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Tibial fractures; Posterior ankle fractures; Posterior malleolus

Introduction

In clinical practice, tibial fractures and malleolus fractures are frequent. Tibia fractures typically manifest as spiral fractures of the bottom third segment, and tibial fracture is a prevalent type of fracture in clinics. Tibia fractures usually co-occur with concealed posterior ankle fractures, which have a major impact on the patient's ability to use their lower limbs. Tibial fractures combined with hidden posterior ankle fractures typically call for posterior ankle fracture repair during the course of treatment. Clinical diagnoses of concealed posterior ankle fractures and tibial fractures are commonly missed. As a result, the real incidence of clinical tibial fractures with concealed posterior ankle fractures is substantially lower. The patient's prognosis has been demonstrated to be impacted by missed diagnoses because improper treatment of ankle fracture components during recovery might result in additional displacement and eventual ankle incoordination. In order to improve the prognosis of patients with tibial fracture combined with occult posterior ankle fracture, it is crucial to effectively master the epidemiological status of tibial fracture combined with occult posterior ankle fracture and effectively identify the high-risk population of tibial fracture combined with occult posterior ankle fracture by mastering the high-risk factors [1].

Materials and Methods

Data collection

Retrospective analysis is done on patients who had tibial fractures in our institution between January 2016 and May 2021. The following are the +e inclusion criteria: All patients had tibial fractures, which were their first diagnosis; they also all had X-rays and CT scans; and they all had ipsilateral ankle CT scans [2].

Exclusion criteria

lacking clinical data and lacking a CT scan; (2) fractures that primarily affect the knee joint (tibial plateau fractures); (3) single, double, and three-toe ankle fractures that primarily affect the ankle joint; (4) fractures in patients over the age of 65; (5) congenital dysplasia, neuromuscular diseases, infections, etc. (6) Bone tumours and other conditions that may alter the normal structure of the skeletal and muscular systems; (7) comminuted tibial shaft fractures; and (8) fractures of the ipsilateral ankles without radiography or CT scans (except the complete length of the tibia and fibula). 186 patients were enrolled, with 51 women (27.342%) and 135 men (72.58%) [3].

Methods

Following admission, all patients had X-rays taken, and depending on the type of fracture, intramedullary nail fixation was administered. To check for ankle fractures, all patients underwent CT or MRI scans at the ankle joint. Both the tibial fracture and general clinical information were noted. Three orthopedic doctors reviewed and decided on all the information collectively [4].

Observation

Both the tibial fracture and general clinical information were noted. (1) +e length of tibial frac- tures: the pro-portion of the tibia length occupied by the calculator and the X-ray and CT images are used to determine the tibia fracture length. (2) Tibial fracture type: based on imaging pictures, the fracture is transverse, oblique, or spiral, and at least two fracture types are noted as complex [5].

Statistical Method

Measurement data was expressed as (x s), comparisons between groups were made using independent sample t-tests, count data was expressed as (n%), and differences between groups were analyzed using the 2 test. Statistical analysis was carried out using SPSS 25.0 version statistical software. In order to investigate the factors that may affect a fractured bone combined with an occult postcomplication fracture, multivariable logistic regression analysis was used. We also used the Receiver Operator Characteristic (ROC) curve to assess the performance of the prediction, calculate the Area under the Curve (AUC), and compare the results [6, 7].

Discussion

It has been discovered that tibial shaft fractures and posterior malleolus fractures frequently occur concurrently in clinical practice. The prevalence of these combined injuries can reach 39%–49%. Identification of posterior ankle injuries has been demonstrated to be crucial for accurate preoperative planning and suitable postoperative physical treatment. Neglecting posterior ankle fractures during tibial fracture therapy may cause iatrogenic displacement. Preventing posterior ankle fractures during intra-medullary nailing or postoperative additional displacement due to inadequate protection can be accomplished by early detection of individuals with tibial fractures in conjunction with occult posterior ankle fractures [8]. However, tibial fractures and posterior ankle fractures are frequently overlooked during clinical diagnosis and therapy. The majority of ankle fractures are hidden fractures, making it challenging to detect them on an X-ray. Since the ankle joint is typically not visible on the initial X-ray film and most doctors only look for obvious displacement of tibial shaft fractures, ankle fractures are frequently missed. Finding good predictors for posterior malleolus fractures will therefore assist patients receive more successful surgical treatment and enhance their prognosis, in line with the characteristics of tibial fractures [9, 10].

Conclusion

In conclusion, concealed posterior ankle fractures are more common in patients with tibial fractures. Spiral tibial fractures and distal third tibial fractures have a high predictive value for occult posterior ankle fractures, which can aid in clinically identifying patients with tibial fractures and occult posterior ankle fractures as early as possible and then administering more precise and effective treatment.

References

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