Table 4.
Studies reporting on the Haraguchi classification
| Study | Patients/ ankles |
Sex/ age |
PMF type distribution | Treatment allocation | Assesing Classification | Reliability | Predictive outcome values | |
|---|---|---|---|---|---|---|---|---|
| Inter OR |
Intra OR |
|||||||
| Haraguchi (2006) [14] | 57/57 | 41m, 16f, 43 (13–80) yo | Type I (38), type II (11), type III (8) | Type I: ORIF only when persistent intra-articular displacement; type II: only fixation of medial fragment and one-part fragments | Yes | n.r | n.r | n.r |
| Erdem (2014) [108] | 40/40 | 20 m, 20f, 48.9 (24–51) yo | Type I (28), type II 10), type III (2) | Screws (20), plate (20) via PL approach | No | n.r | n.r | n.r |
| Mangnus (2015) [20] | 45/45 | n.r | Type I (13), type II (15), type III (17) | n.r | Yes | n.r | n.r | n.r |
| Choi (2015) [112] | 50/50 | 27m, 23f, 47.5 (25–75) yo | Type I (21), type II (29), type III (0) | Single oblique PL approach for ORIF (37 × screw, 3 × buttress plate) | No | n.r | n.r | n.r |
| de Muinck Keizer (2016) [40] | 28/28 | n.r | Type I (17), type II (8), type III (3) | n.r | No | n.r | n.r | n.r |
| Bali (2017) [64] | 15/15 | 9m, 6f, 37.8 yo | Only type II | PM approach for type II fixation | No | n.r | n.r | Good functional outcome using posteromedial approach (OMAS) |
| Zhong (2017) [118] | 48/48 | 18m, 30f, 43.4 ± 12.7 (18–64) yo | Type I (26), type II (13), type III (9) | AP screws using PM approach (20), PA screws using PL approach (28) | No | n.r | n.r | n.r |
| Saygili (2017) [55] | 73/73 | 34m, 39f, 42.65 ± 13.68 yo | Type I (39), type II (28), type III (6) | ORIF: posterior plate (17) percutaneous screw fixation (10) | Yes | n.r | n.r | Correlation was found between PMF ratio and Haraguchi type I and II fractures |
| Yi (2018) [95] | 107/107 | 43m, 64f, 46.58 ± 15.5 yo | Type I (76), type II (30), type III (1) | n.r | No | n.r | n.r | n.r |
| Kumar (2018) [80] | 56/56 | 48m, 8f, 34.7 ± 11.7 yo | 16 of 56 with PMF; type I (9), modified type II into subtypes:A (3);B (1); type III (3) | Prefer a PL incision in type I and a PM incision in type II, both PM and PL incisions preferred in type IIB | Yes | n.r | n.r | n.r |
| Huang (2018) [126] | 111/111 | 72m,39f, 46.6 ± 16.1 yo | 42 of 111 with PMF: type I (41), type II (0), type III (1) | Surgical treatment (19), conservative treatment (23) | No | n.r | n.r | n.r |
| Kim (2018) [124] | 19/19 | 7m, 12f, 45.1 (13–68) yo | Type I (13), type II (6), type III (0) | Release of PITFL through PL approach for PMF reduction with posterior screws (19) | No | n.r | n.r | n.r |
| Sobol (2018) [41] | n.r./193 | n.r | 24 of 193 with PMF: type I (18), type II (6), type III (0) | All type II with 2 AP screws, type I: screws (16), plate (1), no fixation (1); single syndesmotic screw (3 type I, 1 type II) | Yes | n.r | n.r | Type II were significantly more likely than type I fractures to have 2 screws placed |
| Hendrickx (2019) [129] | 164/164 | 118m, 46f, 41.7 (14–90) yo | 36 of 164 patients with PMF, 2 CTs insufficient: type I (33), type II (1), type III (0) | n.r | No | n.r | n.r | Type I was the pattern specific to PMF associated with tibial shaft fractures |
