{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:32Z","timestamp":1783509272145,"version":"3.55.0"},"reference-count":17,"publisher":"MDPI AG","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study was performed to determine the factors that influence the clinical outcomes of surgically treated ankle fractures associated with the posterior malleolus (PM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We evaluated 42 fractures of 42 patients. Posterior malleolus fracture size was calculated using computed tomography. Posterior malleolar fractures with a size less than 10% were left nonfixated. The decision for larger fragments was performed using fluoroscopy following the fixation of other components. If the joint was found to be congruent, the PM was left nonfixated. Otherwise, the PM was reduced and fixated. Clinical outcomes were evaluated based on Weber, Freiburg, and American Orthopaedic Foot and Ankle Society scores. Ankle osteoarthritis was determined according to the Canadian Orthopaedic Foot and Ankle Society classification. The effect of PM fixation, age, PM fragment size, waiting period before surgery, presence of ankle dislocation, and number of injured malleoli on clinical outcomes were assessed. Statistical significance was set at a value of\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean patients age was 48.5 \u00b1 14.9 years (range, 20\u201384 years) and the mean follow-up was 23.7 \u00b1 8.6 months (range, 12\u201356 months). Fixation of the PM was performed solely in 12 patients. Postoperative displacement of the PM and articular step were less than 2 mm in all fractures. Statistically significant worse outcomes were demonstrated based on functional scores in the patients with a PM size greater than or equal to 25% (\n                      <jats:italic>P<\/jats:italic>\n                      = .042,\n                      <jats:italic>P<\/jats:italic>\n                      = .038, and\n                      <jats:italic>P<\/jats:italic>\n                      = .048, respectively) and in patients aged 60 years or older (\n                      <jats:italic>P<\/jats:italic>\n                      = .005,\n                      <jats:italic>P<\/jats:italic>\n                      = .007, and\n                      <jats:italic>P<\/jats:italic>\n                      = .018, respectively). However, there was no significant difference between functional scores and the other factors. Ankle osteoarthritis was observed at a higher rate in patients with PM size greater than or equal to 25% and in patients aged 60 years or older.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clinical outcomes of the patients are mainly influenced by the patient's age and PM fragment size. However, if the tibiotalar joint is congruent, comparable results can be obtained in PM fixated or nonfixated patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7547\/18-184","type":"journal-article","created":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T16:35:56Z","timestamp":1638549356000},"source":"Crossref","is-referenced-by-count":2,"title":["Factors Affecting the Clinical Outcomes of Surgically Treated Ankle Fractures Associated with the Posterior Malleolar Fragment"],"prefix":"10.3390","volume":"111","author":[{"given":"Mehmet","family":"Kuyumcu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Bilgin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Bombac\u0131","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-111-5-Article_13-b01","series-title":"Acta Orthop Scand","first-page":"43","article-title":"Adult ankle fractures\u2014an increasing problem?","volume":"69","author":"Court-Brown","year":"1988","unstructured":"Court-Brown\n              CM\n            \n            \n              McBirnie\n              J\n            \n            \n              Wilson\n              G:\n            \n          \n          Adult ankle fractures\u2014an increasing problem?\n          Acta Orthop Scand\n          69: \n\t\t\t\t\t43,\n\t\t\t\t\t1988."},{"key":"i8750-7315-111-5-Article_13-b02","series-title":"Acta Radiol","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1080\/02841859709172083","article-title":"Isolated fracture of the posterolateral tibial lip (Volkmann's triangle)","volume":"38","author":"Probst","year":"1997","unstructured":"Probst\n              EN\n            \n            \n              Maas\n              R\n            \n            \n              Meenen\n              NM:\n            \n          \n          Isolated fracture of the posterolateral tibial lip (Volkmann's triangle).\n\t\t\t\t\tActa Radiol38: \n\t\t\t\t\t359,\n\t\t\t\t\t1997.\n\t\t\t\t10.1080\/028418597091720839191423"},{"key":"i8750-7315-111-5-Article_13-b03","series-title":"J Trauma","doi-asserted-by":"publisher","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","unstructured":"Jaskulka\n              RA\n            \n            \n              Ittner\n              G\n            \n            \n              Schedl\n              R:\n            \n          \n          Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures.\n\t\t\t\t\tJ Trauma29: \n\t\t\t\t\t1565,\n\t\t\t\t\t1989.