Classifications of posterior malleolar fractures: a systematic literature review
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Classifications of posterior malleolar fractures: a systematic literature review. / und, Klinik; Weel, Hanneke; Frosch, Karl-Heinz; Rolvien, Tim; Schlickewei, Carsten; Mueller, Elena.
In: ARCH ORTHOP TRAUM SU, Vol. 143, No. 7, 07.2023, p. 4181-4220.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Classifications of posterior malleolar fractures: a systematic literature review
AU - und, Klinik
AU - Weel, Hanneke
AU - Frosch, Karl-Heinz
AU - Rolvien, Tim
AU - Schlickewei, Carsten
AU - Mueller, Elena
N1 - © 2022. The Author(s).
PY - 2023/7
Y1 - 2023/7
N2 - INTRODUCTION: Complex ankle fractures frequently involve the posterior malleolus. Many classifications describing posterior malleolar fractures (PMF) exist. The aim of this study was to provide a systematic literature review to outline existing PMF classifications and estimate their accuracy.METHODS: The databases PubMed and Scopus were searched without time limits. Only specific PMF classifications were included; general ankle and/or pilon fracture classifications were excluded. Selection and data extraction was performed by three independent observers. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The methodological quality of the included studies was quantified using the modified Coleman score.RESULTS: A total of 110 studies with a total of 12.614 patients were included. Four main classifications were identified: Those describing the size of the posterior malleolar fracture (n = 66), Haraguchi (n = 44), Bartoníček/Rammelt (n = 21) and Mason (n = 12). The quality of the studies was moderate to good with a median Coleman-score of 43.5 (14-79) and a weighted median Coleman-score of 42.5 points. All classifications achieved a substantial to perfect score regarding the inter- and intraobserver reliability, with Mason scoring the lowest in comparison.CONCLUSIONS: None of the reviewed PMF classifications has been able to establish itself decisively in the literature. Most of the classifications are insufficient in terms of a derivable treatment algorithm or a prognosis with regard to outcome. However, as the Bartoníček/Rammelt classification has the greatest potential due to its treatment algorithm, its reliability in combination with consistent predictive values, its usage in clinical practice and research appears advisable.
AB - INTRODUCTION: Complex ankle fractures frequently involve the posterior malleolus. Many classifications describing posterior malleolar fractures (PMF) exist. The aim of this study was to provide a systematic literature review to outline existing PMF classifications and estimate their accuracy.METHODS: The databases PubMed and Scopus were searched without time limits. Only specific PMF classifications were included; general ankle and/or pilon fracture classifications were excluded. Selection and data extraction was performed by three independent observers. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The methodological quality of the included studies was quantified using the modified Coleman score.RESULTS: A total of 110 studies with a total of 12.614 patients were included. Four main classifications were identified: Those describing the size of the posterior malleolar fracture (n = 66), Haraguchi (n = 44), Bartoníček/Rammelt (n = 21) and Mason (n = 12). The quality of the studies was moderate to good with a median Coleman-score of 43.5 (14-79) and a weighted median Coleman-score of 42.5 points. All classifications achieved a substantial to perfect score regarding the inter- and intraobserver reliability, with Mason scoring the lowest in comparison.CONCLUSIONS: None of the reviewed PMF classifications has been able to establish itself decisively in the literature. Most of the classifications are insufficient in terms of a derivable treatment algorithm or a prognosis with regard to outcome. However, as the Bartoníček/Rammelt classification has the greatest potential due to its treatment algorithm, its reliability in combination with consistent predictive values, its usage in clinical practice and research appears advisable.
KW - Ankle Fractures
KW - Ankle Joint
KW - Fracture Fixation, Internal
KW - Humans
KW - Reproducibility of Results
KW - Retrospective Studies
KW - Tibia
KW - Tibial Fractures
KW - Treatment Outcome
U2 - 10.1007/s00402-022-04643-7
DO - 10.1007/s00402-022-04643-7
M3 - SCORING: Review article
C2 - 36469121
VL - 143
SP - 4181
EP - 4220
JO - ARCH ORTHOP TRAUM SU
JF - ARCH ORTHOP TRAUM SU
SN - 0936-8051
IS - 7
ER -
