, after 2 years of postoperative follow-up, the AOFAS score and VAS score of the following subgroups had good results: 91.18 ± 6.05 and 2.18 ± 1.08 in patients with joint surface collapse, and 92.50 ± 4.80 and 2.50 ± 1.29 in patients with tibial fractures, with 100% excellent and good rate.ConclusionFor simple and complex vertical medial malleolus fractures, buttress plate showed excellent fixation. Despite poor wound healing and extensive soft tissue dissection with this approach, buttress plate may provide a novel insight into medial malleolar fractures, especially for extremely unstable medial malleolar fractures.

A NOVEL TECHNIQUE FOR MANAGEMENT OF A CRITICALLY-SIZED BONE DEFECT IN THE OPEN PROXIMAL TIBIAL FRACTURE: EMPLOYING THE CAPANNA TECHNIQUE IN TRAUMA

A NOVEL TECHNIQUE FOR MANAGEMENT OF A CRITICALLY-SIZED BONE DEFECT IN THE OPEN PROXIMAL TIBIAL FRACTURE: EMPLOYING THE CAPANNA TECHNIQUE IN TRAUMA

The Reliability and Accuracy of the Medial Malleolar Fracture Classification Based on 3D CT Reconstruction.

There is a new medial malleolar fracture classification based on 3D CT reconstruction. However, there is no study assessing the reliability and accuracy of the new classification system and comparison between the new and the classic classification. This study aimed to compare the reliability and accuracy of the medial malleolar fracture classification based on 3D CT reconstruction and the Herscovici classification system. We retrospectively analyzed the consecutive ankle fractures in our hospital from January 2013 to September 2020. Five inexperienced and five experienced orthopedic surgeons were included as observers to assess 68 cases with medial malleolar fractures. Ten evaluators classified the cases according to the two classification systems. The reference results of each case were made by the consensus of three senior trauma surgeons. The interobserver reliability, intraobserver reliability, and accuracy were evaluated at an interval of 6 weeks using Fleiss's kappa (κ) statistics. We found substantial interobserver and intraobserver reliability and 81.4% accuracy for the new classification, which was statistically superior to the Herscovici classification (P < 0.05). The reliability and accuracy of both classifications were similar in inexperienced and experienced groups, except for type III in the new classification. The interobserver reliability of type II was the best (P < 0.05), and the intraobserver reliability of IVc ranked the worst (P < 0.05) in the new classification. The reliability and accuracy of the new classification are superior to the Herscovici classification. Clinical experiences will not affect the assessment of both classification systems in most instances.

Evaluation of Contact Area and Pressure After Malreduction in Isolated Medial Malleolar Fractures With 2 mm of Displacement: A Cadaveric Study

This study was performed to evaluate the changes in contact area and pressure in the tibiotalar joint, with a 2 mm displacement after IMMF(isolated medial malleolar fracture). Ten cadavers with pairs were used to establish a situation in which IMMF occurred during ankle injury. We performed IMMF corresponding to types C and D of the Herscovici classification, and it was displaced by 2 mm. The normal group was defined as a normal tibiotalar joint, the TF(transverse fracture) group as a 2 mm transverse displacement corresponding to the Herscovici classification type C, and the OF(oblique fracture) group as a 2 mm oblique displacement corresponding to the Herscovici classification type D. We measured the contact area and pressure at the tiobiotalar joint. The film was scanned and analyzed using the digital imaging software, Scion Image (Scion Crop. Frederick, MD). In normal group, the average contact area of the tibiotalar joint was 317 mm2 (IQR; interquartile range,256; 347) and 308 mm2 (IQR, 262; 364), average pressure was 2.19 N/mm2 (IQR, 1.94; 2.27) and 2.15 N/mm2 (IQR, 2.06; 2.53). In the TF and OF groups, the average contact area of the tibiotalar joint decreased by 9% and 12%, respectively, and the average pressure increased by 8% and 14%, respectively. There was no statistical difference in peak pressure between the normal, TF, and OF groups. In the case of transverse and oblique fractures, a 2 mm displacement showed significant changes in contact area and contact pressure compared to the normal tibiotalar joint, but there were no significant changes pertaining to type, between the two fractures. Level of Clinical Evidence: 5.

