Posterior approaches in malleolar fracture: When, why and how

The treatment of posterior malleolus fractures has radically changed over the last few years, therefore this study aims to summarize the current evidence on the usefulness of posterior approaches in the management of malleolar fractures. The main elements that suggest the use of a posterior approach to the ankle are: the posterior malleolus fragment shape and size; the presence of loose bodies at the fracture site; the possibility to obtain an anatomic fixation of the fracture; the presence of a posterior ankle subluxation; the eventually osteochondral impaction of the tibial plafond and the mechanical stability of the joint (9). The postero-lateral approach has been widely used to treat these fractures, but the posteromedial approach should be considered in specific cases. The anatomic reduction of these fractures leads to joint stability, with a consequent lesser occurrence of post-traumatic arthritis and better functional outcomes

Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study

Background. Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. Methods. The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. Results. 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. Conclusions. This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings