{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T08:38:52Z","timestamp":1786523932872,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Ankle fracture\u2013dislocation is associated with prolonged recovery, posttraumatic osteoarthritis, and poor functional outcomes. However, the structural factors responsible for ankle fracture\u2013dislocation remain incompletely understood. This study aimed to identify the injury characteristics associated with ankle fracture\u2013dislocation and compare radiographic outcomes between patients with and without dislocation. Methods: A retrospective review was performed on 130 patients who underwent operative treatment for ankle fractures. Patients were divided into dislocation (n = 26) and non-dislocation (n = 104) groups. Demographic characteristics, injury mechanism, trauma energy, fracture morphology, posterior malleolar fracture classification, syndesmotic injury, and deltoid ligament injury were evaluated. Independent risk factors were identified using multivariate logistic regression analysis. Bone union time and postoperative osteoarthritis were also compared. Results: Haraguchi type II posterior malleolar fracture (p &lt; 0.001) and syndesmotic injury (p = 0.017) were independently associated with ankle fracture\u2013dislocation. Bone union took significantly longer in the dislocation group than in the non-dislocation group (7.04 \u00b1 3.75 vs. 5.29 \u00b1 3.48 months; p = 0.026). Postoperative osteoarthritis occurred more frequently in the dislocation group (42.3% vs. 24.0%), although the difference was not statistically significant (p = 0.063). Conclusions: Haraguchi type II posterior malleolar fracture morphology and syndesmotic injury were associated with ankle fracture\u2013dislocation. These findings suggest that posteromedial structural disruption and syndesmotic instability play important roles in ankle fracture\u2013dislocation. Furthermore, ankle fracture\u2013dislocation was associated with delayed bone union, indicating a more severe injury pattern.<\/jats:p>","DOI":"10.3390\/jcm15166231","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T07:57:26Z","timestamp":1786521446000},"page":"6231","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Injury Characteristics and Prognostic Outcomes of Ankle Fracture\u2013Dislocation: The Importance of Posteromedial Extension of Posterior Malleolar Fractures"],"prefix":"10.3390","volume":"15","author":[{"given":"Ji Seong","family":"Park","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon 35365, Republic of Korea"},{"name":"Department of Orthopaedic Surgery, College of Medicine, Konyang University, Daejeon 35365, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7746-598X","authenticated-orcid":false,"given":"Byung Ki","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae Kyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon 35365, Republic of Korea"},{"name":"Department of Orthopaedic Surgery, College of Medicine, Konyang University, Daejeon 35365, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gi Soo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5192-4965","authenticated-orcid":false,"given":"Jae Hwang","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon 35365, Republic of Korea"},{"name":"Department of Orthopaedic Surgery, College of Medicine, Konyang University, Daejeon 35365, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4181","DOI":"10.1007\/s00402-022-04643-7","article-title":"Classifications of posterior malleolar fractures: A systematic literature review","volume":"143","author":"Terstegen","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s00402-015-2353-0","article-title":"Dislocation is a risk factor for poor outcome after supination external rotation type ankle fractures","volume":"136","author":"Sculco","year":"2016","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1097\/00005373-198911000-00018","article-title":"Fractures of the posterior tibial margin: Their role in the prognosis of malleolar fractures","volume":"29","author":"Jaskulka","year":"1989","journal-title":"J. Trauma"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"24730114231195058","DOI":"10.1177\/24730114231195058","article-title":"Republication of \u201cAnkle Fracture-Dislocations: A Review\u201d","volume":"8","author":"Lawson","year":"2023","journal-title":"Foot Ankle Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Cao, M.M., Zhang, Y.W., Hu, S.Y., and Rui, Y.F. (2022). A systematic review of ankle fracture-dislocations: Recent update and future prospects. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.965814"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.2106\/00004623-200605000-00020","article-title":"Pathoanatomy of posterior malleolar fractures of the ankle","volume":"88","author":"Haraguchi","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/01.blo.0000203489.21206.a9","article-title":"Fixation of posterior malleolar fractures provides greater syndesmotic stability","volume":"447","author":"Gardner","year":"2006","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_8","first-page":"e94681","article-title":"Posterior malleolar fractures: From the \u201cforgotten fragment\u201d to modern concepts in management","volume":"17","author":"Mohamed","year":"2025","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.5435\/JAAOSGlobal-D-21-00074","article-title":"Potential benefits of limited clinical and radiographic follow-up after surgical treatment of ankle fractures","volume":"5","author":"Friedman","year":"2021","journal-title":"JAAOS Glob. Res. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3052","DOI":"10.1002\/ksa.12274","article-title":"Deltoid ligament injuries: A review of the anatomy, diagnosis and treatments","volume":"32","author":"Koris","year":"2024","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13018-016-0502-y","article-title":"Treatment and outcome prognosis of patients with high-energy transsyndesmotic ankle fracture dislocation: The \u201clogsplitter\u201d injury","volume":"12","author":"Wang","year":"2017","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1177\/1071100717719533","article-title":"Pathoanatomy and associated injuries of posterior malleolus fracture of the ankle","volume":"38","author":"Mason","year":"2017","journal-title":"Foot Ankle Int."},{"key":"ref_13","unstructured":"World Health Organization Western Pacific Region, International Association for the Study of Obesity, and International Obesity Task Force (2000). The Asia-Pacific Perspective: Redefining Obesity and Its Treatment, Health Communications Australia."},{"key":"ref_14","unstructured":"Tornetta, P., Ricci, W.M., Ostrum, R.F., McQueen, M.M., McKee, M.D., and Court-Brown, C.M. (2019). Rockwood and Green\u2019s Fractures in Adults, Wolters Kluwer. [9th ed.]."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Buckley, R., Moran, C., and Apivatthakakul, T. (2018). AO Principles of Fracture Management, Thieme. [3rd ed.].","DOI":"10.1055\/b-0038-160811"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/01.bot.0000189591.40267.09","article-title":"Stress radiographs after ankle fracture: The effect of ankle position and deltoid ligament status on medial clear space measurements","volume":"20","author":"Park","year":"2006","journal-title":"J. Orthop. Trauma"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1177\/107110078901000308","article-title":"A radiographic evaluation of the tibiofibular syndesmosis","volume":"10","author":"Harper","year":"1989","journal-title":"Foot Ankle"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.fas.2025.02.014","article-title":"Post-traumatic osteoarthritis after ankle fracture fixation: A minimum three-year follow-up","volume":"31","author":"Wang","year":"2025","journal-title":"Foot Ankle Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1177\/10711007211050039","article-title":"Predisposing factors for posttraumatic osteoarthritis after malleolus fracture fixation in patients younger than 50 years","volume":"43","author":"Beak","year":"2022","journal-title":"Foot Ankle Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1016\/j.injury.2019.06.003","article-title":"Posterior malleolar fracture morphology determines outcome in rotational type ankle fractures","volume":"50","author":"Blom","year":"2019","journal-title":"Injury"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1053\/j.jfas.2006.05.002","article-title":"Medial and lateral rotatory dislocations of the ankle after trivial trauma: Pathomechanics and management of two cases","volume":"45","author":"Shaik","year":"2006","journal-title":"J. Foot Ankle Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s00402-015-2171-4","article-title":"Anatomy and classification of the posterior tibial fragment in ankle fractures","volume":"135","author":"Rammelt","year":"2015","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1097\/BOT.0000000000000330","article-title":"Posterior malleolar fracture patterns","volume":"29","author":"Mangnus","year":"2015","journal-title":"J. Orthop. Trauma"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1016\/j.fas.2022.06.012","article-title":"Influence of posterior malleolar fragment morphology on the outcomes of trimalleolar fractures: A systematic review and meta-analysis","volume":"28","author":"Patel","year":"2022","journal-title":"Foot Ankle Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1007\/s11999-009-1111-4","article-title":"Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation","volume":"468","author":"Miller","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"974","DOI":"10.2106\/00004623-200605000-00007","article-title":"Predictors of short-term functional outcome following ankle fracture surgery","volume":"88","author":"Egol","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1097\/BOT.0000000000001007","article-title":"A prospective randomized study on operative treatment for simple distal tibial fractures: Minimally invasive plate osteosynthesis versus minimal open reduction and internal fixation","volume":"32","author":"Kim","year":"2018","journal-title":"J. Orthop. Trauma"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6231\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T08:22:09Z","timestamp":1786522929000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":27,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166231"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166231","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]}}}