‘Quadrimalleolar’ fractures may represent large portion of ankle fractures
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Key takeaways:
- Anterior inferior tibiofibular ligament avulsions were identified in 18.2% of all ankle fractures.
- Overall, 44.6% of patients with trimalleolar fractures had anterior inferior tibiofibular ligament avulsions.
LOUISVILLE, Ky. — Results presented here showed so-called “quadrimalleolar” fractures may represent a significant portion of ankle fracture injuries, despite its relatively limited presence in the ankle literature.
“In conclusion, [quadrimalleolar fractures] QMFs describe a severe fracture conglomeration that is often missed or underreported,” Noopur Ranganathan, BS, said in her presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting.
In a cross-sectional study, Ranganathan and colleagues retrospectively analyzed data from 876 adults with ankle fractures to determine the prevalence and fracture patterns of QMFs, which previously published literature defined as the presence of a trimalleolar fracture plus an anterior inferior tibiofibular ligament avulsion fracture. In addition, Ranganathan said the secondary objective of the study was “to determine if certain clinical or radiological parameters were associated with different types and patterns of QMFs.”
Researchers identified anterior inferior tibiofibular ligament avulsions in 18.2% of all ankle fractures and in 26.1% of patients who had a CT-confirmed ankle fracture.
Moreover, 44.6% of trimalleolar fractures had anterior inferior tibiofibular ligament avulsions as confirmed by CT scan, a significantly higher proportion compared with 4.4% in unimalleolar fractures and 6.4% in bimalleolar fractures.
Ranganathan said the odds of having a concomitant anterior inferior tibiofibular ligament avulsion was 9.9 times greater in trimalleolar fractures compared with unimalleolar or bimalleolar fractures.
“This knowledge of fracture configuration can ultimately help surgeons in determining the optimal surgical approaches for QMFs,” Ranganathan said.
However, she noted more research is needed on the topic.
“Since this is the first study that describes several correlations of QMFs, further research is warranted to determine optimal fixation strategies for these injuries,” she said. “Radiological and functional outcomes of these injuries were not evaluated, so those would be the next steps of this study.”
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Ranganathan N, et al. Epidemiology, pathoanatomy and clinco-radiologic correlations of quadrimalleolar ankle fractures: A cross-sectional study. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 20-23, 2023; Louisville, Kentucky.
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