The posterior malleolar fracture: A parachute injury not to be overlooked - 27/05/14

Doi : 10.1016/j.otsr.2014.02.008

G. Comat ^a, O. Barbier ^b,^⁎ , D. Ollat ^b
^a Hôpital d’instruction des armées R.-Picqué Bordeaux, 351, route de Toulouse, 33800 Villenave-d’Ornon, France
^b Hôpital d’instruction des armées Bégin-Saint-Mandé, 69, avenue de Paris, 94160 Saint-Mandé, France

^⁎Corresponding author. Tel.: +33 143985920.

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Abstract

Introduction

Isolated posterior tibial malleolar fracture, which concerns parachutists in particular, is rare and often overlooked. The present study sought to identify clinical and paraclinical factors able to improve diagnosis and treatment.

Hypothesis

Marginal posterior malleolar fracture is under-diagnosed due to lack of awareness and difficulty of diagnosis. Delayed diagnosis may impair functional prognosis.

Material and method

A multicenter retrospective study included 12 cases of isolated marginal posterior malleolar fracture in military parachutists between 2006 and 2011. Clinical and paraclinical data were collected from medical files and a questionnaire administered in consultation or by telephone.

Results

Diagnosis was initially overlooked in 75% of cases due to non-specific clinical presentation and the low sensitivity of plain radiographs. Diagnostic delay impaired functional outcome.

Discussion

Symptomatology, other than medial retromalleolar pain, is misleading. The Ottawa Ankle Rules should not be used in this particular form of trauma. X-ray should include a lateral view in 50° external rotation. CT provides a useful complement. Delayed diagnosis puts the patient at risk of impaired functional prognosis.