ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2023
Intercalary fragments in posterior malleolar fractures: incidence, treatment implications, and distribution within CT-based classification systems.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- [Surgical Treatment of a Posterior Malleolus Fracture: Literature Review].Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca · 2026Review
- Posterior Malleolar Fractures: From the "Forgotten Fragment" to Modern Concepts in Management.Cureus · 2025Review
- Reduction and outcome of posterior pilon fractures with intercalary fragments: a retrospective cohort study comparing the transfibular and posteromedial approaches.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2025Article
- [Fractures of the upper ankle joint].Chirurgie (Heidelberg, Germany) · 2025Review
- Reduction Quality in Posterior Malleolar Fractures Using a Modified Posteromedial Ankle Approach.Foot & ankle orthopaedics · 2024Article
- Injury to the posterior malleolus in Maisonneuve fractures.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
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8 authors.
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Abstract
introductionComplex ankle fractures frequently include the posterior malleolus (PM). Despite advances in diagnostic and treatment strategies, PM fracture involvement still predisposes to worse outcomes. While not incorporated into the most common PM fracture classifications, the presence of an intercalary fragment (ICF) complicates treatment. This study aims to describe the incidence, morphology, and location of ICFs in PM fractures. MATERIALS AND
methodsA total of 135 patients with a mean age of 54.4 (SD ± 18.9) years and PM fractures were analyzed for the presence of an ICF. Patients with an ICF were compared to those without in terms of age, gender, and treatment received. Characteristics of the ICFs in terms of location and size were assessed. Furthermore, the presence of an ICF in relation to the PM fracture classification according to Haraguchi et al., Bartoníček/Rammelt et al., and Mason et al. was investigated.
resultsICFs presented in 55 (41%) of the 135 patients. Patients with an ICF were younger, and the PM was more often operatively treated when compared to patients without an ICF. A posterolateral approach was used significantly more often in patients with an ICF. Almost all ICFs were found in the posterolateral (58%) and posterocentral (35%) regions. The majority of fragments were found in Bartoníček/Rammelt type 2 fractures, the most common fracture type. Bartoníček/Rammelt type 3 fractures had the highest relative frequency of ICFs.
conclusionICFs are frequently found in PM fractures; however, they are not incorporated into any of the common classifications. They are generally found in younger patients and associated with more complex PM fractures. As they can complicate reduction of the main fragment and may require direct exposure to restore joint congruency, ICFs should be considered in PM fracture classifications. Due to their location, the majority of ICFs are able to be accessed using a posterolateral approach.
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