Epidemiological profile of patients with distal tibia diaphyseal fractures with spiral trace and posterior malleolus fractures

Authors

  • Artur de Oliveira Ribeiro Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.
  • Nicole de Machado Cirilo Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.
  • Rafael Krawczun Maruoka Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.
  • Karen Mayuri Kato Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.
  • Arthur Tescarolli Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.
  • André Felipe Ninomiya Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.
  • Nilson Nonose Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

DOI:

https://doi.org/10.37497/JMRReview.v2i1.36

Keywords:

Orthopedics, Traumatology, Fractures, Malleolus, Spiral Fracture

Abstract

Background: Posterior malleolus fractures (PMF), as well as other ankle joint injuries, are known to occur concomitantly with distal tibia diaphyseal fractures (DTDF), especially when there is a spiral or oblique pattern. If neglected, such fractures can lead to iatrogenic displacement during intramedullary nailing as well as unsatisfactory results even when complete union of the tibial shaft has been achieved. Furthermore, it is accepted that posterior and medial malleolar fractures require fixation in most cases, thus avoiding loss of postoperative reduction.

Aim: To evaluate the epidemiological profile of DTDF patients with spiral line and PMF treated in our Hospital.

Method: Patients treated at the Orthopedics and Traumatology Service of the Hospital Universitário São Francisco na Providência de Deus – HUSF, located in Bragança Paulista – SP, Brazil, from January to December 2022 were included in the study. Age at trauma, presence of any comorbidities, trauma mechanism, treatment, occurrence of effective consolidation after treatment, and clinical evolution were observed.

Results: In our study, the ages of the 5 patients ranged from 26 to 75 years, and the two patients who remained followed up in our Service showed consolidation, one of which was only partial due to loss of follow-up. Neither of the two patients monitored presented post-surgical complications, and both began to walk without assistance and without complaints after fixation.

Conclusion: We believe that many PMF were not included in our sample due to lack of use of the Computed Tomography (CT), available on our Hospital. Therefore, we highlight the importance of CT for the diagnosis of these cases, which will probably increase the accuracy of the diagnosis, thus allowing adequate care to be provided to these patients.

Author Biographies

Artur de Oliveira Ribeiro, Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Serviço de Ortopedia e Traumatologia. Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Nicole de Machado Cirilo, Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Serviço de Ortopedia e Traumatologia. Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Rafael Krawczun Maruoka, Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Serviço de Ortopedia e Traumatologia. Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Karen Mayuri Kato, Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Serviço de Ortopedia e Traumatologia. Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Arthur Tescarolli, Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Serviço de Ortopedia e Traumatologia. Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

André Felipe Ninomiya, Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Serviço de Ortopedia e Traumatologia. Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Nilson Nonose, Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

Serviço de Ortopedia e Traumatologia. Hospital Universitário São Francisco na Providência de Deus – HUSF. Bragança Paulista – SP.

References

BEAR, J.; ROLLICK, N.; HELFET, D. Evolution in Management of Tibial Pilon Fractures. Current Reviews in Musculoskeletal Medicine, v. 11, n. 4, p. 537–545, 20 out. 2018. DOI: https://doi.org/10.1007/s12178-018-9519-7

BORAIAH, S. et al. High association of posterior malleolus fractures with spiral distal tibial fractures. Clinical Orthopaedics and Related Research, v. 466, n. 7, p. 1692–1698, jul. 2008. DOI: https://doi.org/10.1007/s11999-008-0224-5

CARTER, T. H. et al. Open Reduction and Internal Fixation of Distal Tibial Pilon Fractures. JBJS Essential Surgical Techniques, v. 9, n. 3, p. e29, 11 set. 2019. DOI: https://doi.org/10.2106/JBJS.ST.18.00093

CHEN, Q. et al. Effectiveness of Diagnosis and Treatment of Spiral Fracture of the Distal Third of the Tibia Combined with Posterior Malleolus Fracture: A Series of Ten Cases. Journal of the American Podiatric Medical Association, v. 108, n. 2, p. 106–114, 1 mar. 2018. DOI: https://doi.org/10.7547/15-181

DRAKE, R. L.; VOGL, W.; MITCHELL, A. W. M. Gray’s Anatomy for Students. Elsevier, 2023.

FRANCESCO, P. et al. When is indicated fibular fixation in extra-articular fractures of the distal tibia? Acta Bio Medica: Atenei Parmensis, v. 89, n. 4, p. 558–563, 2018.