MEDIAL MALLEOLUS: OPERATIVE OR NONOPERATIVE (MOON): A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL OF OPERATIVE VERSUS NONOPERATIVE MANAGEMENT OF ASSOCIATED MEDIAL MALLEOLUS FRACTURES IN UNSTABLE ANKLE FRACTURES

This prospective randomised trial aimed to assess the superiority of internal fixation of well-reduced medial malleolar fractures (displacement □2mm) compared with non-fixation, following fibular stabilisation in patients undergoing surgical management of a closed unstable ankle fracture.A total of 154 adult patients with a bi- or trimalleolar fracture were recruited from a single centre. Open injuries and vertically unstable medial malleolar fractures were excluded. Following fibular stabilisation, patients were randomised intra-operatively on a 1:1 basis to fixation or non-fixation after satisfactory fluoroscopic fracture reduction was confirmed. The primary outcome was the Olerud Molander Ankle Score (OMAS) at 12 months post-randomisation. Complications were documented over the follow-up period.The baseline group demographics and injury characteristics were comparable. There were 144 patients reviewed at the primary outcome point (94%). The median OMAS was 80 (IQR, 60-90) in the fixation group vs. 72.5 (IQR, 55-90) in the non-fixation group (p=0.165). Complication rates were comparable, although significantly more patients (n=13, 20%) in the non-fixation group developed a radiographic non-union (p&lt;0.001). The majority (n=8/13) were asymptomatic, with one patient requiring surgical reintervention. In the non-fixation group, a superior outcome was associated with an anatomical medial malleolar fracture reduction.Internal fixation is not superior to non-fixation of well-reduced medial malleolar fractures when managing unstable ankle fractures. However, one in five patients following non-fixation developed a radiographic non-union and whilst the re-intervention rate to manage this was low, the longer-term consequences of this are unknown. The results of this trial may support selective non-fixation of anatomically reduced fractures.

Mucormycosis in compound grade IIIa tibial plafond with medial malleolus fracture: A case report

Tibial plafond fracture is defined by intra articular involvement of the distal tibia with metaphyseal extension. The plafond fracture accounts for less than 1% of lower limb injuries and 3–10% of tibial fractures. The rate of deep infection in open ankle fractures is approximately 5%. Pilon fractures are frequently associated with severe soft- tissue injuries that alter the management plan. Here we describe the case of 35year old man brought to ER after sustaining machinery injury to right ankle. On local examination a Laceration of 7x2x2 cms present over left ankle anteriorly extending from Medial Malleolus to Lateral Malleolus and cut ends of tendons of extensor digitorum longus, extensor hallucis longus and Tibialis anterior were identified. X-ray left ankle Ap and Lateral views were taken. X-ray showed Left Distal Tibia fracture. Thorough Wound wash given. Under spinal anesthesia debridement of wound was done and K-wire fixation done for distal tibia fracture. Tendon repair for extensor digitorum longus, extensor hallucis longus and tibialis anterior done using Ethibond suture material using Modified Kessler Technique. On 2 Post operative day a swab from the wound site sent for culture and sensitivity which revealed fungal growth of zygomycetes species. In view of angioinvasive properties of Zygomycetes, after checking Renal parameters patient was started on Inj Amphotericin B 1mg/kg for 4 days and later converted to Tablet Posaconazole 600mg BD. Patient was kept on posaconazole tablet for 6weeks. Regular dressings were done. On regular follow ups and regular dressings wound healed well.

