ArticleJournal of foot and ankle research2017
3-D computer modelling of malunited posterior malleolar fractures: effect of fragment size and offset on ankle stability, contact pressure and pattern.
Article in Journal of foot and ankle research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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12 citing papers in PubMed, 39 citations in OpenAlex.
- Medial Malleolar Fracture Fixation with Stainless Steel, Titanium, Magnesium, and PLGA Screws: A Finite Element Analysis.Journal of functional biomaterials · 2026Article
- Delta external fixation as a suitable option for definitive fixation of osteoporotic pilon fractures in biomechanics: a finite element analysis.Frontiers in bioengineering and biotechnology · 2026Article
- Comparison of the mechanical performance of intramedullary nail and locking plate in tibiotalocalcaneal arthrodesis : a finite element analysis.Bone & joint research · 2025Article
- Comparative finite element analysis of contact and stress distribution in tibiotalar articular cartilage: Healthy versus varus ankles.Journal of orthopaedics · 2024Article
- Investigation into the effect of deltoid ligament injury on rotational ankle instability using a three-dimensional ankle finite element model.Frontiers in bioengineering and biotechnology · 2024Article
- Biomechanical insights into ankle instability: a finite element analysis of posterior malleolus fractures.Journal of orthopaedic surgery and research · 2023Article
- Analysis of the epidemiological characteristics of posterior malleolus fracture in adults.Journal of orthopaedic surgery and research · 2023Article
- The Influence of Sagittal Angle of Posterior Malleolus Fracture on Ankle Joint Stability: A Retrospective Study of 120 Cases.Orthopaedic surgery · 2023Article
- Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2023Article
- Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries.Journal of clinical medicine · 2022Article
- Effect of cartilage thickness mismatch in osteochondral grafting from knee to talus on articular contact pressures: A finite element analysis.Joint diseases and related surgery · 2021Article
- An extended discrete element method for the estimation of contact pressure at the ankle joint during stance phase.Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine · 2020Article
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe positioning of the fracture fragment of a posterior malleolus fracture is critical to healing and a successful outcome as malunion of a posterior malleolar fracture, a condition seen in clinical practice, can affect the dynamics of the ankle joint, cause posterolateral rotational subluxation of the talus and ultimately lead to destruction of the joint. Current consensus is to employ anatomic reduction with internal fixation when the fragment size is larger than 25 to 33% of the tibial plafond.
methodsA 3-dimensional finite element (FE) model of ankle was developed in order to investigate the effect of fragment size (6-15 mm) and offset (1-4 mm) of a malunited posterior malleolus on tibiotalar joint contact area, pressure, motion of joint and ligament forces. Three positions of the joint were simulated; neutral position, 20° dorsiflexion and 30° plantarflexion.
resultsCompared to the intact joint our model predicted that contact area was greater in all malunion scenarios considered. In general, the joint contact area was affected more by section length than section offset. In addition fibula contact area played a role in all the malunion cases.
conclusionsWe found no evidence to support the current consensus of fixing posterior malleolus fractures of greater than 25% of the tibial plafond. Our model predicted joint instability only with the highest level of fracture in a loaded limb at an extreme position of dorsiflexion. No increase of peak contact pressure as a result of malunion was predicted but contact pattern was modified. The results of our study support the view that in cases of posterior malleolar fracture, posttraumatic osteoarthritis occurs as a result of load on areas of cartilage not used to loading rather than an increase in contact pressure. Ankle repositioning resulted in increased force in two ankle ligaments. Our finding could explain commonly reported clinical observations.
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