Weber B Ankle Fractures With Associated Posterior Malleolus Fracture (PMFIX)
Posterior Malleolus Fractures, Ankle Fractures, Syndesmotic Injuries
About this trial
This is an interventional treatment trial for Posterior Malleolus Fractures focused on measuring Posterior malleolus fractures, Ankle factures, Weber B fractures, Syndesmotic injuries, Fixation, Randomized Controlled Trial
Eligibility Criteria
Inclusion Criteria:
- Posterior malleolar (PM) fracture, of Mason & Molly type 2A/2B, associated with Weber B/C lateral malleolar fracture, and/or medial malleolar fracture
- Patients informed, written consent
- Age 18-65 years
For inclusion axial CT images are examined
- Measurements are performed 5 millimeters (mm) cranial to the tibia plafond
- Posterior malleolus fractures involving less than 40% of the fibular notch are included.
Exclusion Criteria:
- Non-compliant patient, i.e.: dementia, alcohol- or substance abuse
- ASA-4 patients
- Known congenital bone decease
- Pathological fractures
- Immunocompromised patients
- Tourists or patients on a short-term work/study permit
- Previous injury or condition of the ipsilateral ankle or ipsilateral lower extremity with a resulting dysfunction
- Tibia shaft fractures with an associated posterior malleolar fracture
- Fracture of the upper half of the fibula
- Poor controlled diabetes
- Patients with known arterial insufficiency
- Open fractures
- Severely traumatized patients (ISS>16)
Sites / Locations
- Haukeland University Hospital, Orthopedic departmentRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Fixation group
Non-fixation group
Patients are placed in a prone position on the operating table. Fixation of the posterior malleolus fracture. Posterior, and/or lateral and medial malleolus fractures will be treated with open reduction and internal fixation. ORIF of the posteromedial fragment in Mason and Molloy type 2B with one or more screws, or plate, if it is displaced more than 2 mm. Deltoid ligament injuries are repaired if incarcerated between medial malleolus and talus. The posteromedial fragment in Mason and Molloy type 2B will be fixed with one or more screws, or plate, if this fragment is displaced more than 2 mm. A Tillaux-Chaput or Wagstaffe fragment is fixed with suture anchor, plate, screw or pin if displaced >2 mm depending on size and comminution of the fragment. The syndesmosis is tested under fluoroscopy by lateralizing and then externally rotating the talus. If unstable it is fixed with one or two 3.5 mm cortical screws or a suture button.
Patients are placed in a supine position on the operating table. No fixation of the PMF. The PMF is reduced by ligamentotaxis. Lateral and/or medial malleolus fractures will be treated with ORIF if present. ORIF of the posteromedial fragment in Mason and Molloy type 2B with one or more screws, or plate, if it is displaced more than 2 mm. Deltoid ligament injuries are repaired if incarcerated between medial malleolus and talus. A Tillaux-Chaput or Wagstaffe fragment is fixed with suture anchor, plate, screw or pin if displaced >2 mm depending on size and comminution of the fragment. The syndesmosis is tested under fluoroscopy by lateralizing and then externally rotating the talus. If unstable it is fixed with one or two 3.5 mm cortical screws or a suturebutton.