Electric scooter injuries: Incidence and injury patterns at a level I trauma center

PurposeElectric scooters (e-scooters) have become an increasingly popular mode of public transportation in recent years. As the incidence of related injuries rises, it is important to understand specific fracture patterns unique to e-scooters and electric bikes (e-bikes) to help guide management. The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and e-bike related injuries at the busiest level 1 trauma center in the borough of Manhattan. MethodsChart review to determine mechanism of injury was performed on all patients for whom an orthopedic consult was requested from 1/1/2021 to 12/31/2021. All patients whose injuries were sustained due to an e-scooter or e-bike were further reviewed for demographics, injury characteristics including fracture pattern, and definitive injury management. Any patients who had an orthopedic consult placed for a reason other than an acute injury were excluded. Descriptive statistics are reported as frequency (percentage) for categorical variables and means for continuous variables. ResultsOf the 1815 orthopedic consults requested, 1357 (74.8%) were for acute injury management. Of those with acute injuries, 119 (8.8%) sustained 136 e-scooter or e-bike related injuries. There were 92 (77.3%) males at an average age of (33.8 ± 15.7) years. Approximately one-fifth of all patients presented in June 2021 (26, 21.8%). There was a 9.2% rate of open fractures. The 136 injuries were evenly split between the upper and lower extremities, with 57 (47.9%) upper extremity, 57 (47.9%) lower extremity injuries, and 5 (4.2%) concomitant upper and lower extremity injuries. The most common fracture patterns were ankle fractures (16, 11.7%), followed by tibial shaft (14, 10.2%), tibial plateau (13, 9.5%), and radial head fractures (11, 8.0%). There was a 33.3% incidence of associated posterior malleolar fractures in the spiral tibial shaft fractures, 31.0% of posterior malleolar involvement and 18.8% of isolated vertical medial malleolar fractures in the ankle fractures, and 61.5% of posterior comminution in the tibial plateau fractures. ConclusionE-scooter and e-bike related injuries have a high incidence of tibial shaft fractures, ankle fractures, tibial plateau fractures, and radial head fractures. There should be a high index of suspicion for posterior and medial involvement in lower extremity fractures sustained due to e-scooter or e-bikes. Identifying specific fracture patterns seen in e-scooter and e-bike related mechanisms will help guide management of these injuries.

Редкая травма лодыжки: клинический случай о переломе Мезоннева

Maisonneuve fracture is a rare and complex ankle fracture characterized by a triad of injuries, including a medial malleolar fracture, injury to the inferior tibiofibular syndesmotic complex, and a proximal fibula fracture. This case report presents the case of a 53-year-old female who sustained a Maisonneuve fracture following a fall on the stairs. Physical examination revealed tenderness and swelling in the left ankle, and radiographs confirmed fractures of the medial and posterior malleolus of the left ankle. Despite receiving conservative treatment in the form of a plaster cast, the patient subsequently presented to the hospital with severe pain in the left ankle and proximal fibula. Further imaging examinations confirmed a Maisonneuve fracture accompanied by a proximal fibula fracture, medial malleolar fracture, and posterior malleolar fracture. The patient underwent successful open reduction and internal fixation of the left ankle. This clinical case underscores the significance of a thorough examination and imaging to precisely diagnose rare and complex fractures such as the Maisonneuve fracture, which may be overlooked in clinical practice. Therefore, clinicians should be vigilant of the potential for a Maisonneuve fracture in patients with ankle injuries to ensure timely and appropriate treatment.Key words: Maisonneuve fracture, tibiofibular syndesmotic complex, proximal fibular fracture, rare ankle fracture, clinical case.

A study of tension band wiring in patella, olecranon and malleolar fractures in adults

