Background
fracture, dislocation, postoperative instability, fractures, Fractures
POST-TRAUMATIC OSTEOARTHRITIS, INTRAOPERATIVE COMPLICATIONS, SECONDARY
Concomitant fractures of the posterior malleolus (PM) typically occur in distal tibia fractures (Arbeitsgemeinschaft für Osteosynthesefragen Classification; AO:43A) and especially in spiral fractures of the tibial shaft (AO:42/43A) with a fracture line extending from proximal-lateral to distal-medial in the anterior–posterior (AP) view (type A). The incidence of concomitant PM fractures in tibial shaft fractures type A has been cited to be greater than 50%, and importantly, not all of them were detected preoperatively [Although the occurrence of PM fractures in tibial shaft spiral fractures is now well established, there is no evidence that plain X-ray imaging is sufficient to rule out additional PM fractures. This is clinically relevant—especially for tibial shaft fractures with a high risk of additional PM fractures—to avoid unnecessary radiation, but at the same time not to overlook any PM fractures. Missed PM fractures can lead to intraoperative complications such as secondary dislocation as well as postoperative instability and post-traumatic osteoarthritis. Fractures with an increased risk of PM involvement have already been described several times in the literature [The management of fractures of the PM is currently changing. Several recent publications suggest that surgical fixation—even of small fragments—is important for restoring the articular surface, the fibular notch and trans-syndesmotic stability [This study investigated the hypothesis that plain X-ray is not sufficient for a reliable diagnosis of associated non-displaced PM fractures in tibial shaft spiral fractures.