\n\t\t\t\t10.1097\/00005373-198911000-000182585569"},{"issue":"(suppl 4)","key":"i8750-7315-111-5-Article_13-b04","series-title":"Injury","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/S0020-1383(15)30028-0","article-title":"Size matters: the influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures","volume":"46","author":"Evers","year":"2015","unstructured":"Evers\n              J\n            \n            \n              Barz\n              L\n            \n            \n              W\u00e4hnert\n              D\n            \n            :\n          \n          Size matters: the influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures.\n\t\t\t\t\tInjury46(suppl 4): \n\t\t\t\t\t109,\n\t\t\t\t\t2015.\n\t\t\t\t10.1016\/S0020-1383(15)30028-0http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000363905200018&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-111-5-Article_13-b05","series-title":"Clin Orthop Relat Res","first-page":"182","article-title":"Tibiotalar contact area. Contribution of posterior malleolus and deltoid ligament","volume":"320","author":"Hartford","year":"1995","unstructured":"Hartford\n              JM\n            \n            \n              Gorczyca\n              JT\n            \n            \n              McNamara\n              JL\n            \n            :\n          \n          Tibiotalar contact area. Contribution of posterior malleolus and deltoid ligament.\n\t\t\t\t\tClin Orthop Relat Res320: \n\t\t\t\t\t182,\n\t\t\t\t\t1995."},{"key":"i8750-7315-111-5-Article_13-b06","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"347","DOI":"10.2106\/00004623-199173030-00005","article-title":"The joint-contact area of the ankle. The contribution of the posterior malleolus","volume":"73","author":"Macko","year":"1991","unstructured":"Macko\n              VW\n            \n            \n              Matthews\n              LS\n            \n            \n              Zwirkoski\n              P\n            \n            :\n          \n          The joint-contact area of the ankle. The contribution of the posterior malleolus.\n\t\t\t\t\tJ Bone Joint Surg Am73: \n\t\t\t\t\t347,\n\t\t\t\t\t1991.\n\t\t\t\t200207210.2106\/00004623-199173030-00005"},{"key":"i8750-7315-111-5-Article_13-b07","series-title":"Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.fas.2015.05.003","article-title":"Longterm outcome of 886 posterior malleolar fractures: a systematic review of the literature","volume":"22","author":"Veltman","year":"2016","unstructured":"Veltman\n              ES\n            \n            \n              Halma\n              JJ\n            \n            \n              de Gast\n              A:\n            \n          \n          Longterm outcome of 886 posterior malleolar fractures: a systematic review of the literature.\n\t\t\t\t\tFoot Ankle Surg22: \n\t\t\t\t\t73,\n\t\t\t\t\t2016.\n\t\t\t\t27301724http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000377868100003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1016\/j.fas.2015.05.003"},{"key":"i8750-7315-111-5-Article_13-b08","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1053\/j.jfas.2015.04.001","article-title":"Management of posterior malleolar fractures: a systematic review","volume":"55","author":"Odak","year":"2016","unstructured":"Odak\n              S\n            \n            \n              Ahluwalia\n              R\n            \n            \n              Unnikrishnan\n              P\n            \n            :\n          \n          Management of posterior malleolar fractures: a systematic review.\n\t\t\t\t\tJ Foot Ankle Surg55: \n\t\t\t\t\t140,\n\t\t\t\t\t2016.\n\t\t\t\thttp:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000367071200032&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1053\/j.jfas.2015.04.00126100091"},{"key":"i8750-7315-111-5-Article_13-b09","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1097\/00005373-200207000-00012","article-title":"Results of ankle fractures with involvement of the posterior tibial margin","volume":"53","author":"Langenhuijsen","year":"2002","unstructured":"Langenhuijsen\n              JF\n            \n            \n              Heetveld\n              MJ\n            \n            \n              Ultee\n              JM\n            \n            :\n          \n          Results of ankle fractures with involvement of the posterior tibial margin.\n\t\t\t\t\tJ Trauma Acute Care Surg53: \n\t\t\t\t\t55,\n\t\t\t\t\t2002.\n\t\t\t\t10.1097\/00005373-200207000-00012"},{"key":"i8750-7315-111-5-Article_13-b10","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1053\/j.jfas.2010.12.013","article-title":"Ankle fractures with posterior malleolar fragment: management and results","volume":"50","author":"Mingo-Robinet","year":"2011","unstructured":"Mingo-Robinet\n              J\n            \n            \n              L\u00f3pez-Dur\u00e1n\n              L\n            \n            \n              Galeote\n              JE\n            \n            :\n          \n          Ankle fractures with posterior malleolar fragment: management and results.\n\t\t\t\t\tJ Foot Ankle Surg50: \n\t\t\t\t\t141,\n\t\t\t\t\t2011.