Background: Fractures of the eccentrically loaded bones like patella, olecranon, and medial malleolus are one of the most common fractures encountered by an orthopaedic surgeon. They continue to pose vexing problems as these being intra-articular are being subjected to continuous deforming forces from muscles.Objectives: To evaluate the clinical results of the tension band wiring in patella, olecranon and malleolar fractures in adults.Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Orthopaedics, Government General Hospital, Mahbubnagar. Study Period: May 2022 – Jan 2023 [9 months]. Study population: Cases of fractures of Patella, Olecranon, Malleoli treated by tension band wiring. Sample size: study consisted of 30 subjects. Sampling Method: Purposive sampling technique. Study tools and Data collection procedure: As soon as the patient was admitted, a detailed history was taken and a meticulous examination of the patient was done. The required information was recorded and proforma was prepared. Radiographs were taken in approximate views and diagnosis was established by clinical and radiological means. Then splinting of fractures was done with above knee POP slab for patellar fractures above elbow POP slab for olecranon fractures and below knee POP slab for medial malleolar fracture. All patients were taken for elective surgery as soon as possible after necessary blood, urine and radiographic preoperative work-up.Results: In our study, best results were obtained in fracture of patella 60%, olecranon fracture 42.8%, and medial malleolus 46.15%. In total of 30 cases, 15 (50%) had excellent results, 8 (26.66%) had good results, 3 (10%) had fair and poor result is 4(13.33%).Conclusion: It was concluded from the present study that, Tension band wiring by principle overcomes the distractive force, achieves compression at the fracture site and maintains the alignment by minimum hardware. By achieving compression at fracture site, the fracture heals faster and the patient is back to work earlier.

Isolated medial malleolar non-union, a cancellous screw with Kirshner wire as a valid and practical option: a case report

Medial malleolar fracture non-union are relatively uncommon. Not many studies have been found in the literature concerning its management, the great majority of studies in the orthopedic literature describe the use of either two cancellous screws or tension band wiring for its management. The use of one cancellous screw with Kirshner wire has not been described in the literature for the management of medial malleolar non-union. In this article we present two cases of medial malleolus non-union successfully managed with a sole cancellous screw associated with a Kirshner wire in two patients highlighting its possible advantages and a review of the literature on the management of medial malleolar non-union.

A COMPARATIVE STUDY OF INTERNAL FIXATION OF FRACTURE MEDIAL MALLEOLUS TREATED WITH TENSION BAND WIRING AND MALLEOLAR SCREW FIXATION

Background: As with all intraarticular fractures, malleolar fracture necessitates accurate reduction and stable internal xation. Undisplaced medial malleolus fractures can be treated conservatively. Various surgical modalities are now available for internal xation of such fractures. This study aims at comparing the two common xation methods. A total of 50 patient Materials and methods: s who met the inclusion criteria were included in the study and were divided into 2 groups- Group A comprised those patients treated with tension band wiring(n=25) while Group B patients were treated with malleolar screw xation(n=25). In cases of bimalleolar fractures, lateral malleolus was xed with one-third tubular plate. All post-operative patients were evaluated at 2weeks, 6weeks, 12weeks, and 6months. The mean t Results and conclusion: ime to radiological union was 9.32weeks in group A and 12weeks in group B with a highly signicant p-value. The nal functional outcome was compared by Modied Olerud &amp; Molander Score. 23 (92%) cases in group A and 20(80%) cases in group B had excellent to good results (P=0.007). Tensionband was technically more advantageous than malleolar screw and hence provided earlier bone union and better functional outcome

A COMPARATIVE ANALYSIS AND FUNCTIONAL OUTCOME OF MEDIAL MALLEOLUS FRACTURES TREATED WITH TENSION BAND WIRE VERSUS SCREW FIXATION

Back Ground:Ankle joint is a close-tting complex hinge joint. The attachments of ligaments increase the complexity of inferior tibio-bular &amp; tibio- talar joint. Ankle fractures can lead to long term morbidity with pain, arthritis &amp; joint instability. So management of the ankle fractures are challenging for the surgeons.Materials &amp; Methods:Acomparative study was done with 40 cases of medial malleolus fracture treated surgically at Government General Hospital, Srikakulam from June 2020 to October 2022 &amp; studied for 6-18 months. 15 fractures were treated by tension band wire &amp; 25 fractures by screw xation. Results: Tension Band wire gave excellent results in small &amp; osteoporotic fractures. Screw xation gave excellent results in vertical fractures. Range of motion was better in screw xation. Radiation exposure was less in TBW but operation time is higher. There was no signicant difference in union time, Infection rate &amp; functional outcome between both the procedures. Average time for bony union for screw xation was 10.8 weeks &amp; 10 weeks for tension band wire. Conclusion:Both the methods can be done in malleolar fractures. TBW can be preferred in small &amp; Osteoporotic fractures &amp; screw xation should be preferred in vertical fractures due to selective advantages

Technique Tip: Bicortical Fixation of Medial Malleolus Fractures With 2.7 mm Screws

Bicortical fixation of medial malleolus fractures provides increased interfragmentary compression and resistance to pull out. Achieving bicortical fixation with two 3.5 mm screws can be challenging especially with smaller fractures. We present a simple technique where two 2.7 mm screws are utilized for fixation of medial malleolus fractures. Level of Evidence: Level V—expert opinion.

