Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2020; 8(1): 29-37
Published online Jan 6, 2020. doi: 10.12998/wjcc.v8.i1.29
Three-dimensional computed tomography mapping of posterior malleolar fractures
Qi-Hang Su, Juan Liu, Yan Zhang, Jun Tan, Mei-Jun Yan, Kai Zhu, Jin Zhang, Cong Li
Qi-Hang Su, Yan Zhang, Jun Tan, Mei-Jun Yan, Kai Zhu, Jin Zhang, Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
Juan Liu, Department of the First Clinical Medical School, Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
Jun Tan, Department of Orthopedics, Pinghu Second People’s Hospital, Pinghu 314200, Zhejiang Province, China
Cong Li, Department of Trauma Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
Author contributions: Su QH and Liu J contributed equally to this work; Su QH, Liu J, Li C and Tan J designed the research; Su QH, Liu J, Zhang Y, Yan MJ and Zhu K performed the research; Zhang J and Li C contributed new analytic tools; Su QH and Juan Liu analyzed data; and Su QH and Liu J wrote the paper.
Supported by Multicenter Clinical Trial of hUC-MSCs in the Treatment of Late Chronic Spinal Cord Injury, No. 2017YFA0105404; and Key Discipline Construction Project of Pudong Health Bureau of Shanghai, No. PWZxk2017-08.
Institutional review board statement: Shanghai East Hospital (East Hospital Affiliated to Tongji University) Medical Ethics Committee approved the study protocol, which met the relevant guidelines and regulations of Shanghai Medical Ethics Committee. All included volunteers had signed an informed consent form.
Informed consent statement: Informed written consent was obtained from the patients for publication of this manuscript and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Cong Li, MD, Doctor, Department of Trauma Surgery, Shanghai East Hospital, Tongji University School of Medicine, No. 150, Jimo Road, Pudong New Area, Shanghai 200120, China. 15900549514@163.com
Received: October 9, 2019
Peer-review started: October 9, 2019
First decision: November 13, 2019
Revised: November 28, 2019
Accepted: November 30, 2019
Article in press: November 30, 2019
Published online: January 6, 2020
Processing time: 89 Days and 19 Hours
Abstract
BACKGROUND

Posterior malleolar fractures have been reported to occur in < 40% of ankle fractures.

AIM

To reveal the recurrent patterns and characteristics of posterior malleolar fractures by creating fracture maps of the posterior malleolar fractures through the use of computed tomography mapping.

METHODS

A consecutive series of posterior malleolar fractures was used to create three-dimensional reconstruction images, which were oriented and superimposed to fit an ankle model template by both aligning specific biolandmarks and reducing reconstructed fracture fragments. Fracture lines were found and traced in order to generate an ankle fracture map.

RESULTS

This study involved 112 patients with a mean age of 49, comprising 32 pronation-external rotation grade IV fractures and 80 supination-external rotation grade IV fractures according to the Lauge-Hansen classification system. Three-dimensional maps showed that the posterior ankle fracture fragments in the supination-external rotation grade IV group were relatively smaller than those in the pronation-external rotation grade IV group after posterior malleolus fracture. In addition, the distribution analyses on posterior malleolus fracture lines indicated that the supination-external rotation grade IV group tended to have higher linear density but more concentrated and orderly distribution fractures compared to the pronation-external rotation grade IV group.

CONCLUSION

Fracture maps revealed the fracture characteristics and recurrent patterns of posterior malleolar fractures, which might help to improve the understanding of ankle fracture as well as increase opportunities for follow-up research and aid clinical decision-making.

Keywords: Three-dimensional imaging; Maps; Ankle fractures; Computed tomography

Core tip: With increasing concern over the big data analytics, the distribution map of fracture lines (named fracture mapping) based on three dimensional computed tomography has also been widely used in the orthopedic field to characterize fractures. By creating fracture maps of the posterior malleolar fractures, the study revealed the fracture characteristics and recurrent patterns of posterior malleolar fractures.