The incidence of posterior malleolar involvement in distal spiral tibia fractures: Is it higher than we think?

Garret L. Sobol, M. Kareem Shaath, Mark C. Reilly, Mark R. Adams, Michael S. Sirkin

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Objectives: To investigate the incidence of concomitant posterior malleolar fractures (PMFs) in operative, distal-third, spiral tibia fractures. Design: Prospective protocol with retrospective review of data. Setting: Single, Level 1 trauma center. Patients/Participants: One hundred ninety-three consecutive, skeletally mature patients with operatively treated fractures of the distal-third, tibial shaft and metaphysis. Pilon fractures were excluded. Intervention: Computed tomography (CT) scans were obtained in all distal-third, spiral fractures of the tibia to determine fracture morphology and presence of a PMF. Main Outcome Measurements: The incidence of concurrent PMFs in operative spiral fractures of the distal tibia. Results: Twenty-six distal-third, spiral fractures were identified with an ipsilateral PMF diagnosed in 92.3% of cases (24 cases). PMFs were over 25 times more likely to occur in distal-third, spiral fractures when compared with other distal-third fracture patterns (relative risk = 25.7, 95% confidence interval, 11.6–56.8). PMFs were treated with supplemental fixation in 23/24 (95.8%) cases. Conclusions: There is a high incidence of concomitant, ipsilateral fractures of the posterior malleolus in patients presenting with operative distal-third, spiral fractures of the tibia. A preoperative ankle computed tomography should be strongly considered in all cases with this specific fracture morphology.

Original languageEnglish
Pages (from-to)543-547
Number of pages5
JournalJournal of Orthopaedic Trauma
Issue number11
StatePublished - 2018
Externally publishedYes


  • Ankle injury
  • Distal tibia fracture
  • Posterior malleolus
  • Spiral tibia fracture


Dive into the research topics of 'The incidence of posterior malleolar involvement in distal spiral tibia fractures: Is it higher than we think?'. Together they form a unique fingerprint.

Cite this