GUZIK, Grzegorz. Pathomorphism of spiral tibial fractures in computed tomography imaging. Ortopedia, Traumatologia, Rehabilitacja, v. 13, n. 5, p. 479-488, 2011. DOI: https://doi.org/10.5604/15093492.967226

HOU, Z. et al. An occult and regular combination injury: the posterior malleolar fracture associated with spiral tibial shaft fracture. The Journal of Trauma, v. 66, n. 5, p. 1385–1390, maio 2009. DOI: https://doi.org/10.1097/TA.0b013e31817fdf0a

HUANG, Z. et al. Effects of precursors on silica particle generation in CVD synthesis for fused silica glass. Journal of Non-Crystalline Solids, v. 499, p. 86–94, 1 nov. 2018. DOI: https://doi.org/10.1016/j.jnoncrysol.2018.07.020

JUNG, K. J. et al. Concomitant Ankle Injuries Associated With Tibial Shaft Fractures. Foot & Ankle International, v. 36, n. 10, p. 1209–1214, 1 out. 2015. DOI: https://doi.org/10.1177/1071100715588381

KONRATH, G. et al. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. Journal of Orthopaedic Trauma, v. 11, n. 3, p. 200–205, abr. 1997. DOI: https://doi.org/10.1097/00005131-199704000-00011

KUKKONEN, J. et al. Posterior malleolar fracture is often associated with spiral tibial diaphyseal fracture: a retrospective study. The Journal of Trauma, v. 60, n. 5, p. 1058–1060, maio 2006. DOI: https://doi.org/10.1097/01.ta.0000196700.74272.10

QI, Hongfei et al. One quick and simple fixation method: posterior malleolus fractures in spiral tibial fractures. BMC Musculoskeletal Disorders, v. 24, n. 1, p. 244, 2023. DOI: https://doi.org/10.1186/s12891-023-06319-8

SCHIAVI, P. et al. Distal tibial fractures treated with intramedullary nailing: management of associated posterior and medial malleolar injuries. Injury, v. 53 Suppl 1, p. S29–S33, mar. 2022. DOI: https://doi.org/10.1016/j.injury.2021.02.005

SOBOL, G. L. et al. The Incidence of Posterior Malleolar Involvement in Distal Spiral Tibia Fractures: Is it Higher than We Think? Journal of Orthopaedic Trauma, v. 32, n. 11, p. 543–547, nov. 2018. DOI: https://doi.org/10.1097/BOT.0000000000001307

STUERMER, E. K.; STUERMER, K. M. Tibial shaft fracture and ankle joint injury. Journal of Orthopaedic Trauma, v. 22, n. 2, p. 107–112, fev. 2008. DOI: https://doi.org/10.1097/BOT.0b013e31816080bd

TSAI, C.-E. et al. Concomitant tibial shaft and posterior malleolar fractures can be readily diagnosed from plain radiographs: A retrospective study. Journal of the Chinese Medical Association: JCMA, v. 77, n. 2, p. 95–100, fev. 2014. DOI: https://doi.org/10.1016/j.jcma.2013.10.002

VAN DER WERKEN, C.; ZEEGERS, E. V. Fracture of the lower leg with involvement of the posterior malleolus; a neglected combination? Injury, v. 19, n. 4, p. 241–243, jul. 1988. DOI: https://doi.org/10.1016/0020-1383(88)90035-6

WARNER, S. J. et al. Ankle injuries in distal tibial spiral shaft fractures: results from an institutional change in imaging protocol. Archives of Orthopaedic and Trauma Surgery, v. 134, n. 12, p. 1661–1666, 1 dez. 2014. DOI: https://doi.org/10.1007/s00402-014-2095-4

WASCHKE, J.; BÖCKERS, T. M. Sobotta Anatomia clínica. GEN Guanabara Koogan, 2019.

Published

2023-11-08

How to Cite

Ribeiro, A. de O., Cirilo, N. de M., Maruoka, R. K., Kato, K. M., Tescarolli, A., Ninomiya, A. F., & Nonose, N. (2023). Epidemiological profile of patients with distal tibia diaphyseal fractures with spiral trace and posterior malleolus fractures. Journal of Medical Residency Review, 2(1), e036. https://doi.org/10.37497/JMRReview.v2i1.36

Issue

Section

Relato de caso

Most read articles by the same author(s)