{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T02:39:39Z","timestamp":1789439979935,"version":"build-2803163510"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2021,1,28]],"date-time":"2021-01-28T00:00:00Z","timestamp":1611792000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,28]],"date-time":"2021-01-28T00:00:00Z","timestamp":1611792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001702","name":"AO Foundation","doi-asserted-by":"publisher","award":["AR2013_06"],"award-info":[{"award-number":["AR2013_06"]}],"id":[{"id":"10.13039\/501100001702","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Projekt DEAL"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study investigated the effects of a small posterior malleolar fragment (PMF), containing less than 25% articular surface\u00a0area, on ankle joint stability via computed tomography (CT) scanning under full weight bearing in a human cadaveric ankle fracture model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A trimalleolar fracture with a PMF of less than 25% articular surface\u00a0area was created in 6 pairs of fresh-frozen human cadaveric lower legs.\u00a0The specimens were randomized into 2 groups stabilized by internal fixation including a positioning screw for syndesmotic reconstruction. In Group I the PMF was addressed by direct screw osteosynthesis, whereas\u00a0in Group II the fragment was not fixed. Six predefined distances within the ankle were measured under axial loading. CT scans of each specimen\u00a0were performed in intact and fixated states in neutral position, dorsiflexion and plantar-flexion of the ankle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In plantar-flexion, significant differences were detected\u00a0between the groups with regard to rotational instability. Group II demonstrated a significantly increased inward rotation of the fibula compared with Group I.<\/jats:p>\n                    <jats:p>No significant differences were detected between the groups\u00a0for each one of the measured distances in any of the three foot\u00a0positions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Additional reduction and fixation of a small PMF seems to neutralize rotational forces in the ankle more effectively than a sole syndesmotic screw. Clinically, this becomes relevant in certain phases of the gait cycle. Direct screw osteosynthesis of a small PMF stabilizes the ankle more effectively than a positioning screw.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-021-03772-9","type":"journal-article","created":{"date-parts":[[2021,1,28]],"date-time":"2021-01-28T07:12:56Z","timestamp":1611817976000},"page":"1031-1037","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Leave it or fix it? How fixation of a small posterior malleolar fragment neutralizes rotational forces in trimalleolar fractures"],"prefix":"10.1007","volume":"142","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0571-3611","authenticated-orcid":false,"given":"Julia","family":"Evers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maren","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Raschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Riesenbeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Milstrey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Gehweiler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Ochman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,28]]},"reference":[{"key":"3772_CR1","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1007\/s00068-015-0560-6","volume":"41","author":"J Bartoni\u010dek","year":"2015","unstructured":"Bartoni\u010dek J, Rammelt S, Tu\u010dek M, Na\u0148ka O (2015) Posterior malleolar fractures of the ankle. Eur J Trauma Emerg Surg 41:587\u2013600","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"6","key":"3772_CR2","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1177\/1071100715570895","volume":"36","author":"CC Drijhout van Hooff","year":"2015","unstructured":"Drijhout van Hooff CC, Verhage SM, Hoogendoorn JM (2015) Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures. Foot Ankle Int 36(6):673\u2013678","journal-title":"Foot Ankle Int"},{"key":"3772_CR3","doi-asserted-by":"publisher","unstructured":"Evers J, Barz L, W\u00e4hnert D, Gr\u00fcneweller N, Raschke MJ, Ochman S (2015) Size matters: The influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures. Injury https:\/\/doi.org\/10.1016\/S0020-1383(15)30028-0","DOI":"10.1016\/S0020-1383(15)30028-0"},{"key":"3772_CR4","doi-asserted-by":"crossref","unstructured":"Wang C, Yang J, Wang S, Ma X, Wang X, Huang J, Zhang C, Chen L, Geng X, Wang K (2015) Three-dimensional motions of distal syndesmosis during walking. J Orthop Res 24(10): 166","DOI":"10.1186\/s13018-015-0306-5"},{"key":"3772_CR5","doi-asserted-by":"crossref","unstructured":"Anwar A, Zhang Z, Lv D, Lv G, Zao Z, Wang Y, Cai Y, Qasim W, Nazir MU, Lu M (2018) Biomechanical efficacy of AP, PA lag screws and posterior plating for fixation of posterior malleolar fractures: a three dimensional finite element study, BMC Musculoskelet Disord 19(1): 73","DOI":"10.1186\/s12891-018-1989-7"},{"key":"3772_CR6","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1007\/s00402-018-2949-2","volume":"138","author":"SM Verhage","year":"2018","unstructured":"Verhage SM, Hoogendoorn JM, Krijnen P, Schipper IB (2018) When and how to operate the posterior malleolus fragment in trimalleolar fractures: a systematic literature review. Arch Orthop Trauma Surg 