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
ARTICLE HIGHLIGHTS
Research background

Posterior malleolar fractures have been reported to occur in < 40% of ankle fractures, which is widely regarded as a critical prognostic factor or outcome indicator following ankle fracture treatment. The morphology of posterior malleolar fractures can be more crucial than fragment size alone for clinical decision making.

Research motivation

The optimal treatment procedures for posterior malleolar fractures remain controversial. The fracture characteristics and recurrent patterns of the posterior malleolar fractures are unclear.

Research objectives

In this study, the authors aimed 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.

Research methods

A consecutive series of posterior malleolar fractures was used to create three-dimensional reconstruction images to produce the distribution map of fracture lines through three-dimensional computed tomography mapping in the Mimics and 3-matic software.

Research results

Three-dimensional maps showed that the posterior ankle fracture fragments in supination-external rotation grade IV fractures were relatively smaller than those in pronation-external rotation grade IV fractures after posterior malleolus fracture. In addition, the distribution analyses on posterior malleolus fracture lines indicated that supination-external rotation group tended to have higher linear density but more concentrated and orderly distribution fractures compared to pronation-external rotation group.

Research conclusions

Fracture maps revealed the fracture characteristics and recurrent patterns of the posterior malleolar fractures, which might help to improve the understanding of ankle fracture.

Research perspectives

Multifactor analyses and assessments, larger sample size, prolonged follow-up period and multicenter prospective controlled trials are needed for future investigations.