Beijing United Family Hospital, China
Title: The highly variable typologies of posterior malleolus fractures of the ankle
Dr. Jike Lu is an Orthopaedic surgeon, Chairperson, Professor, Dept of Orthopaedics at Wenzhou Med University, BJU, Beijing China. He completed his doctorate at the University of New South Wales in Sydney. Before his doctoral studies in Australia, Dr. Lu was a qualified orthopedic spine surgeon and Professor of Orthopedic Surgery at Xinjiang Medical University. Dr. Lu accumulated ten years of extensive experience in orthopedic trauma, tumors, joint replacement, and spinal surgeries. He has served in numerous hospital institutions in Melbourne and Sydney. Dr. Luâ€™s primary clinical interest is orthopedic surgery for adults and children. In addition, Dr. Lu has also served as a visiting professor of orthopedic surgery at Wenzhou Medical University. Dr. Lu has over 30 years of clinical experience in the treatment and diagnosis of spinal degenerative disorders, cervical spondylosis, lumbar disc herniation, stenosis and spondylolisthesis, and spinal trauma and tumors. Dr. Lu specializes in orthopedic trauma, joint arthroplasty, and total knee joint and hip replacement. Dr. Jike Lu has published over 50 Research articles in Chinese in scientific and medical journals. Dr. Lu currently holds unconditional national medical board registration and is certified by the Australia Medical Council.
Objectives: Although historical studies frequently classify posterior malleolus fractures (PMFs) according to fragment size, our hypothesis is that PMFs have more complex patterns than is widely recognized. None of the studies so far have provided a comprehensive picture of the complexity of PMFs or guidelines for surgical decision making. The optimal management of PMFs is still unclear. This study aims to look at the typology of PMFs using a combination of initial injury radiographs, preoperative computed tomographic (CT) scans, and intra-operative image intensifier (II) screening, as well as fixation technique and a surgery fixation approach, in order to gain insight into PMFs.
Methods: Between 2013 and 2015, 56 consecutive patients, all with bi- or tri-malleolar fracture or dislocation of ankle joints, with one or more posterior fragments, who were treated at our institute, were identified. We retrospectively analysed the patients’ preoperative initial injury radiographs, CT scans, and II data to see the stability of the ankle joints in coronal and sagittal planes, and look at the typology in relation to fracture fixation technique and surgery fixation approach.
Conclusions: Bi- or tri-malleolar fractures of the ankle with associated posterior malleolar fractures appear to be highly variable. We identified certain types of PMFs which we can categorise. Ankle stability in the coronal and sagittal planes on initial injury radiographs, intra-operative II and preoperative CT scans are critical in order to identify different PMFs pat- terns. PMFs have highly variable typology regardless of fragment size and this must take into consideration when deciding treatment plans.