# Integrating Quadrimalleolar Fractures of the Ankle in a Johannesburg Academic Center: A New Classification

## TL;DR

This paper introduces a new classification system for rare quadrimalleolar ankle fractures based on CT scans and patient data from a South African hospital.

## Contribution

A novel classification system for quadrimalleolar ankle fractures based on fracture patterns and demographic data.

## Key findings

- Quadrimalleolar fractures were identified in 8 out of 145 reviewed CT scans.
- The classification system divides these fractures into four distinct patterns.
- Most patients were male with an average age of 39 years at injury.

## Abstract

Background

Quadrimalleolar ankle fractures, which consist of trimalleolar fractures with additional anterior fractures, were initially described in a case report. We present a limited series of unusual fractures of the four ankle malleoli and demographic variables to create a comprehensive quadrimalleolar ankle fracture classification system.

Methodology

We conducted a retrospective review of CT scans of patients who sustained ankle fractures at our academic hospital over three years. We included patients who had sustained quadrimalleolar ankle fractures. We classified all fractures based on preoperative CT scans.

Results

A total of 145 CT scans were reviewed, demonstrating quadrimalleolar ankle fractures in just eight cases. Of the eight cases included, 75% were male, and the mean age at the time of injury was 39 years (range = 21-59 years). We integrated quadrimalleaolar ankle fractures into four classifications based on the fracture pattern.

Conclusions

Recognizing these unique fracture patterns as distinct entities would contribute to more comprehensive knowledge and improve the classification system for quadrimalloelar ankle fractures and patient care.