CME OnDemand: 2022 AOFAS Annual Meeting-Do Concomitant Posterior Malleolus Fractures Affect Mid-Term Functional Outcomes in Tibial Shaft Fractures?

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The study aimed to determine whether concomitant posterior malleolus fractures affect mid-term functional outcomes in tibial shaft fractures. The association between tibial shaft fractures and posterior malleolus fractures has been reported in 4 to 25% of cases. Early diagnosis is crucial and may alter the surgical strategy.<br /><br />The study compared the functional and quality of life outcomes in patients with tibial shaft fractures with and without concomitant posterior malleolus fractures. In a series of closed tibial shaft fractures, the presence of a posterior malleolus fracture did not affect functional results, time to return to work, or return to sports. The SF-12 score was better in the group with posterior malleolus fractures. All patients in this group had a timely diagnosis and anatomical reduction, which likely contributed to the good clinical results. There were no additional procedures or degenerative complications in the group with posterior malleolus fractures.<br /><br />The study included patients with tibial shaft fractures classified by AO type 42, 43A, and 43B1.1, with a minimum one-year follow-up. Open fractures, pathological bone fractures, and patients with a previous history of ipsilateral bone injury were excluded. The posterior malleolus fracture was fixed before the tibial fracture, and postoperative CT was used to assess the quality of reduction. Functional and quality of life results were evaluated using the LEFS, VAS, and SF-12. Times of return to work/sports, complications, and additional procedures were compared.<br /><br />Twenty patients with posterior malleolus fractures and 22 patients without were included in the study. The average age of the groups was comparable. All fractures healed, and CT showed anatomical articular reduction in all patients. At final follow-up, there were no significant differences in LEFS score, VAS scale, time of return to work/sports between the two groups. However, the group with posterior malleolus fractures scored better in physical and mental SF-12.<br /><br />In conclusion, the study found that concomitant posterior malleolus fractures did not significantly affect mid-term functional outcomes in tibial shaft fractures. The group with posterior malleolus fractures showed better scores in the SF-12. These findings suggest that early diagnosis and anatomical reduction are crucial for achieving good clinical results in these cases.

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Gonzalo F. Bastias, MD, Jose Ignacio Quezada Morales, MD, Paulina Gutierrez, Felipe G. Diaz, Rodrigo Melo, MD, Natalio R. Cuchacovich Mikenberg, MD, Gerardo Munoz, MD, CAE, Jorge Filippi, MD, MBA

Keywords

concomitant posterior malleolus fractures

mid-term functional outcomes

tibial shaft fractures

association

diagnosis

surgical strategy

functional and quality of life outcomes

SF-12 score

anatomical reduction

complications