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Results of Ankle Fractures with Involvement of the Posterior Tibial Margin

Langenhuijsen, Johan F. MD; Heetveld, Martin J. MD; Ultee, Jan M. MD; Steller, E. Philip MD, PhD; Butzelaar, Rudi M. J. M. MD, PhD

Journal of Trauma and Acute Care Surgery: July 2002 - Volume 53 - Issue 1 - p 55-60
Original Articles

Background  Ankle fractures have a significantly worse functional outcome when they include a posterior tibial fragment. In 57 trimalleolar fractures, the effect of size, internal fixation, and anatomic reduction of the posterior fragment on the prognosis was evaluated.

Methods  A modified Weber protocol was used, providing a rating system for subjective, objective, and radiographic results. A visual analogue scale for subjective actual pain was also scored.

Results  The involvement of the articular surface ranged from 8% to 55%. Size or fixation of the fragment did not influence prognosis. Joint congruity in fragments ≥ 10% of the articular surface was a significant factor influencing prognosis. Overall, the modified Weber protocol result was excellent in 10%, good in 15%, fair in 25%, and poor in 50% of patients. However, the low average visual analogue scale of 3.0 in the whole group does not appear representative of 50% poor results, indicating that the modified Weber protocol is fairly strict and overestimates the number of poor results.

Conclusion  Joint congruity with or without fixation was a significant factor influencing prognosis. Congruity should be achieved for fragments ≥ 10% of the tibial articular surface.

From the Department of General Surgery, St. Lucas Andreas Hospital, Amsterdam, The Netherlands.

Submitted for publication March 21, 2001.

Accepted for publication March 2, 2002.

Presented at the Annual Meeting of the Dutch Association of Surgeons, May 18, 2000, Veldhoven, The Netherlands.

Address for reprints: E. Philip Steller, MD, PhD, Department of General Surgery, St. Lucas Andreas Hospital, location St. Lucas, Jan Tooropstraat 164, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands; email:

© 2002 Lippincott Williams & Wilkins, Inc.