Hasan May1, Özkan Köse1, Özlem Kastan2,3, Tuluhan Yunus Emre4, Muzaffer Sindel2, Mehmet Orçun Akkurt5

1Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
2Department of Anatomy, Akdeniz University, Medical Faculty, Antalya, Turkey
3Vocational School of Health Services, Akdeniz University, Antalya, Turkey
4Department of Orthopedics and Traumatology, Biruni University, Medical Faculty, Istanbul, Turkey
5Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey

Keywords: Anatomy, fracture, posterior malleolus, screw fixation, tibia.


Objectives: This study aims to determine the secure location and angle of the most distal screw during posterior malleolar (PM) fracture fixation.

Materials and methods: This prospective study was performed on September 15, 2019. Distal tibial concave articular depth and PM inclination angle were measured on 100 (50 male and 50 female) dry tibia bones using a digital caliper. A comparative analysis between male and female tibias was performed.

Results: Anteroposterior width of male tibia (38.3±3.1 mm) was wider than female tibia (35.3±3.2 mm) (p:<0.001). Mediolateral length of the male tibia (44.8±3.5 mm) was longer than female tibia (42.7±3.4 mm) (p:0.003). Male tibial joint (5.4±0.7 mm) was deeper than that of female (4.7±0.3 mm) (p:<0.001). The PM inclination angle was higher in male tibia (18.0±1.5°) than female tibia (15.4±1.3°) (p:<0.001).

Conclusion: If a screw placement parallel to the joint surface is desired, the screw insertion should be located 6 mm and 5 mm superior to the distal edge of the PM rim in males and females, respectively. If a more distal screw is required, the screw should be inserted in at least 18° and 15° anterosuperior direction for males and females, respectively.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.