Study finds, Incidence and missed diagnosis risk of occult p
Tibial shaft fractures (TSFs) combined with occult posterior malleolar fractures (PMFs) are becoming widely recognized in the field of orthopedics. The purpose of this study was to determine the clinical incidence, missed diagnosis rate, and treatment strategies of this combined injury.

--21 of the 1278 identified studies were eligible for inclusion. Each study reported on the incidence of this combined injury, and 12 studies documented the missed diagnosis rate.

--17 studies reported surgical intervention strategies for PMFs. In the present review, PMFs frequently occurred in spiral TSFs (70%), especially distal third spiral TSFs (70.4%), based on CT scans or additional MRI.

--Based on the original X-ray detection, approximately 50% of PMFs were missed in patients with a combined injury. In addition, the treatment strategies for PMFs were inconsistent.

--Most studies (11/17) believe that specific surgical management needs to be developed based on the fragment size, displacement, and stability of the PMF.

In conclusion, the TSF spiral TSFs are closely related to TSFs and are often not well detected by X-ray alone in patients with TSFs, in particular, distal third spiral TSFs. The missed diagnostic rate of occult PMFs may be greatly reduced by advanced CT and MRI tests.