| Baumbach (2019) [48] | 236/236 | 99m, 137f, 53.0 ± 18.3 (18–100) yo | Type I (112), type II (81), type III (43) | ORIF: type I (44), type II (34), type III (0); CRIF: type I (15), type II (28), type III (1); no fixation type I (53) type II (19), type III (42) | No | n.r | n.r | n.r |
| Blom (2019) [19] | 73/73 | 30m, 43f, 48 ± 14.8 yo | Type I (20), type II (21), type III (32) | Type I: direct fixation (8), non-direct fixation (6), no fixation (6); type II: direct fixation (13), non-direct fixation (1), no fixation (7); type III: direct fixation (1), non-direct fixation (20), no fixation (11) | Yes | n.r | n.r | Type II: worse outcome (FAOS, symptoms, pain, ADL) |
| Kang (2019) [49] | 62/62 | 35m, 27f, 50.7 (19–78) yo | Only type I involving < 25% of the articular surface | 32 × screw fixation for PMFs (group A), 30 × internal fixation for malleolar fractures without screw fixation for PMFs (group B) | Yes | n.r | n.r | Surgical fixation of type I PMFs involving < 25% of the articular surface results in better clinical outcome (AAOS, FS-36, FAOS) |
| Kellam (2019) [130] | 115/115 | 52m, 63f, 47 (16–93) yo | Type I (62), type II (43), type III (10) | PMF in tibial shaft fractures: 50 (93%) underwent direct surgical fixation, PMF in ankle fx: 38 (63%) direct surgical fixation | Yes | n.r | n.r | PMF in tibial shaft fx: 14 (47%) of type II injuries had additional fracture line oriented in the sagittal plane (fx pattern unique to these injuries) and more frequently extended to include MM |
| Meijer (2019) [131] | 31/31 | 12m, 19f, 46 (19–73) yo | Type I (17), type II (7), type III (7) | Type I: fixation (8), no fixation (9); type II both fragments fixed (3)(2xplate, 1 × AP screws),only PL fragment (4); type III: syndesmotic screw (2), no fixation(5) | No | n.r | n.r | n.r |
| Mitchell (2019) [42] | n.r./122 | n.r | 59 of 122 with PMF; 44 of 59 with CT data: type I (41), type II (3), type III (0) | 30 treated with 1—2 screws, 29 treated nonoperatively | No | n.r | n.r | n.r |
| Sheikh (2019) [60] | 20/20 | 11m, 9f, 50.4 (22–76) yo | Modified after Kumar: Type I (10), type IIA (5), type IIB (4), type III (1) | n.r | No | n.r | n.r | n.r |
| Yang (2020) [136] | 27/27 | 11m, 16f, 61.5 (53–67) yo | Only type II | ORIF (combined posterolateral and posteromedial approach) | No | n.r | n.r | n.r |
| Mertens (2020) [65] | 50/50 | 24m, 26f, 54 (21–83) yo | Only 46 of 50 patients classified: type I (23), type II (20), type III (3) | All ORIF (plate osteosynthesis) | Yes | n.r | n.r | Improving clinical outcomes (AOFAS score) from type I to type III |
| Blom (2020) [63] | 70/70 | 30m, 40f, 47 ± 14.6 yo | Type I (23), type II (22), type III (25) | Type I: direct fixation (10), non-direct fixation (7), no fixation (6); type II: direct fixation (16), non-direct fixation (1), no fixation (5); type III: direct fixation (1), non-direct fixation (20), no fixation (4) | Yes | n.r | n.r | Type II with poorer FAOS; Type I: quality of reconstruction of tibial articular surface as predictive factor; Type III: quality of syndesmosis stabilization as predictive factor |
| Wang (2020) [138] | 78/78 | 40m, 38f, 49.05 ± 15.97 yo | Created subtypes of type II: Type I (40), type II (38) | n.r | No | n.r | n.r | n.r |
| Zhang (2020) [135] | 106/106 | 59m, 47f, 47.3 (21–75) yo | Only type I | n.r | No | n.r | n.r | n.r |
| Wang (2020) [137, 140] | 48/48 | 13m, 35f, 48.9 (16–82) yo | Type I (25), type II (18), type III (5) | All were treated surgically (33 underwent ORIF: 5 × plates, 28 × screws) | No | n.r | n.r | n.r |
| He (2020) [140] | 41/41 | 32m, 9f, 37.9 (18–61) yo | 34 of 41 patients with PMF: type I (20), type II (4), type III (10) | n.r | No | n.r | n.r | n.r |
| Palmanovich (2020) [62] | 85/85 | 23m,62f, 53.4 (17–89) yo | Modified Haraguchi: 61 cases “postero-lateral” 4 cases “postero-medial” 20 cases “postero-central” | Mean trajectory angle for single PA screw was 21° lateral for “postero-lateral” fragments, 7° lateral for “postero-central” fragments, and 28° medial for “postero-medial” | Yes | n.r | n.r | n.r |
| Martin (2021) [142] | 28/28 | 16m, 12f, 36 (19–69) yo | Type I (13), type II (14), type III (1) | Posterior arthroscopic reduction and internal fixation | No | n.r | n.r | n.r |
| Yu (2021) [143] | 76/76 | 49m, 27f, 47.2 ± 13,5 yo | Only type I | Percutaneous PA and AP screw fixation | No | n.r | n.r | n.r |
| Quan (2021) [79] | 95/95 | 28m, 67f, 50.07 (20–83) yo | Type I (66), type II (19), type III (10) | n.r | Yes | n.r | n.r | Most multifragment fractures cannot be defined with Haraguchi classification |
| Black (2021) [145] | 279/279 | 93m, 186f, 55 ± 19 yo | Type I (161), type II (94), type III (24) | n.r | No | n.r | n.r | n.r |
| Fidan (2021) [146] | 65/65 | 29m, 36f, 39.6 (18–89) yo | Type I (45), type II (12), type III (8) | Posterior plating via PL approach | No | n.r | n.r | n.r |
| Erinç (2021) [147] | 86/86 | 53m, 33f, 41.70 ± 14.24 yo | Type I (27), type II (59), type III (0) | AP screw (50), ORIF (36) | No | n.r | n.r | n.r |
| Sun (2021) [98] | 46/46 | 20m, 26f, 52.9 ± 14.1 yo | Type I (11), type II (38), type III (0) | Single-fragment type: posterior plate fixation with PL approach; double-fragment type: AP screw for PL fragment, PA screw for PM fragment | No | n.r | n.r | |
| Ræder (2021) [59] | 210/210 | 130m, 80f, 44.74 ± 14.63 yo | 125 of 210 with PMF: type I (61), type II (28), type III (36) |
Syndesmotic stabilization in all patients; 13% treated surgically (5 × type 1, 12 × type 2) |
Yes | C.kappa 0.797 | n.r | Presence of OA after 2 years ranged from 34% in type III group to 64% in type II group; type II had lower AOFAS score compared to no PMF |
| Schoenmakers (2022) [78] | 26/26 | 10m, 16f, 58.08 ± 18.9 (22–78) yo | Type I (11), type II (11), type III (4) | Surgical treatment in 14 of 26 | Yes | n.r | n.r | Classification showed no relationship with functional outcome |
| Kleinertz (2022) [32] | 113/113 | 37m, 76f, 56.2 ± 17.8 yo | n.r | n.r | Yes | C.kappa 0.799 | C.kappa 0.985 | n.r |
| Yamamoto (2022) [57] | 110/110 | 44m, 66f, 52.5 ± 12.9 yo | Only Type I if > 5% of joint surface and type II; type I (70), type II (40) | n.r | Yes | n.r | n.r | Postoperative complications associated with low AOSAF score but not reduction and fixation |
| Patton (2022) [149] | 153/153 | 46m, 107f, 51 ± 8 (18–89) yo | Type I (50), type II (49), type III (37), unclassifiable (5) | n.r | No | n.r | n.r | No association to Lauge-Hansen injury mechanism |
| Pflüger (2022) [24] | 193/193 | n.r | n.r | n.r | Yes | F.kappa 0.70 | F.kappa 0.77 | n.r |
| Sun (2022) [150] | 32/32 | 11m, 21f, 45.6 ± 6.3 (32–59) yo | Type I (20), type II (12), type III (0) | PL approach with distal locking plate | No | n.r | n.r | n.r |