{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T23:47:43Z","timestamp":1782258463896,"version":"3.54.5"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The posterior malleolar fragment (PMF) in ankle fractures can be fixed with closed\n\t\t\t\treduction and percutaneous fixation with an anteroposterior screw (Closed Reduction\n\t\t\t\tInternal Fixation \u2013 CRIF), or with open reduction using a posterior approach and\n\t\t\t\tbuttress plating (Open Reduction Internal Fixation \u2013 ORIF). The objective of this\n\t\t\t\tstudy was to compare these two techniques with respect to postoperative\n\t\t\t\tcomplications and patient-reported outcome measures (PROMs).<\/jats:p>\n                  <jats:p>In this retrospective study, data were analysed from 106 consecutive ankle\n\t\t\t\tfracture cases involving the PMF that were operated between 2021 and 2022 in a\n\t\t\t\tsingle institution. The PMF was managed either via CRIF (n\u00a0=\u00a043) or via ORIF\n\t\t\t\t(n\u00a0=\u00a063). A comprehensive analysis was conducted, encompassing patient-,\n\t\t\t\tfracture-specific characteristics, and treatment modalities.A minimum follow-up\n\t\t\t\tperiod of three months was deemed necessary in order to ascertain the complication\n\t\t\t\trate, which was available for a total of 65 patients. The documented complications\n\t\t\t\tincluded superficial wound healing impairment without surgical revision, deep wound\n\t\t\t\thealing impairment necessitating surgical revision, iatrogenic nerve injury, delayed\n\t\t\t\tbone union, and revision surgery.In the second part of the study, patients were\n\t\t\t\tcontacted for a follow-up assessment using the Foot and Ankle Outcome Score (FAOS),\n\t\t\t\tthe Foot and Ankle Ability Measure (FAAM) and a numerical rating scale for pain\n\t\t\t\t(NRS). Thirty-nine patients participated.<\/jats:p>\n                  <jats:p>Analyses revealed significant disparities in the distribution of Barton\u00ed\u010dek\n\t\t\t\tfracture types between the ORIF and CRIF groups: type II was more prevalent, and\n\t\t\t\ttypes III and IV less common, in the CRIF group (n\u00a0=\u00a043) than in the ORIF group\n\t\t\t\t(n\u00a0=\u00a063; p\u00a0=\u00a00.03). The PMFs in the ORIF group were found to be significantly larger\n\t\t\t\t(p\u00a0=\u00a00.006), and the mean surgical time was significantly prolonged in comparison to\n\t\t\t\tthe CRIF group (p\u00a0&lt;\u00a00.0001). The placement of a positioning screw was observed to\n\t\t\t\tbe significantly more prevalent in the CRIF group than in the ORIF group (18 cases\n\t\t\t\t[42%] vs. 10 cases [16%], p\u00a0=\u00a00.003).Following a median follow-up period of\n\t\t\t\teight months (range 3\u201337 months), the complication rate was found to be higher in\n\t\t\t\tthe ORIF group (37%) than in the CRIF group (18%), although this difference was not\n\t\t\t\tstatistically significant (p\u00a0=\u00a00.116).After a median follow-up period of 21\n\t\t\t\t(14\u201336) months, the CRIF group patients showed significantly better results in the\n\t\t\t\tFAOS subscales activities of daily living and quality of life compared to the\n\t\t\t\tpatients in the ORIF group (p\u00a0=\u00a00.049 and p\u00a0=\u00a00.045, respectively). Furthermore, the\n\t\t\t\tself-assessed ankle function compared to the status prior to the fracture, in the\n\t\t\t\tsports category of the FAAM, was better in the CRIF than in the ORIF group\n\t\t\t\t(p\u00a0=\u00a00.029).No significant differences were identified in FAOS total score or\n\t\t\t\tNRS between the two groups (p\u00a0=\u00a00.107 and p\u00a0=\u00a00.236, respectively).<\/jats:p>\n                  <jats:p>ORIF of the PMF reduces the likelihood of additional syndesmotic stabilisation in\n\t\t\t\tcomparison with CRIF; however, it is associated with increased surgical time while\n\t\t\t\tmaintaining similar complication rates.