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The Incidence of Posterior Malleolar Involvement in Distal Spiral Tibia Fractures

Is it Higher than We Think?

Sobol, Garret L., MD; Shaath, M. Kareem, MD; Reilly, Mark C., MD; Adams, Mark R., MD; Sirkin, Michael S., MD

doi: 10.1097/BOT.0000000000001307
Original Article

Objectives: To investigate the incidence of concomitant posterior malleolar fractures (PMFs) in operative, distal-third, spiral tibia fractures.

Design: Prospective protocol with retrospective review of data.

Setting: Single, Level 1 trauma center.

Patients/Participants: One hundred ninety-three consecutive, skeletally mature patients with operatively treated fractures of the distal-third, tibial shaft and metaphysis. Pilon fractures were excluded.

Intervention: Computed tomography (CT) scans were obtained in all distal-third, spiral fractures of the tibia to determine fracture morphology and presence of a PMF.

Main Outcome Measurements: The incidence of concurrent PMFs in operative spiral fractures of the distal tibia.

Results: Twenty-six distal-third, spiral fractures were identified with an ipsilateral PMF diagnosed in 92.3% of cases (24 cases). PMFs were over 25 times more likely to occur in distal-third, spiral fractures when compared with other distal-third fracture patterns (relative risk = 25.7, 95% confidence interval, 11.6–56.8). PMFs were treated with supplemental fixation in 23/24 (95.8%) cases.

Conclusions: There is a high incidence of concomitant, ipsilateral fractures of the posterior malleolus in patients presenting with operative distal-third, spiral fractures of the tibia. A preoperative ankle computed tomography should be strongly considered in all cases with this specific fracture morphology.

Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ.

Reprints: Garret L. Sobol, MD, Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen St, Suite D-1610, Newark, NJ 07103 (e-mail:

The authors report no conflict of interest.

Accepted July 12, 2018

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