ArticleArchives of orthopaedic and trauma surgery2019
Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures.
Article in Archives of orthopaedic and trauma surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 4 of them syntheses that pooled it.
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Who cites it
45 citing papers in PubMed, 4 syntheses or guidelines pooled it, 107 citations in OpenAlex.
- Likelihood of secondary surgery due to osteoarthritis following ankle fracture fixation: a systematic review.Journal of orthopaedic surgery and research · 2026Pooled it
- Open Reduction and Internal Fixation of the Posterior Malleolus Fragment in Ankle Fractures Improves the Patient-Rated Outcome: A Systematic Review.Foot & ankle international · 2023Pooled it
- Classifications of posterior malleolar fractures: a systematic literature review.Archives of orthopaedic and trauma surgery · 2023Pooled it
- [Established classification systems of posterior malleolar fractures : A systematic literature review].Unfallchirurgie (Heidelberg, Germany) · 2023Pooled it
- AO type C ankle fractures with additional posterior malleolus fragment: radiological and functional results of osseous reconstruction of the tibiofibular syndesmosis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- [Injuries of the tibiofibular syndesmosis].Unfallchirurgie (Heidelberg, Germany) · 2026Article
- [Injuries of the tibiofibular syndesmosis: surgical technique].Unfallchirurgie (Heidelberg, Germany) · 2026Review
- Clinical and radiological outcomes of surgical treatment using a posterolateral approach based on computed tomography-based fracture morphology in posterior malleolar fractures: A single-center retrospective analysis.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2026Article
- Mid-term outcomes of posterior malleolar fracture plating: identifying predictors of adverse outcomes.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- The Diagnosis, Treatment, and Aftercare of Ankle Fractures.Deutsches Arzteblatt international · 2026Review
- Development and incremental value assessment of a risk prediction model for post-traumatic osteoarthritis following ankle fracture surgery: a prospective study.BMC musculoskeletal disorders · 2026Article
- Molecular-biomechanical phenotyping of ankle osteoarthritis: from synovial biomarkers to weight-bearing digital signatures.Frontiers in medicine · 2026Review
- Joint-preserving corrective reconstruction strategy for malunions of tibial pilon fractures in young patients.International orthopaedics · 2026Article
- Machine learning prediction of post-traumatic osteoarthritis based on three-dimensional printing-derived joint congruence biomechanics in ankle fractures.Frontiers in medicine · 2026Article
- Posterior Malleolar Fractures: From the "Forgotten Fragment" to Modern Concepts in Management.Cureus · 2025Review
- Radiology and clinical prognosis of posterior malleolar fractures with different Step-off levels.BMC musculoskeletal disorders · 2025Article
- Treatment Strategy for Posterior Malleolar Fractures: Different Operative Strategies Are Needed for Each Morphological Type.Journal of clinical medicine · 2025Article
- Type B ankle fractures with additional medium-sized posterior fragment: mid-term functional and radiological outcome after fixation versus no fixation of the posterior fragment.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Comparison of the exposure of the distal tibial articular surface for posterior pilon fractures via a medial or lateral malleolar osteotomy: a preliminary cadaveric study.Frontiers in surgery · 2025Article
- Review
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTraditionally, size of the posterior fragment is considered the most important indicator for fixation in trimalleolar fractures. It remains unclear which factors contribute to worse functional and radiological outcome. This study was designed to determine predictors for the development of posttraumatic osteoarthritis and worse functional outcome in trimalleolar fractures.
methodsThis retrospective cohort study evaluated outcomes of 169 patients with a trimalleolar fracture treated between 1996 and 2013 in a level-1 trauma hospital in the Netherlands after a mean follow-up of 6.3 (range 2.4 to 15.9) years. The average fragment size was 17%. Twenty patients had a posterior fragment smaller than 5% of the intra-articular surface, 119 patients a fragment of 5-25% and 30 patients a posterior fragment larger than 25%. In total, 39 patients (23%) underwent fixation of the posterior fragment.
resultsClinical union was achieved in all 169 patients. The median AOFAS score after follow-up was 93 (interquartile range 76-100) and the median AAOS score was 92 (interquartile range 81-98). A persistent postoperative step-off larger than 1 mm was found in 65 patients (39%) and osteoarthritis was present in 49 patients (30%). Higher age and postoperative step-off > 1 mm were independent, significant risk factors for the development of osteoarthritis. Osteoarthritis and BMI were independent, significant risk factors for worse functional outcome.
conclusionIt is advisable to correct intra-articular step-off of intraarticular posterior malleolar fragments to reduce the risk of developing osteoarthritis and, consequently, the risk of worse functional outcome after long-term follow-up. LEVEL OF EVIDENCE: Level IIB.
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