\n\t\t\t\t21353996http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000287730300003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1053\/j.jfas.2010.12.013"},{"key":"i8750-7315-111-5-Article_13-b11","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1053\/j.jfas.2005.02.002","article-title":"Long-term results of ankle fractures with a posterior malleolar fragment","volume":"44","author":"De Vries","year":"2005","unstructured":"De Vries\n              JS\n            \n            \n              Wijgman\n              AJ\n            \n            \n              Sierevelt\n              IN\n            \n            :\n          \n          Long-term results of ankle fractures with a posterior malleolar fragment.\n\t\t\t\t\tJ Foot Ankle Surg44: \n\t\t\t\t\t211,\n\t\t\t\t\t2005.\n\t\t\t\t10.1053\/j.jfas.2005.02.00215940600"},{"key":"i8750-7315-111-5-Article_13-b12","series-title":"J Orthop Trauma","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1097\/00005131-199408000-00009","article-title":"Plain radiographic interpretation in trimalleolar ankle fractures poorly assesses posterior fragment size","volume":"8","author":"Ferries","year":"1994","unstructured":"Ferries\n              JS\n            \n            \n              DeCoster\n              TA\n            \n            \n              Firoozbakhsh\n              KK\n            \n            :\n          \n          Plain radiographic interpretation in trimalleolar ankle fractures poorly assesses posterior fragment size.\n\t\t\t\t\tJ Orthop Trauma8: \n\t\t\t\t\t328,\n\t\t\t\t\t1994.\n\t\t\t\t796529510.1097\/00005131-199408000-00009"},{"key":"i8750-7315-111-5-Article_13-b13","series-title":"Int Orthop","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1007\/s00264-012-1591-9","article-title":"A retrospective study of posterior malleolus fractures","volume":"36","author":"Xu","year":"2012","unstructured":"Xu\n              HL\n            \n            \n              Li\n              X\n            \n            \n              Zhang\n              DY\n            \n            :\n          \n          A retrospective study of posterior malleolus fractures.\n\t\t\t\t\tInt Orthop36: \n\t\t\t\t\t1929,\n\t\t\t\t\t2012.\n\t\t\t\thttp:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000307994300025&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1007\/s00264-012-1591-922777382"},{"key":"i8750-7315-111-5-Article_13-b14","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1177\/1071100715570895","article-title":"Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures","volume":"36","author":"Drijfhout van Hooff","year":"2015","unstructured":"Drijfhout van Hooff\n              CC\n            \n            \n              Verhage\n              SM\n            \n            \n              Hoogendoorn\n              JM:\n            \n          \n          Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures.\n\t\t\t\t\tFoot Ankle Int36: \n\t\t\t\t\t673,\n\t\t\t\t\t2015.\n\t\t\t\t25672944http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000357296600009&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1177\/1071100715570895"},{"key":"i8750-7315-111-5-Article_13-b15","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1053\/j.jfas.2009.02.005","article-title":"Operative outcome of 41 ankle fractures: a retrospective analysis","volume":"48","author":"Still","year":"2009","unstructured":"Still\n              GP\n            \n            \n              Atwood\n              TC:\n            \n          \n          Operative outcome of 41 ankle fractures: a retrospective analysis.\n\t\t\t\t\tJ Foot Ankle Surg48: \n\t\t\t\t\t330,\n\t\t\t\t\t2009.\n\t\t\t\t10.1053\/j.jfas.2009.02.005http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000265792800007&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f319423033"},{"key":"i8750-7315-111-5-Article_13-b16","series-title":"J Bone Joint Surg Am","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":"Haraguchi","year":"2006","unstructured":"Haraguchi\n              N\n            \n            \n              Haruyama\n              H\n            \n            \n              Toga\n              H\n            \n            :\n          \n          Pathoanatomy of posterior malleolar fractures of the ankle.\n\t\t\t\t\tJ Bone Joint Surg Am88: \n\t\t\t\t\t1085,\n\t\t\t\t\t2006.\n\t\t\t\t10.2106\/JBJS.E.0085616651584"},{"key":"i8750-7315-111-5-Article_13-b17","series-title":"Injury","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/0020-1383(91)90106-O","article-title":"Operative treatment of ankle fractures in adults: correlation between types of fracture and final results","volume":"22","author":"Broos","year":"1991","unstructured":"Broos\n              PLO\n            \n            \n              Bisschop\n              APG:\n            \n          \n          Operative treatment of ankle fractures in adults: correlation between types of fracture and final results.\n\t\t\t\t\tInjury22: \n\t\t\t\t\t403,\n\t\t\t\t\t1991.\n\t\t\t\t180650610.1016\/0020-1383(91)90106-O"}],"container-title":["Journal of the American Podiatric Medical 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Retrospective Analysis"],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":17,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.7547\/18-184","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2021,9]]}}}