![]() ![]() ![]() When the study cohort was divided in groups-one including only foot and ankle and trauma surgeons and another all other subspecialties -the following treatment preferences were observed: Based on radiographs only, in the foot and ankle and trauma group, 37 % (32) suggested nonoperative management and 63 % (53) internal fixation with the addition of CT images, only 17 % (15) supported nonoperative management, and 83 % (70) recommended surgery ( p = 0.001) (Fig. L lateral malleolus fracture only is seen on radiographs L+P concomitant posterior malleolus fracture is seen on computed tomography (CT) cuts Treatment preferences among orthopaedic surgeons. We hypothesized that in cases of minimally displaced lateral malleolus fracture, the presence of concomitant minimally displaced posterior malleolus fracture can shift the preferred treatment approach towards operative intervention, and that type of orthopaedic subspecialty may be associated with such decisions. We therefore conducted a questionnaire-based study among an international group of orthopaedic surgeons by presenting specific management dilemmas that relate to this type of injury. Understanding current treatment preferences among an international community of orthopaedic surgeons in cases of minimally displaced lateral malleolus fractures that occur in combination with minimally displaced posterior malleolus fractures can assist in delineating treatment guidelines for this injury. Accordingly, in a recent review, no consensus was found as to which posterior malleolus fragment size should be internally fixed. Yet, common combinations of minimally displaced lateral malleolus fractures with minimally displaced posterior malleolus fractures that involve <50 % of the articular surface increase the uncertainty regarding preferred treatment. Accordingly, 97 % of surgeons preferred operative management for posterior malleolus fractures in one study when >50 % of the articular surface was involved. Although there is still debate whether the primary role of the posterior malleolus is related to peak stress distribution or to tibiotalar stability, indications for operative intervention in cases of posterior malleolus fractures are frequently based on fragment size. However, fractures of the posterior malleolus, which usually occur in combination with lateral malleolus fractures, may alter treatment decisions even when there is minimal displacement of the fragments. When there is minimal displacement, it is acceptable to treat lateral malleolus fractures nonoperatively. ĭespite the high incidence of fractures involving the lateral or posterior malleolus, the indications for operative intervention remain an issue of controversy among orthopaedic surgeons. Posterior malleolus fractures occur in 7–44 % of ankle fractures. Between 60 % and 70 % are unimalleolar fractures, the majority involving the lateral malleolus. Ankle fractures are among the most common fractures treated by orthopaedic surgeons, with an incidence of approximately 187 fractures per 100,000 people each year. ![]()
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