<\/jats:p>","DOI":"10.1055\/a-2879-5116","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T23:24:15Z","timestamp":1782257055000},"source":"Crossref","is-referenced-by-count":0,"title":["Posterior Malleolus Fractures of the Tibia: Open Reduction and Buttress Plating versus Percutaneous Fixation with an Anteroposterior Screw"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7182-9404","authenticated-orcid":false,"given":"Leyla","family":"T\u00fcmen","sequence":"additional","affiliation":[{"name":"Eberhard Karls Universit\u00e4t T\u00fcbingen, BW, Deutschland","place":["T\u00fcbingen"],"department":["BG Klinik T\u00fcbingen"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Zoehrlaut","sequence":"additional","affiliation":[{"name":"Eberhard Karls Universit\u00e4t T\u00fcbingen, BW, Deutschland","place":["T\u00fcbingen"],"department":["BG Klinik T\u00fcbingen"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Histing","sequence":"additional","affiliation":[{"name":"Eberhard Karls Universit\u00e4t T\u00fcbingen, BW, Deutschland","place":["T\u00fcbingen"],"department":["BG Klinik T\u00fcbingen"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"K\u00f6rner","sequence":"additional","affiliation":[{"name":"Eberhard Karls Universit\u00e4t T\u00fcbingen, BW, Deutschland","place":["T\u00fcbingen"],"department":["BG Klinik T\u00fcbingen"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"385","DOI":"10.3113\/FAI.2011.0385","article-title":"Surgeon practices regarding operative treatment of posterior malleolus\n\t\t\t\t\tfractures","volume":"32","author":"MJ Gardner","year":"2011","journal-title":"Foot Ankle Int"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1177\/1071100717735839","article-title":"Stability of the Syndesmosis After Posterior Malleolar Fracture\n\t\t\t\t\tFixation","volume":"39","author":"MA Miller","year":"2018","journal-title":"Foot Ankle Int"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1016\/j.injury.2018.12.025","article-title":"Open reduction and internal fixation of the posterior malleolus fragment\n\t\t\t\t\tfrequently restores syndesmotic stability","volume":"50","author":"SF Baumbach","year":"2019","journal-title":"Injury"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.2106\/JBJS.E.00856","article-title":"Pathoanatomy of posterior malleolar fractures of the ankle","volume":"88","author":"N Haraguchi","year":"2006","journal-title":"J Bone Joint Surg Am"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/s00402-015-2171-4","article-title":"Anatomy and classification of the posterior tibial fragment in ankle\n\t\t\t\t\tfractures","volume":"135","author":"J Barton\u00ed\u010dek","year":"2015","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.19.00207","article-title":"Posterior Malleolar Fractures: A Critical Analysis Review","volume":"8","author":"S Rammelt","year":"2020","journal-title":"JBJS Rev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1007\/s00402-018-2949-2","article-title":"When and how to operate the posterior malleolus fragment in trimalleolar\n\t\t\t\t\tfractures: a systematic literature review","volume":"138","author":"SM Verhage","year":"2018","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1016\/j.fas.2024.05.004","article-title":"Comparison between anterior-to-posterior screw fixation versus\n\t\t\t\t\tposterolateral approach plate fixation for posterior malleous fracture: A\n\t\t\t\t\tsystematic review and meta-analysis","volume":"30","author":"Y Gao","year":"2024","journal-title":"Foot Ankle Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1007\/s00402-014-1994-8","article-title":"Translation and validation of the German version of the foot and ankle\n\t\t\t\t\toutcome score","volume":"134","author":"CJA van Bergen","year":"2014","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1136\/bjsm.2009.067637","article-title":"Translation, cross-cultural adaption and validation of the German version\n\t\t\t\t\tof the Foot and Ankle Ability Measure for patients with chronic ankle\n\t\t\t\t\tinstability","volume":"45","author":"T