{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T19:47:37Z","timestamp":1761767257236,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:00:00Z","timestamp":1700784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Introduction: We investigated the biomechanical behaviour of different fixations of the tibial posterior malleolus (TPM), simulating distinct situations of involvement of the tibiotalar articular surface (TTAS) through a finite element model (FEM). Material and methods: A 3D computer-aided design model of the left ankle was obtained. The materials used were divided according to their characteristics into ductile and non-ductile, and all materials were assumed to be linear elastic, isotropic, and homogenous. Three different fracture lines of the TPM were defined, with sagittal angles of 10\u00b0, 25\u00b0, and 45\u00b0. For biomechanical comparison, different constructions using a trans-syndesmotic screw (TSS) only (Group T), a one-third tubular plate only with (Group PT) and without (Group PS) a TSS, and a locked compression plate with (Group LCPT) and without (Group LCPS) a TSS were tested. FEM was used to simulate the boundary conditions of vertical loading. Load application regions were selected in the direction of the 700 N Z-axis, 90% on the tibia and 10% on the fibula. Data on the displacement and stress in the FEM were collected, including the total principal maximum (MaxT) and total principal minimum (MinT) for non-ductile materials, total displacement (desT), localized displacement at the fragment (desL), localized displacement at syndesmosis (desS), and Von Mises equivalent stress for ductile materials. The data were analysed using ANOVA and multiple comparison LSD tests were used. Results: For TPM fractures with sagittal angles 10\u00b0 and 25\u00b0, desL in the PT and LCP groups was significantly lower, as well as Von Mises stress in Group LCPT in 10\u00b0, and PT and LCPT groups in 25\u00b0. For TPM fractures with a sagittal angle of 45\u00b0, desL in the LCP group and Von Mises stress in Group LCPS and LCPT were significantly lower. We found that any TPM fracture may indicate instability of the distal tibiofibular syndesmosis, even when the fragment is small. Conclusion: Our study showed that in fragments involving 10% of the TTAS, the use of a TSS is sufficient, but when the involvement is greater than 25% of the TTAS, either a non-locked or locked plate must be used to buttress the TPM. In posterior fragments affecting 45% or more of the TTAS, the use of a locking plate is recommended.<\/jats:p>","DOI":"10.3390\/diagnostics13233520","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T03:43:59Z","timestamp":1700797439000},"page":"3520","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Biomechanical Efficacy of Three Methods for the Fixation of Posterior Malleolar Fractures: A Three-Dimensional Finite Element Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4429-312X","authenticated-orcid":false,"given":"Vincenzo","family":"Giordano","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua M\u00e1rio Ribeiro 117, Rio de Janeiro 22430-160, Brazil"},{"name":"Cl\u00ednica S\u00e3o Vicente, Rede D\u2019or S\u00e3o Luiz, R. Jo\u00e3o Borges 204, Rio de Janeiro 22451-100, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7988-1071","authenticated-orcid":false,"given":"M\u00e1rcio Ant\u00f4nio","family":"Babinski","sequence":"additional","affiliation":[{"name":"Departamento de Morfologia, Universidade Federal Fluminense, Avenida Prof. Hernani-Mello 101, Niter\u00f3i 24210-150, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6555-8193","authenticated-orcid":false,"given":"Anderson","family":"Freitas","sequence":"additional","affiliation":[{"name":"HOME\u2014Hospital Ortop\u00e9dico e Medicina Especializada, Quadra 613\u2014Conjunto C\u2014Asa Sul, Bras\u00edlia 70200-730, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3572-5576","authenticated-orcid":false,"given":"Robinson Esteves","family":"Pires","sequence":"additional","affiliation":[{"name":"Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais (UFMG), Avenida Prof. Alfredo Balena 190, Belo Horizonte 30130-100, Brazil"},{"name":"Hospital Fel\u00edcio Rocho, Avenida do Contorno 9530, Belo Horizonte 30110-934, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe Serr\u00e3o de","family":"Souza","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua M\u00e1rio Ribeiro 117, Rio de Janeiro 22430-160, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4121-9126","authenticated-orcid":false,"given":"Luiz Paulo Giorgetta de","family":"Faria","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua M\u00e1rio Ribeiro 117, Rio de Janeiro 22430-160, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro Jos\u00e9","family":"Labronici","sequence":"additional","affiliation":[{"name":"Departamento de Ortopedia e Traumatologia, Universidade Federal Fluminense (UFF), Avenida Marqu\u00eas do Paran\u00e1 303, Niter\u00f3i 24220-000, Brazil"},{"name":"Servi\u00e7o de Ortopedia e Traumatologia Prof. Dr. Donato D\u2019\u00c2ngelo, Hospital Santa Teresa, Rua Paulino Afonso 477, Petr\u00f3polis 25680-003, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-1869","authenticated-orcid":false,"given":"Alexandre","family":"Godoy-Santos","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ov\u00eddio Pires de Campos, S\u00e3o Paulo 05403-010, Brazil"},{"name":"Hospital Israelita Albert Einstein, Avenida Albert Einstein 627, S\u00e3o Paulo 05652-900, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1007\/s001130050578","article-title":"Verletzungen der unteren tibiofibularen Syndesmose","volume":"103","author":"Grass","year":"2000","journal-title":"Unfallchirurg"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s00068-019-01292-1","article-title":"Influence of syndesmotic injuries and posterior malleolar ankle fractures on fibula position in the ankle joint: A cadaveric study","volume":"47","author":"Vetter","year":"2021","journal-title":"Eur. 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Orthop."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/23\/3520\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:28:56Z","timestamp":1760131736000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/23\/3520"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,24]]},"references-count":26,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["diagnostics13233520"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13233520","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2023,11,24]]}}}