Role of the posterior deep deltoid ligament in ankle fracture stability: A biomechanical cadaver study

The deltoid ligament is a key component of ankle fracture stability. Clinical tests to assess deltoid ligament injury have low specificity. In supination external-rotation (SER) type-IV ankle fractures, there is either a medial malleolus fracture or deltoid ligament injury. These injuries are often considered unstable, requiring surgical stabilisation. We look to identify the anatomical basis for this instability. This study investigates the anatomical basis for such instability by re-creating SER type ankle fractures in a standardised cadaveric study model, investigating the anatomical basis for such instability. To investigate the anatomical basis for fracture instability in SER type ankle fractures. Four matched pairs of cadaveric limbs were tested for stability both when axially loaded and under external rotation stress. Four matched pairs of cadaveric limbs (8 specimens) were tested for stability when axially loaded to 750 N with a custom rig. Specimens were tested through increasing stages of SER injury in a stepwise fashion before restoring the lateral side with open reduction and internal fixation (ORIF). Clinical photographs and radiographs were recorded at each step. We defined instability in accordance with well accepted radiological parameters: > 4 mm medial clear space opening on a mortise-view radiograph or > 7 degrees of talar tilt. All specimens with an intact posterior deep deltoid ligament were stable. Once the posterior deep deltoid ligament was sectioned there was instability in all specimens. Stabilisation of the lateral side prevented talar shift, but not talar tilt. If the posterior deep deltoid ligament is intact then SER fractures can be managed without surgery. If the posterior deep deltoid is incompetent, ORIF and cautious rehabilitation is recommended because the talus can still tilt in the mortise.

A comparative study in management of vertical medial malleolus fractures by cannulated screw versus plating

A comparative study in management of vertical medial malleolus fractures by cannulated screw versus plating

Intra-articular fracture patterns associated with tibial shaft fractures: more than just the posterior malleolus.

The association of tibial shaft fractures(TSFs) with posterior malleolarfractures is well described. The purpose of this study was to identify specific radiographic parameters that are predictive of any pattern of associated distalintra-articular fractures in TSFs. All TSFs presenting over a 6-year period were identified. A radiographic review of plain radiographs and CT scans included: identification of any associated ankle fracture, classification using the OTA System, measurements of the TSF obliquity angle (FOA), relative distance from distal extent of the TSF to plafond (DFP%), and presence and level of any associated fibular fractures. Patients with and without associated ankle fractures were statistically compared. Multivariate logistic regression determined independent predictors of associated ankle fractures. 405 TSFs in 397 patients were identified, with 145 TSFs with associated distal intra-articular fractures. There were 94 (23.2%) posterior malleolar fractures, 19 (13.1%) medial malleolar fractures, 42 (29.0%) lateral malleolar fractures involving the syndesmosis and 14 (9.7%) Chaput fragments. Multivariate regression demonstrated AO/OTA classification type 42-A1, 42-B1 or 42-C1 (OR 2.3 [95% CI 1.3-4.0]; p = 0.003), FOA greater than 45° (OR 2.7 [95% CI 1.5-4.8]; p = 0.001) and DFP% less than 33% (OR 4.1 [95% CI 2.0-9.0]; p = 0.005) were independent correlates of associated ankle fractures regardless of mechanism of injury. Different patterns of intra-articular fractures beyond posterior malleolar fractures can occur in TSFs. Fracture angles greater than 45° and extent into the distal 33% of the tibial shaft are independent predictors of distal intra-articular fractures in TSFs regardless of mechanism of injury. Diagnostic Level III.