Objective: To describe the radiographic consequences of posterior malleolus fractures (PMF) present with tibial shaft fractures fixed with intramedullary nails.
Design: Retrospective cohort study.
Setting: Level 1 trauma center.
Patients/participants: Seven hundred thirty-three patients with tibial shaft fractures.
Intervention: Intramedullary nail fixation and prophylactic articular fixation.
Main outcome measure: Displacement of PMF with intramedullary nail insertion.
Results: Seven hundred thirty-three patients were identified with tibial shaft fractures treated with intramedullary nail fixation at a Level 1 trauma center without a uniform preoperative computed tomography protocol. One hundred thirty-three patients had an identifiable PMF appreciated on preoperative imaging. Of the 600 remaining patients without a known PMF, 29 had PMF identified after nail insertion: 24 patients with nondisplaced fractures that all healed radiographically at final follow-up, 3 patients had fractures <30% of the articular surface displaced 1-2 mm, and 2 patients had fractures >30% of the joint surface that displaced 1-2 mm.
Conclusions: The incidence of radiographically observable PMF associated with tibial shaft fractures is high, even without a preoperative computed tomography screening protocol in place. In patients without an appreciable PMF on injury films, less than 1% (2/600) had displacement of a large, clinically significant PMF with nail placement.
Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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