Abstract
Introduction: Trimalleolar ankle fractures have a poorer prognosis than mono- or bimalleolar fracture types, in general, and in particular, with a fracture dislocation. The mere size of the posterior tibial fragment which is hard to be assessed from standard radiography alone is not decisive for the final outcome.
Methods: Computed tomography scanning (CT) including 3D reformatting allows for exact assessment of the posterior tibial fragment and classification of the injury which is of therapeutic relevance. The posterior tibial fragment may represent a disturbance of tibiotalar incongruency, the formation or presence of intermediate and displaced joint fragments, a lesion of the integrity of the fibular incisura and an extension into the medial malleolar fracture.
Results/Conclusions: The adequate analysis of the fracture type via CT scan and correct reduction of the posterior tibial fragment may be of utmost importance for the restoration of ankle joint congruency. The posteromedial and posterolateral approaches provide a direct view to the fracture site of the posterior tibial fragment and offer the best choice if open reduction is indicated.
Regularly, this approach makes the use of a tibiofibular set screw dispensable. A postoperative CT scan as a quality control for the surgical intervention can demonstrate a correct reconstruction of the ankle anatomy.