Nauck","year":"2011","journal-title":"Br J Sports Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1053\/j.jfas.2017.01.053","article-title":"Comparing Different Surgical Techniques for Addressing the Posterior\n\t\t\t\t\tMalleolus in Supination External Rotation Ankle Fractures and the Need for\n\t\t\t\t\tSyndesmotic Screw Fixation","volume":"56","author":"M Li","year":"2017","journal-title":"J Foot Ankle Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1097\/BOT.0000000000000330","article-title":"Posterior Malleolar Fracture Patterns","volume":"29","author":"L Mangnus","year":"2015","journal-title":"J Orthop Trauma"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1016\/j.fas.2022.06.012","article-title":"Influence of posterior malleolar fragment morphology on the outcomes of\n\t\t\t\t\ttrimalleolar fractures: A systematic review and meta-analysis","volume":"28","author":"S Patel","year":"2022","journal-title":"J Foot Ankle Surg"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2021.101894","article-title":"Open reduction and internal fixation of the posterior malleolus fragment\n\t\t\t\t\tvia the posterolateral approach is radiologically superior to \u201eA to P\u201c screw\n\t\t\t\t\tfixation","volume":"51","author":"SM Verhage","year":"2022","journal-title":"Foot (Edinb)"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1177\/10711007231165771","article-title":"Open Reduction and Internal Fixation of the Posterior Malleolus Fragment\n\t\t\t\t\tin Ankle Fractures Improves the Patient-Rated Outcome: A Systematic\n\t\t\t\t\tReview","volume":"44","author":"RC Miksch","year":"2023","journal-title":"Foot Ankle Int"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2525","DOI":"10.1007\/s00590-022-03455-0","article-title":"Open fixation of the posterior malleolus increases the morbidity of\n\t\t\t\t\ttrimalleolar ankle fracture fixation","volume":"33","author":"S Aravindan","year":"2023","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1177\/1071100720969431","article-title":"Traditional Approach vs Posterior Approach for Ankle Fractures Involving\n\t\t\t\t\tthe Posterior Malleolus","volume":"42","author":"K Pilskog","year":"2021","journal-title":"Foot Ankle Int"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1053\/j.jfas.2015.04.001","article-title":"Management of Posterior Malleolar Fractures: A Systematic\n\t\t\t\t\tReview","volume":"55","author":"S Odak","year":"2016","journal-title":"J Foot Ankle Surg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1392","DOI":"10.1016\/j.injury.2019.06.003","article-title":"Posterior malleolar fracture morphology determines outcome in rotational\n\t\t\t\t\ttype ankle fractures","volume":"50","author":"RP Blom","year":"2019","journal-title":"Injury"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"4099","DOI":"10.1007\/s00402-022-04620-0","article-title":"Posterolateral approach for posterior malleolus fixation in ankle\n\t\t\t\t\tfractures: functional and radiological outcome based on Bartonicek\n\t\t\t\t\tclassification","volume":"143","author":"L Yang","year":"2023","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1177\/1071100714540893","article-title":"Comparison of lag screw versus buttress plate fixation of posterior\n\t\t\t\t\tmalleolar fractures","volume":"35","author":"MN Erdem","year":"2014","journal-title":"Foot Ankle Int"}],"container-title":["Zeitschrift f\u00fcr Orthop\u00e4die und Unfallchirurgie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2879-5116.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T23:24:17Z","timestamp":1782257057000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2879-5116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":21,"URL":"https:\/\/doi.org\/10.1055\/a-2879-5116","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1864-6697","1864-6743"],"issn-type":[{"value":"1864-6697","type":"print"},{"value":"1864-6743","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]}}}