Quan Yuan, Lu Hao, Xu Hailin, Liu Yijun, Xie Wenyong, Zhang Boyu, Zhang Dianying, Jiang Baoguo
Orthopaedic and Traumatology, Peking University People's Hospital, Beijing, China.
Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China.
Foot Ankle Int. 2021 Jul;42(7):959-966. doi: 10.1177/1071100721996700. Epub 2021 Mar 20.
The morphology and classification of posterior malleolus (PM) fractures remain controversial. An increasing number of studies have found that merely focusing on the fragment size does not lead to a satisfactory prognosis. This study aimed to demonstrate the fracture line and comminution zones of PM fractures using computed tomography (CT), in order to provide insights into the injury mechanism of PM fractures.
We retrospectively reviewed the data of 95 patients with PM fractures between 2013 and 2018 at a level 1 trauma center. The CT data of the PM of the patients were reconstructed using software. Images of all patients were superimposed together, and drawn as a heat map of the fragments and line distributions of PM fractures.
Our study included 66 type I, 19 type II, and 10 type III PM fractures according to the classification of Haraguchi. In the single-fragment fracture group, the fracture lines were mainly concentrated in the posterolateral tibial tubercle area (Volkmann's tubercle) and a larger tubercle area involving the tibialis posterior groove. In the multifragment fracture group, there were 10 (43.5%) patients with a 2-fragment pattern and 13 (56.5%) patients with a compressive-fragment pattern.
According to the fracture map and previous studies on the syndesmosis, our study provides a different understanding of the pathomechanisms of ankle injuries compared with previous classifications of PM fractures.
Level III, retrospective study.
后踝骨折的形态学及分类仍存在争议。越来越多的研究发现，单纯关注骨折块大小并不能带来满意的预后。本研究旨在利用计算机断层扫描（CT）显示后踝骨折的骨折线及粉碎区域，以便深入了解后踝骨折的损伤机制。
我们回顾性分析了2013年至2018年在一家一级创伤中心就诊的95例后踝骨折患者的数据。使用软件重建患者后踝的CT数据。将所有患者的图像叠加在一起，并绘制为后踝骨折的骨折块及骨折线分布热图。
根据原口分类，本研究纳入66例I型、19例II型和10例III型后踝骨折。在单骨折块组中，骨折线主要集中在胫骨后外侧结节区域（Volkmann结节）以及涉及胫后肌沟的较大结节区域。在多骨折块组中，10例（43.5%）患者为两骨折块模式，13例（56.5%）患者为压缩骨折块模式。
根据骨折图谱及以往关于下胫腓联合的研究，与以往后踝骨折分类相比，本研究对踝关节损伤的发病机制提供了不同的认识。
III级，回顾性研究。