138:1213\u20131222","journal-title":"Arch Orthop Trauma Surg"},{"key":"3772_CR7","doi-asserted-by":"crossref","unstructured":"Weigelt L, Hasler J, Flury A, Dimitriou D, Helmy N (2020) Clinical and radiological mid- to long-term results after direct fixation of posterior malleolar fractures through a posterolateral approach. Arch Orthop Trauma Surg","DOI":"10.1007\/s00402-020-03353-2"},{"key":"3772_CR8","doi-asserted-by":"crossref","unstructured":"Gardner MJ, Brodsky A, Briggs SM, Nielson JH, Lorich DG (2006) Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res; 447:165-71","DOI":"10.1097\/01.blo.0000203489.21206.a9"},{"key":"3772_CR9","doi-asserted-by":"crossref","unstructured":"Haraguchi N, Haruyama H, Toga H, Kato F (2006) Pathoanatomy of Posterior Malleolar Fractures of the Ankle. JBJS Am 88(5): 1085\u201392","DOI":"10.2106\/JBJS.E.00856"},{"key":"3772_CR10","doi-asserted-by":"crossref","unstructured":"Evers J, Fischer M, Zderic I, W\u00e4hnert D, Richards RG, Gueorguiev B, Raschke MJ, Ochman S (2018) The role of a small posterior malleolar fragment in trimalleolar fractures. Bone Joint J 100-B:95\u2013100","DOI":"10.1302\/0301-620X.100B1.BJJ-2017-0435.R1"},{"key":"3772_CR11","doi-asserted-by":"crossref","unstructured":"Zwipp H (1994) Chirurgie des Fu\u00dfes. Springer-Verlag: 171 [German]","DOI":"10.1007\/978-3-7091-6638-3_5"},{"key":"3772_CR12","doi-asserted-by":"crossref","unstructured":"Grass R, Rammelt S, Biewener A, Zwipp H (2003) Peroneus longus ligamentoplasty for chronic instability of the distal tibiofibular sydesmosis. Foot Ankle Int 24(5): 392\u20137","DOI":"10.1177\/107110070302400503"},{"key":"3772_CR13","doi-asserted-by":"crossref","unstructured":"Shakoor D, Osgood GM, Brehler M, Zbijewski WB, de Cesar Netto C, Shafiq B, Orapin J, Thawait GK, Shon LC, Demehri S (2019) Cone-beam CT measurements of distal tibio-fibular syndesmosis in asymptomatic uninjured ankles: does weight-bearing matter? Skeletal Radiology 48(4):583\u2013594","DOI":"10.1007\/s00256-018-3074-6"},{"key":"3772_CR14","first-page":"509","volume":"71","author":"MC Nelson","year":"1940","unstructured":"Nelson MC, Jensen NK (1940) Surg Gynec Obst 71:509\u2013514","journal-title":"Surg Gynec Obst"},{"key":"3772_CR15","first-page":"54","volume-title":"The joints of the Ankle","author":"VT Inman","year":"1976","unstructured":"Inman VT (1976) The joints of the Ankle. The Williams & Wilkins Company, Baltimore, p 54"},{"key":"3772_CR16","doi-asserted-by":"crossref","unstructured":"Lindsj\u00f6 U (1985) Operative treatment of ankle fracture-dislocations. A follow-up study of 306\/321 consecutive cases. Clin Orthop Relat Res Oct (199): 28\u201338.","DOI":"10.1097\/00003086-198510000-00005"},{"key":"3772_CR17","first-page":"279","volume":"66","author":"MPJ van den Bekerom","year":"2009","unstructured":"van den Bekerom MPJ, Haverkamp D, Kloen P (2009) Biomechanical and Clinical Evaluation of Posterior Malleolar Fractures. A Systematic Review of the Literature. J Trauma 66:279\u2013284","journal-title":"J Trauma"},{"key":"3772_CR18","doi-asserted-by":"crossref","unstructured":"Hu WK, Chen DW, Li B, Yan YF, Yu GR (2019) Motion of the distal tibiofibular syndesmosis under different loading patterns: a biomechanical study. J Orthop Surg (Hong Kong) 27(2): 23094990109842879","DOI":"10.1177\/2309499019842879"},{"key":"3772_CR19","doi-asserted-by":"crossref","unstructured":"Hoogervorst P, Working ZM, El Naga A, Marmor M (2019) In Vivo CT analysis of physiological fibular motion at the level of the ankle syndesmosis during plantigrade weightbearing. Foot Ankle Spec 12 (3): 233\u2013237","DOI":"10.1177\/1938640018782602"},{"key":"3772_CR20","doi-asserted-by":"crossref","unstructured":"Lepoj\u00e4rvi S, Niinim\u00e4ki J, Pakarinen H, Leskel\u00e4 HV (2016) Rotational dynamics of the normal distal tibiofibular joint with weight-bearing computed tomography. Foot Ankle Int 27(6): 627\u201335","DOI":"10.1177\/1071100716634757"},{"key":"3772_CR21","doi-asserted-by":"crossref","unstructured":"Chao EY, Arminger RS, Yoshida H Lim J, Haraguchi N (2007) Virtual interactive musculoskeletal system (VIMS) in orthopaedic research, education and clinical patient care. J Orthop Surg Res 2: 2","DOI":"10.1186\/1749-799X-2-2"},{"key":"3772_CR22","doi-asserted-by":"crossref","unstructured":"Fitzpatrick E, Goetz JE, Sittapairoj T, Siddappa VH, Femino JE, Phisitkul P (2018) Effect of posterior malleolus fracture on syndesmotic reduction: a cadaveric study. J Bone Joint Surg Am 100(3): 243\u2013248","DOI":"10.2106\/JBJS.17.00217"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-021-03772-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-021-03772-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-021-03772-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T10:26:27Z","timestamp":1652696787000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-021-03772-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,28]]},"references-count":22,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["3772"],"URL":"https:\/\/doi.org\/10.1007\/s00402-021-03772-9","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,28]]},"assertion":[{"value":"28 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 April 2021","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Former problem: Funding information was missing and Correct information: Open Access funding enabled\nand organized by Projekt DEAL","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no Conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}